“We don’t want our clothes to smell smoke”: changing malaria control practices and opportunities for integrated community-based management in Baringo, Kenya

Abstract

BackgroundThe decline in global malaria cases is attributed to intensified utilization of primary vector control interventions and artemisinin-based combination therapies (ACTs). These strategies are inadequate in many rural areas, thus adopting locally appropriate integrated malaria control strategies is imperative in these heterogeneous settings. This study aimed at investigating trends and local knowledge on malaria and to develop a framework for malaria control for communities in Baringo, Kenya.MethodsClinical malaria cases obtained from four health facilities in the riverine and lowland zones were used to analyse malaria trends for the 2005–2014 period. A mixed method approach integrating eight focus group discussions, 12 key informant interviews, 300 survey questionnaires and two stakeholders’ consultative forums were used to assess local knowledge on malaria risk and develop a framework for malaria reduction.ResultsMalaria cases increased significantly during the 2005–2014 period (tau = 0.352; p < 0.001) in the riverine zone. March, April, May, June and October showed significant increases compared to other months. Misconceptions about the cause and mode of malaria transmission existed. Gender-segregated outdoor occupation such as social drinking, farm activities, herding, and circumcision events increased the risk of mosquito bites. A positive relationship occurred between education level and opinion on exposure to malaria risk after dusk (χ2 = 2.70, p < 0.05). There was over-reliance on bed nets, yet only 68% (204/300) of respondents owned at least one net. Complementary malaria control measures were under-utilized, with 90% of respondents denying having used either sprays, repellents or burnt cow dung or plant leaves over the last one year before the study was conducted. Baraza, radios, and mobile phone messages were identified as effective media for malaria information exchange. Supplementary strategies identified included unblocking canals, clearing Prosopis bushes, and use of community volunteers and school clubs to promote social behaviour change.ConclusionsThe knowledge gap on malaria transmission should be addressed to minimize the impacts and enhance uptake of appropriate malaria management mechanisms. Implementing community-based framework can support significant reductions in malaria prevalence by minimizing both indoor and outdoor malaria transmissions.

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“…This finding is similar to previous quantitative studies where few methods were being integrated due to lack of knowledge [45][46][47]50]. Similar to our study, knowledge and use of LLINs was prominent in previous qualitative and quantitative studies including in Kenya and Tanzania [40,44,47,49]. Adequate knowledge on LLINs among populations may be attributed to the mass campaigns on use of mosquito nets including by the Ugandan Ministry of Health [8].…”

“…Herbs that were used for malaria prophylaxis can easily be collected from gardens, bushes, as well as nearby shrubs and neighbourhoods [38]. Previous qualitative and quantitative studies in Uganda [38,39], Kenya [40][41][42], West Africa [43], Tanzania [44], and India [45] have all reported burning of cow dung and plant repellents to prevent mosquito bites and entry into houses. Eating herbal plants in groundnut paste to prevent malaria has also been documented elsewhere [38].…”

Decision-takers’ Attitudes Towards SARS-CoV-2 Self-Testing in Kenya: A Qualitative Inquiry

“…Other studies on oral HIV self-testing [22] and on self-collection of samples for cervical cancer screening [23] in the same geography of our study (Mombasa) reported users' high acceptability of these approaches, which reduced users' dependency on traditional testing conducted by HCWs. In fact, Kenya has a broad tradition of community-grounded strategies for conditions as varied as soil-transmitted helminths [24], malaria [25] or violence and discrimination against LGBT+ persons [26]. These strategies have in common a willingness to understand the communities' health needs and resources, and to empower both community members and cadres of healthcare practitioners other than nurses or physicians.…”

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“…There is lack of strong and efficient collaboration between the Ministry of Health and Wellness malaria programme and other relevant government sectors/ministries, the private sector, the community/public and academia who are all essential in malaria control and elimination in Botswana [29]. Several studies suggest there is a positive impact of intersectoral collaboration in malaria control and elimination [21,[88][89][90][91][92][93]. Effective inter-sectoral collaboration is, however, influenced by factors such the approach, resources, relationships, management and shared vision [94].…”