“People will say that I am proud”: a qualitative study of barriers to bed net use away from home in four Ugandan districts

Monroe, April; Harvey, Steven A.; Lam, Yukyan; Muhangi, Denis; Loll, Dana; Kabali, Asaph Turinde; Weber, Rachel

doi:10.1186/1475-2875-13-82

Cited by 36 publications

(52 citation statements)

References 22 publications

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“…Similarly, a study in Uganda identi ed outdoor biting exposure barriers, including social, logistical and access issues. In line with this study, attendance at funeral services was a signi cant limitation to LLIN use [12].Our results con rm those of Moshi et al in 2017 who pointed out that participants were frequently bitten by mosquitoes during the evening when they were outdoors, compared to when they were indoors [13]. Most participants stay outdoors in the early evening to do housework which are not possible indoors.…”

Section: Discussionsupporting

confidence: 91%

Malaria Risks Related To Poor Practices In The Use of Mosquito Bite Control Tools During The Cold And Hot Seasons

Sominahouin¹,

Dagnon²,

Padonou

et al. 2020

Preprint

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Abstract Background: It is generally accepted that one of the reasons for the declining effectiveness of vector control tools (LLINs, IRS) is the misuse of these tools. Some people sleep outside while the walls of houses are treated with insecticide to protect people from mosquito bites.Methods:To check whether communities that misuse these tools are more exposed to malaria, we used the technique of direct and participatory observation of sleeping habits and we clocked every 30 min, the activities and positions of the communities from 7pm to 7am. The survey was conducted in 3 departments Northern Benin. These were mainly treatments related to variance analysis and descriptive statistics. Softwares used included SPSS 21, SAS 9.2 and Arcgis 10.4.Results: The study shows that 95% of the villages population included in the study stay in their rooms from 7:00 pm to 7:00 am, and only 5% of household members are outdoors during same time intervals during the harmattan season. On the other hand, during hot weather, there are more households outdoors (37%). Less than 20% of household members are outside their rooms during the harmattan season. This number decreases gradually until 10:00 pm when all of them are inside their rooms.Student Newman Keuls test shows that the household members being inside or outside their rooms does not depend on the urbanization situation of the village, but rather on the period. 65% exposed to mosquito bites gave irritation as the main reason for their behavior and 15% because of heat and lack of space. Overall, because of household member mobility and malaria vector behaviors, human exposure to An. gambiae was higher outside than inside, despite all the observed food preferences in the vectors.Conclusion:To curtail residual malaria transmission, it must be prioritized to raise awareness in the best use of the tools and provide other complementary control tools for use outside the home.

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Section: Discussionsupporting

confidence: 91%

Malaria Risks Related To Poor Practices In The Use of Mosquito Bite Control Tools During The Cold And Hot Seasons

Sominahouin¹,

Dagnon²,

Padonou

et al. 2020

Preprint

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“…Furthermore, most respondents reported night-time communal ceremonies/gatherings, which may take more than three days. Similar observations are increasingly documented in many other malaria endemic resource-poor settings [17,43,[44][45][46]. Cooking and communal ceremonies/gatherings have been reported among the popular activities that kept people outdoors in many endemic areas of Africa notably Kilombero Valley, southern Tanzania [17,44,47], Unguja Island, Zanzibar [46], northern…”

Section: Discussionsupporting

confidence: 60%

“…Tanzania [17,44,46] and elsewhere in Africa [43,45,48], respondents reported little or no protection at all during outdoor activities at or away from home. Purportedly, the study communities experience a high risk of malaria because the documented night-time outdoor activities take long periods which may coincide with vector's peak biting time.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitudes, Practices and Risk factors about Malaria in High Endemic Rural Eastern Tanzania

Mnyone

Mwamundela

2020

Preprint

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Background: Understanding area-specific knowledge, attitudes, practices and demographic risk factors towards malaria is becoming critical for designing appropriate awareness and control strategies. Methods: A cohort of respondents from 243 randomly selected households across 3 villages in eastern Tanzania was assessed using a standard questionnaire and direct observation.Results: Fifty-three percent of respondents cited Anopheles mosquitoes that were responsible for transmitting malaria, and 85% of those explicitly cited female Anopheles mosquitoes. The rest (47%) knew that malaria is transmitted by a mosquito but could not name it. Commonly cited mosquito breeding sites were water bodies (75%) and rubbish (24%). Majority (61%) knew that the under-fives were most vulnerable to malaria. ITNs were mostly (64%) cited as a means of malaria control. Commonly cited malaria mosquito entry routes were windows (46%), eave opening (10%) and opening on the walls (4%). Majority (70%) confirmed malaria at the health facility. The rest (30%) relied on symptoms. Majority (96%) preferred modern antimalarials. Seventy-nine percent of the respondents owned at least one ITN. Cooking was done predominantly (77%) outdoors, finished cooking and went to bed after 20:00h. Most (58%) respondents still attended night-time outdoor communal gatherings without malaria protection. Conclusions: The current study indicate that majority of participants were aware that Anopheles mosquitoes were responsible for transmitting malaria, they bred in water, under-five children were most vulnerable to malaria, and ITNs constituted the most deployed control measure. Most respondents preferred confirming malaria at the health facility and treatment with modern antimalarials. Yet, the rate of self-diagnosis and self-medication, as well as inappropriate use of bednets requires great improvement. Demographic risk factors for early- and/or outdoor-transmission included night-time outdoor cooking and attending communal gatherings without malaria protection. The findings warrant a subsequent study to show a causal link between night-time outdoor activities, vector biting patterns and malaria prevalence.

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“…This may leave no spare LLINs for visitors, or for carrying during travel. In this study, other factors that may have contributed to limited use of LLINs during travel include social barriers, such as attending a funeral or wedding where individuals are expected to stay outdoors all night, or fear of appearing rude or disrespectful during communal gatherings [22]. These factors should be considered when designing strategies to increase LLIN adherence in travellers.…”

Section: Discussionmentioning

confidence: 97%

“…Although travellers may be at increased risk of malaria due to exposure to higher malaria transmission [18,19], changes in behaviour while away from home may also contribute. Some studies have suggested that individuals who travel within malaria-endemic areas may take part in outdoor activities, go to bed late, and be less likely to use LLINs, all behaviours that increase exposure to mosquitoes and risk of malaria infection [20][21][22][23]. To further explore associations between overnight travel and behaviours that might modify the risk of malaria infection, data collected over a two-year period from a cohort of individuals living in Tororo, Uganda, were analysed.…”

Section: Introductionmentioning

confidence: 99%

Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

Arinaitwe

Nankabirwa

Krezanoski

et al. 2020

Preprint

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Background: The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognised as a risk factor for malaria, but behaviours associated with travel are not well-understood. To address this knowledge gap, malaria-relevant behaviours of cohort participants were assessed during travel and at home in Uganda.Methods: Residents from 80 randomly selected households in Nagongera sub-county, Tororo district were enrolled into a cohort to study malaria in rural Uganda. All participants were given long-lasting insecticidal nets (LLINs) at enrolment and were evaluated every 4 weeks at the study clinic. Participants were asked if they had travelled overnight from their home, and if so, a questionnaire was administered to capture information on travel details and behaviours. Behaviour while at home was assessed using a similar questionnaire during two-weekly home visits. Behaviours while travelling vs at home were compared using generalized estimating equations adjusting for repeated measures in the same individual. Results: Between October 2017 and October 2019, 527 participants were enrolled and assessed for travel. Of these, 123 (23.2%) reported taking 211 overnight trips; 149 (70.6%) trips were within Tororo. Participants were less likely to use LLINs when travelling than when at home (41.0% vs. 56.2%, relative risk [RR] 0.73, 95% CI: 0.60-0.89, p=0.002); this difference was noted for women (38.8% vs 59.2%, RR 0.66, 95% CI 0.52-0.83, p=0.001) but not men (48.3% vs 46.6%, RR 0.96, 95% CI 0.67-1.40, p=0.85). In an adjusted analysis, factors associated with LLIN use when travelling included destination (travelling to districts not receiving indoor residual spraying [IRS] 65.8% vs Tororo district 32.2%, RR 1.80, 95% CI 1.31-2.46, p<0.001) and duration of travel (>7 nights 60.3% vs one night 24.4%, RR 1.97, 95% CI 1.07-3.64, p=0.03).Conclusions: Travellers, particularly women, were less likely to use LLINs when travelling than when at home. LLIN adherence was higher among those who travelled to non-IRS districts and for more than one week, suggesting that perceived malaria risk influences LLIN use. Strategies are needed to raise awareness of the importance of using LLINs while travelling.

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“People will say that I am proud”: a qualitative study of barriers to bed net use away from home in four Ugandan districts

Cited by 36 publications

References 22 publications

Malaria Risks Related To Poor Practices In The Use of Mosquito Bite Control Tools During The Cold And Hot Seasons

Malaria Risks Related To Poor Practices In The Use of Mosquito Bite Control Tools During The Cold And Hot Seasons

Knowledge, Attitudes, Practices and Risk factors about Malaria in High Endemic Rural Eastern Tanzania

Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

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