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Makungu C, Stephen S, Kumburu S, Govella NJ, Dongus S, Hildon ZJL, Killeen GF, Jones C. Informing new or improved vector control tools for reducing the malaria burden in Tanzania: a qualitative exploration of perceptions of mosquitoes and methods for their control among the residents of Dar es Salaam. Malar J 2017; 16:410. [PMID: 29020970 PMCID: PMC5637339 DOI: 10.1186/s12936-017-2056-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effectiveness of malaria prevention with long-lasting insecticidal nets and indoor residual spraying is limited by emerging insecticide resistance, evasive mosquito behaviours that include outdoor biting, sub-optimal implementation and inappropriate use. New vector control interventions are required and their potential effectiveness will be enhanced if existing household perceptions and practices are integrated into intervention design. METHODS This qualitative descriptive study used focus groups discussions, in-depth interviews and photovoice methods to explore mosquito control perceptions and practices among residents in four study sites in Dar es Salaam, Tanzania. RESULTS Mosquitoes were perceived as a growing problem, directly attributed to widespread environmental deterioration and lack of effective mosquito control interventions. Malaria and nuisance biting were perceived as the main problem caused by mosquitoes. Breeding sites were clearly distinguished from resting sites but residents did not differentiate between habitats producing malaria vector mosquitoes and others producing mostly nuisance mosquitoes. The most frequently mentioned protection methods in the wealthiest locations were bed nets, aerosol insecticide sprays, window screens, and fumigation, while bed nets were most frequently mentioned and described as 'part of the culture' in the least wealthy locations. Mosquito-proofed housing was consistently viewed as desirable, but considered unaffordable outside wealthiest locations. Slapping and covering up with clothing were most commonly used to prevent biting outdoors. Despite their utility outdoors, topical repellents applied to the skin were considered expensive, and viewed with suspicion due to perceived side effects. Improving the local environment was the preferred method for preventing outdoor biting. Affordability, effectiveness, availability, practicality, as well as social influences, such as government recommendations, socialization and internalization (familiarization and habit) were described as key factors influencing uptake. CONCLUSIONS Outdoor transmission is widely accepted as an obstacle to malaria elimination. Larval source management, targeting both malaria vectors and nuisance-biting mosquitoes, is the preferred method for mosquito control among the residents of Dar es Salaam and should be prioritized for development alongside new methods for outdoor personal protection. Even if made available, effective and affordable, these additional interventions may require time and user experience to achieve positive reputations and trustworthiness.
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Affiliation(s)
- Christina Makungu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Stephania Stephen
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Salome Kumburu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Nicodem J. Govella
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
| | - Stefan Dongus
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
- Vector Biology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA UK
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Zoe Jane-Lara Hildon
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
- Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, USA
| | - Gerry F. Killeen
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania
- Vector Biology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA UK
| | - Caroline Jones
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, London, UK
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Ewing VL, Tolhurst R, Kapinda A, SanJoaquin M, Terlouw DJ, Richards E, Lalloo DG. Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi. PLoS One 2015; 10:e0125439. [PMID: 26087147 PMCID: PMC4472932 DOI: 10.1371/journal.pone.0125439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 03/16/2015] [Indexed: 01/15/2023] Open
Abstract
Background Universal access to, and community uptake of malaria prevention and treatment strategies are critical to achieving current targets for malaria reduction. Each step in the treatment-seeking pathway must be considered in order to establish where opportunities for successful engagement and treatment occur. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced. Methods Qualitative data were collected between September 2010 and February 2011. A total of 12 Focus Group Discussions and 22 Critical Incident Interviews were conducted with primary caregivers who had reported a recent febrile episode for one of their children. Findings and Conclusion The phrase ‘kutentha thupi’, or ‘hot body’ was used to describe fever, the most frequently mentioned causes of which were malungo (translated as ‘malaria’), mauka, nyankhwa and (m)tsempho. Differentiating the cause was challenging because these illnesses were described as having many similar non-specific symptoms, despite considerable differences in the perceived mechanisms of illness. Malungo was widely understood to be caused by mosquitoes. Commonly described symptoms included: fever, weakness, vomiting, diarrhoea and coughing. These symptoms matched well with the biomedical definition of malaria, although they also overlapped with symptoms of other illnesses in both the biomedical model and local illness classifications. In addition, malungo was used interchangeably to describe malaria and fever in general. Caregivers engaged in a three-phased approach to treatment seeking. Phase 1—Assessment; Phase 2—Seeking care outside the home; Phase 3—Evaluation of treatment response. Within this paper, the three-phased approach is explored to identify potential interventions to target barriers to appropriate treatment. Community engagement and health promotion, the provision of antimalarials at community level and better training health workers in the causes and treatment of non-malarial febrile illnesses may improve access to appropriate treatment and outcomes.
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Affiliation(s)
- Victoria L. Ewing
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrew Kapinda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Dianne J. Terlouw
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Esther Richards
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David G. Lalloo
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Maslove DM, Mnyusiwalla A, Mills EJ, McGowan J, Attaran A, Wilson K. Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9:26. [PMID: 19852857 PMCID: PMC2782321 DOI: 10.1186/1472-698x-9-26] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 10/25/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Africa, an estimated 300-500 million cases of malaria occur each year resulting in approximately 1 million deaths. More than 90% of these are in children under 5 years of age. To identify commonly held beliefs about malaria that might present barriers to its successful treatment and prevention, we conducted a systematic review of qualitative studies examining beliefs and practices concerning malaria in sub-Saharan African countries. METHODS We searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention. RESULTS The majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39). CONCLUSION These findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis.
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Affiliation(s)
- David M Maslove
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Anisa Mnyusiwalla
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Edward J Mills
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Jessie McGowan
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Amir Attaran
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
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Muula AS, Misiri HE. Physical trauma experience among school children in periurban Blantyre, Malawi. Int Arch Med 2009; 2:20. [PMID: 19630960 PMCID: PMC2724376 DOI: 10.1186/1755-7682-2-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 07/24/2009] [Indexed: 11/12/2022] Open
Abstract
Background Physical trauma is an important cause of childhood morbidity and mortality in Africa. There are however, few community-based reports on the subject on the continent. The present study was conducted to explore school children's experience of physical trauma in a disadvantaged periurban area of Blantyre, in Malawi. Methods A cross sectional questionnaire study was carried out among school children in Ndirande-Blantyre, Malawi in 2004. Data were obtained to describe the following aspects of trauma experience: being a victim or observer of motor vehicular accidents involving pedestrians; history of falls from heights; and knowledge about road safety. Sex differences were determined for some of the variables in order to gain insights as to whether there is a difference in trauma experience between boys and girls. Results A total of 217 school children, 99 (45.6%) boys and 118 (54.4%) girls participated in the study. Eight of them reported to have ever been hit by a motor vehicle, 87 (40.1%) had witnessed a road accident where a pedestrian had been hit and 83 (38.2%) had witnessed a pedestrian they knew having been hit by a motor vehicle. Of those that reported to have ever been hit by motor vehicle, 2 (25%) reported that they had been hospitalized as a result of injury. With regard to falling from heights, 86 reported to have ever fallen from tree, 44 of these (51.2%) were injured from the fall and 14 (16.3%) were hospitalized as a result of injury sustained from the fall. Girls were more likely to fall from trees and getting injured as compared to males (p = 0.04 for both situations). Just under half (41.9%) of the study participants were able to report the correct procedure of crossing the road despite the fact that the majority (80%) reported having been taught road safety at home or school. Conclusion Many school children in Blantyre, Malawi have been exposed to trauma either involving themselves or someone they observed. Prevention, including education, supervision and management of trauma must receive the necessary attention they deserve in terms of resources, surveillance and impact mitigation.
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Affiliation(s)
- Adamson S Muula
- Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi.
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An exploratory study of community factors relevant for participatory malaria control on Rusinga Island, western Kenya. Malar J 2007; 6:48. [PMID: 17456231 PMCID: PMC1871595 DOI: 10.1186/1475-2875-6-48] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 04/24/2007] [Indexed: 11/23/2022] Open
Abstract
Background Capacity strengthening of rural communities, and the various actors that support them, is needed to enable them to lead their own malaria control programmes. Here the existing capacity of a rural community in western Kenya was evaluated in preparation for a larger intervention. Methods Focus group discussions and semi-structured individual interviews were carried out in 1,451 households to determine (1) demographics of respondent and household; (2) socio-economic status of the household; (3) knowledge and beliefs about malaria (symptoms, prevention methods, mosquito life cycle); (4) typical practices used for malaria prevention; (5) the treatment-seeking behaviour and household expenditure for malaria treatment; and (6) the willingness to prepare and implement community-based vector control. Results Malaria was considered a major threat to life but relevant knowledge was a chimera of scientific knowledge and traditional beliefs, which combined with socio-economic circumstances, leads to ineffective malaria prevention. The actual malaria prevention behaviour practiced by community members differed significantly from methods known to the respondents. Beside bednet use, the major interventions implemented were bush clearing and various hygienic measures, even though these are ineffective for malaria prevention. Encouragingly, most respondents believed malaria could be controlled and were willing to contribute to a community-based malaria control program but felt they needed outside assistance. Conclusion Culturally sensitive but evidence-based education interventions, utilizing participatory tools, are urgently required which consider traditional beliefs and enable understanding of causal connections between mosquito ecology, parasite transmission and the diagnosis, treatment and prevention of disease. Community-based organizations and schools need to be equipped with knowledge through partnerships with national and international research and tertiary education institutions so that evidence-based research can be applied at the grassroots level.
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