Factors impeding the acceptability and use of malaria preventive measures: implications for malaria elimination in eastern Rwanda

Abstract

BackgroundLong-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) and malaria case treatment with artemisinin-based combination therapy (ACT) have been proven to significantly reduce malaria, but may not necessarily lead to malaria elimination. This study explored factors hindering the acceptability and use of available malaria preventive measures to better inform area specific strategies that can lead to malaria elimination.MethodsNine focus group discussions (FGD) covering a cross-section of 81 lay community members and local leaders were conducted in Ruhuha, Southern Eastern Rwanda in December 2013 to determine: community perceptions on malaria disease, acceptability of LLIN and IRS, health care-seeking behaviours and other malaria elimination strategies deployed at household and environmental levels. Discussions were recorded in Kinyarwanda, transcribed into English and coded using Nvivo 10 software.ResultsParticipants ranked malaria as the top among five common diseases in the Ruhuha sector. Participants expressed comprehensive knowledge and understanding of malaria transmission and symptoms. The concept of malaria elimination was acknowledged, but challenges were reported. Sleeping under a bed net was negatively affected by increase of bedbugs (and the associated irritability) as well as discomfortable warmness particularly during the dry season. These two factors were reported as common hindrances of the use of LLIN. Also, widespread use of LLIN in constructing chicken pens or as fences around vegetable gardens was reported.Participants also reported that IRS appeared to lead to an increase in number of mosquitoes and other household bugs rather than kill them. Prompt health centre utilization among participants with presumed malaria was reported to be common particularly among subscribers to the subsidized community-based health insurance (CBHI) scheme. In contrast, the lack of CBHI and/or perceptions that health centre visits were time consuming were common reasons for the use of over-the-counter medicines for malaria management.ConclusionIn this study, identification of behavioural determinants in relation to LLIN use, IRS acceptability and health care seeking is a critical step in the development of effective, targeted interventions aiming to further reduce malaria transmission and elimination in the area.

Using an intervention mapping approach for planning, implementing and assessing a community-led project towards malaria elimination in the Eastern Province of Rwanda

“…However, bedbug infestation of LLINs and perceptions that IRS activated mosquitos, rather than killing them were enumerated as hindrances for use in a series of focus group discussions [20]. Furthermore, only two-thirds of the population was found to have a community based health insurance (CBHI) at baseline while malariometric data showed a 5% malaria parasite carriage prevalence (asymptomatic) and 13% of households had at least one member with malaria parasitemia [20, 21]. …”

An exploratory study of the acceptability of indoor residual spraying for malaria control in upper western Ghana

“…Some household participants expressed their worry about the possibility of having the contents of their belongings revealed to the public by some unscrupulous spray operators. A similar study in Tanzania reported that the fear of domestic intrusion led to the perception that spray operators were spying on people's lives [55], while a similar concern in Rwanda resulted in some householders refusal to spray their bedrooms and storage areas [63]. In a sociological analysis of the impact of vector control at the household level, some scholars argued that the entry into homes by uniformed male spray operators not only extends the power of public institutions into the domestic front, but also raises serious security concerns since the householders present during the day-when spraying is conducted-are mostly women and children [64].…”

Bedbug Infestation Affects Utilization of Long-Lasting Insecticidal Nets in Kola Shara, South-West Ethiopia: A Longitudinal Study

“…The absence of nets most frequently in a household is probably predisposing the family members, especially susceptible groups to malaria. Although a study mentioned that bedbug jeopardize persistent net utilization or barrier to net users [3][4][5]12], another study that focused on Bedbug containment practices [9,13], no detailed evidence available on the magnitude of the Bedbug versus net utilization.…”

“…Possibly, this bene t is believed to play a vital role in improving community acceptance of LLINs for malaria vector control [11]. Nevertheless, the lethal dose to mosquito vectors appears not only ineffective to kill bedbugs and managed to reproduce and multiplied rapidly on nets [12,13], but also irritates them to come out of their hide and actively feed on human. Although the resurgence of bedbug is documented, the reason why rises in resurgence of bedbugs infestations not yet well understood [14,15].…”