Community health priorities: Lessons for malaria prevention from Balaka district, Malawi

Abstract

IntroductionCommunication to address priority health challenges typically draws on epidemiological research in conjunction with referencing global and country strategies. While community-level perspectives on health challenges typically align with national priorities, nuances and barriers that constrain health response may be less well known. To deepen understanding of the relation between situational aspects of health and ways of making meaning, community insights into health priorities were explored.MethodsAction Media, an established participatory research methodology for informing health communication design and strategy, was undertaken with parents of children under 5 in Balaka District, Malawi.ResultsParticipants identified malaria as a priority concern in their community. While it was reported that there was strong commitment to consistent use of long lasting insecticide treated nets, there was frustration that malaria incidence remained high. It was observed that risk of exposure to mosquito bites was increased as a result of chores and other activities that extended into the early evenings prior to retiring to bed under a bed net. Bed bug infestations were said to be a common and ongoing concern. Some community members alleviated discomfort by abandoning their beds and sleeping outside without adequate protection while others boiled their bed nets to remove bed bugs. Accessing distant health facilities when ill with malaria was difficult for adults and children. Participants identified the need for effective strategies to address these concerns including accessing mosquito repellant, eradicating bed bugs, treating malaria locally and collaborating in malaria control activities.ConclusionsMeeting targets for malaria prevention requires consideration of contextual factors that undermine effective malaria prevention in affected communities. Such factors are not immediately apparent through epidemiological data. Regularly assessing contextual challenges in high malaria incidence areas provides opportunities to understand gaps, to refine intervention strategies and to inform communication programming.

Behavioral interactions of bed bugs with long-lasting pyrethroid-treated bed nets: challenges for vector control

“…These results suggest that despite proper use of LLINs, pyrethroid-resistant bed bugs would proliferate. Thus, our findings support the concerns of recent research in sub-Saharan Africa, where the presence of pyrethroid-resistant bed bugs leads to LLIN abandonment, misuse and failure to regularly reimpregnate the bed net with insecticide [ 24 , 26 , 27 , 30 ]. Recent research has sought to address issues of stalled progress in the fight against malaria, with a focus on bio-efficacy and a perspective beyond insecticide resistance [ 53 , 54 ].…”

Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda

“…Anecdotal reports from health officials in the district noted an outbreak of bedbugs leading people to use their LLINs less, and 25% of cohort participants reported bedbugs as a potential reason for not using an LLIN. Associations between household insect infestations, IRS and LLIN use have been reported previously, but the evidence is mixed on the direction of associations with LLIN adherence, as concerns regarding bedbugs have been identified as both facilitators [ 18 ] and barriers [ 19 ] to LLIN use.…”

Review on the impacts of indoor vector control on domiciliary pests: good intentions challenged by harsh realities

“…It has been shown for decades that while communities appreciate the long-term health benefits associated with decreased malaria burden, they place as high or higher value on the practical, immediate and tangible relief from indoor nuisance and biting pests [27]. Indeed, this predilection has been shown by several studies to promote the uptake and adherence to IVC practices by user communities; conversely, when the ancillary benefit of pest control is lost, community perception and adherence to IVC procedures diminishes [28][29][30][31][32][33][34][35][36][37][38][39]. Yet, a dearth of modern research has investigated the impacts of IVC on indoor pest populations, and subsequently, how domiciliary pest control affects IVC.…”

“…Additionally, we identified three relevant WHO publications not present in the WHO repository through snowballing of identified publications [41]. We identified a final total of only 28 peer-reviewed publications that met our search criteria, spanning from 1971 to 2022 [28][29][30][31][32][34][35][36][37][38][39][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], and an additional seven WHO publications spanning from 1968 to 2022 [3,5,26,[59][60][61][62]. It is important to note that these expansive criteria likely fail to capture historic publications from researchers in frequently underrepresented regions and countries which may be excluded from modern research repositories.…”