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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 10 11; 16(1):410.MJ

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.

Authors+Show Affiliations

Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania. cmakungu@ihi.or.tz.Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania.Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania.Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Kiko Avenue, Mikocheni, PO Box 78373, Dar Es Salaam, United Republic of Tanzania.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.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.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.KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. London School of Hygiene and Tropical Medicine, London, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29020970

Citation

Makungu, Christina, et al. "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." Malaria Journal, vol. 16, no. 1, 2017, p. 410.
Makungu C, Stephen S, Kumburu S, et al. 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(1):410.
Makungu, C., Stephen, S., Kumburu, S., Govella, N. J., Dongus, S., Hildon, Z. J., Killeen, G. F., & Jones, C. (2017). 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. Malaria Journal, 16(1), 410. https://doi.org/10.1186/s12936-017-2056-9
Makungu C, et al. 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 10 11;16(1):410. PubMed PMID: 29020970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Makungu,Christina, AU - Stephen,Stephania, AU - Kumburu,Salome, AU - Govella,Nicodem J, AU - Dongus,Stefan, AU - Hildon,Zoe Jane-Lara, AU - Killeen,Gerry F, AU - Jones,Caroline, Y1 - 2017/10/11/ PY - 2017/06/09/received PY - 2017/10/05/accepted PY - 2017/10/13/entrez PY - 2017/10/13/pubmed PY - 2018/5/15/medline KW - Bed net KW - Community perceptions KW - Larval source management KW - Malaria KW - Mosquito KW - Photovoice KW - Qualitative KW - Repellent SP - 410 EP - 410 JF - Malaria journal JO - Malar J VL - 16 IS - 1 N2 - 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/29020970/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_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-017-2056-9 DB - PRIME DP - Unbound Medicine ER -