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ACKNOWLEDGEMENT
2
This dissertation has been undertaken as a partial fulfillment of the Bachelor of Arts Degree
in the Anthropology and human ecology. I wish to acknowledge the Almighty God for His
grace and providence throughout the course. Also acknowledge the community in Pedo
village for accepting to participate in the study.
I would also like to sincerely thank my lecturer Maurice Kongongo and more so the entire
department of Anthropology and Human ecology for the facilitation of dissertation course.
Lastly I would like to pass my gratitude to my parents for their support and encouragement
and my friends and classmates. Their generous contribution towards the success and
completion of my course will be rewarded abundantly.
TABLE OF CONTENTS
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CHAPTER ONE.
INTRODUCTION.
STATEMENT OF THE
PROBLEM
CHAPTER TWO.
LITERATURE REVIEW
INTRODUCTION
UTILIZATION OF MOSQUITO NETS .
OWNERSHIP VERSUS UTILIZATION OF ITN
ITNS VS MALARIA PREVENTION...
CHAPTER THREE.
RESEARCH
METHODOLOGY...
INTRODUCTION..
RESEARCH
DESIGN
AREA OF
STUDY
METHODS
CHAPTER FOUR
FINDINGS..
CHAPTER FIVE.
CONCLUSIONS AND RECOMMENDATIONS ON HOW TO IMPROVE
THESETUATION
APPENDICES..
CHAPTER ONE
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INTRODUCTION
1.1 BACKGROUND TO THE PROBLEM.
In spite of mankinds longstanding struggle to control malaria mosquitoes, malaria remains a
foremost threat to individual health (Minakawa et al., 2005). There were approximated 881,000
malaria deaths in 2006, of which 91% were in Africa and 85% were of children under 5 years
(WHO, 2008). P. falciparum is the most serious human malaria parasite and the most common
one in Africa south of the Sahara (Snow et al., 2005).
The main tools in the global fight against malaria vectors are insecticide treated nets (ITNs) and
indoor residual spraying (IRS) which targets adult malaria vectors. Regular and proper use of
ITNs by children can reduce their overall risk of dying by 20% and the number of clinical malaria
occurrence by almost 50% (RBM, 2002). IRS continuous to be the most widely method used in
malaria control and about half of African countries included IRS as part of their malaria control
effort (WHO and UNICEF, 2005). Early studies reported that IRS and ITNs sharply reduce
malaria transmission (Gimnig et al., 2003a; ter Kuile et al., 2003); but they do not eliminate it
entirely; the information on the perception and the ITNs use and the effect of the distance to the
nearest health facility to peruse medical treatment are urgently needed to help understand how to
maintain and reduce vector density and transmission intensity.
2003a; ter Kuile et al., 2003). Regular, proper and adherence to ITNs use reduces overall children
risk of mortality by 20% and the number of clinical malaria occurrence by almost 50% (RBM, 2002;
Jane .A. Alai 2013). Despite increased ITNs coverage, malaria prevalence and mortality remain high
this could be due to, lack of adherence and improper use of in which could result into resistance by
the mosquito as reported (ter Kuile et al., 2003)
My study therefore was of the interest to explore the challenges facing ITNs use and the peoples
perceptions on malaria prevention in Pedo village Rarieda Sub County. The findings of this study has
helped to fill in the gap of knowledge on regular, proper and adherence to ITNs use.
a social science oriented study looking at peoples perception, the information collected will be useful
in enabling the government and other stakeholders to come up with an informed education program
to enhance proper use of ITNs in the prevention of malaria.
CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION
This chapter deals with the review of the literature. The review will be divided into three; the
Utilization of Mosquito nets, Ownership versus utilization of ITN, ITNs Vs Malaria prevention
other African countries including Uganda, there are no by laws which address the common practice
of men sleeping under the only net in the household even though children under five are the most at
risk from malaria (Marslend 2006). This accounts for the continued high child mortality rates due to
malaria in sub-Saharan Africa. To improve accessibility to ITNs by target population in rural areas,
distribution is carried out mainly through national health services (Fixed post and outreach mobile
team) in Djibouti. However, NGOs and Community based association are involved in ITN promotion
and distribution in the peri-urban and urban areas. In the study conducted in Mukono district about
preventing malaria in pregnancy, participants knew that mosquito nets were a useful preventive
measure against malaria and that pregnant women and children were supposed to sleep under nets
since they are the most vulnerable groups. However the availability and use of nets in this community
was found to be very low. Over three quarters of participants in all the FGDs and key informant
interviews reported that very few people in the community use mosquito nets (Mbonyi et al 2005).
This study therefore seeks to establish why utilization is still low specifically among the under-fives.
In the same study, another constraint to ITNs access was the cost and uncaring husbands. Over three
quarters of women in this study complained that men did not care about the health of their wives and
their children. Men were reported not to prioritize the issue of health. Women thought that men use
their money on items like alcohol and forget about buying nutritious foods and providing health care
to their families. Women participants at Kimenyedde sub-county said that they fear to buy mosquito
nets because their husband 11 would question them about the source of the money. This is because
women in this community are not expected to have money, or if they have money, the husbands feel
obliged to know its source. More than half of the women participants in all the FGDs expressed fear
that if a woman bought a net, the husbands would suspect that she got the money from another man
(Mbonyi et al 2005). This study specifically investigated affordability of ITNs to under-fives within
the household setting which was not covered in the previous studies.
age ranged between 0 percent and 16 percent (Korenromp 2003). This is still unacceptably very low
to have an impact on reduction of malaria episodes among the under-fives. Equality is a major issue
in ITN ownership. Net ownership has been found to be lowest among the poorest households
(UNICEF 2005); thus possibly linking possession to the cost of the net (Guyatt 2002). Authors of a
study conducted on the effect of lowering cost on nets and netting materials predict that reducing cost
on insecticides and ITNs from 42 percent to 0 percent and the cost on netting materials from 40
percent to 5 percent would increase demand for ITNs by 927 percent (Simon 2002). Wiseman et al
reported a significant association between good access roads to the community and net ownership
(Wiseman 2007). Perceived risk of malaria and benefits of the nets by the population also drive
demand. Onwujekwe et al, in a Nigerian study, found that households with a recent attack of malaria
and those with higher willingness to pay were more likely to purchase a 12 net than their counterparts
(Onwejekwe et al 2003). Such communities have a perceived need for utilizing ITNs. Utilization has,
however, been found to vary with seasons of the year and acceptability of the nets in terms of size,
colour and shape. Binka et al showed that the time of the year during which the nets are delivered
affects use. In their study, 99 percent of the net recipients were found to use the nets during rainy
season, while only 20 percent used it during the dry season (Binka et al 1997). Demographic
characteristics like age, education, size of household and ethnicity also influence use of bed nets.
Some studies show that children are less likely to use nets, particularly in rural areas, while others
found no significant association between age and net use. My study explored more demographic
characteristics like age, size of household and main household use as a determining factor to the net
use.
away from the sleeping people, but would die when they come into contact with the insecticide. In
subsequent studies, it was demonstrated further that use of ITNs in pregnancy reduces maternal
parasitaemia, anemia and premature deliveries, increases mean birth weight and subsequently reduces
neonatal and infant mortality (Dolan et al 1993). This shows that the role of ITNs among the underfive in protecting them against malaria should not be ignored. ITNs have a mean protective efficacy
against malaria episodes of approximately 50 percent in highly endemic areas of Africa (Langeler and
Snow 2004). They have also been found to reduce overall mortality among children by 63 percent in
villages using impregnated nets. A recent review has similarly shown that ITNs are highly effective
in reducing morbidity and mortality from malaria. Bed nets given to pregnant women have been found
to be protective to women and their children against malaria in both high and low malaria transmission
areas of Kenya (Guyatt and Ochola 2003). To monitor progress toward Abuja targets, RBM developed
indicators using the number of under-5s or pregnant women from all households, including those that
do not own nets, as the denominator. This indicator is appropriate for looking at nationwide progress
toward Abuja targets, but the resulting percentage is necessarily constrained by the percent of
households owning a net. However, these indicators are general; they do not reveal intra-household
net-use patterns which the current study plan explore. Few studies look only among net-owning
households and analyze if and by whom nets are used, which requires measuring use by under-5s
compared to that of other household members. A few studies do address some aspects of intrahousehold net use, with one in the Gambia concluding that vulnerable groups were more likely than
other family members to use a net (DAlessandro et al 1994). It also found a small margin, adults
used nets more than children (but defined children as under 10 years of age. A study based on
secondary analyses of the Demographic and Health Survey in Uganda concluded that young children
were sleeping under a net only because their mothers were using the net (Mugisha et al 2003). Several
other studies focusing on who uses the household net were intervention studies where nets were given
free to those living in a research area in Kenya (Alaii et al 2003) or to pregnant women attending
antenatal clinics in Kenya, or where nets were acquired via vouchers distributed to pregnant women
in Tanzania (Tami at al 2006). The first found that adults were slightly more likely than young
children to be using the net; and the last 2 found that nets were being used by the groups targeted by
the intervention: pregnant women and infants. Because these are intervention sites, however, we do
not know whether these findings apply to the general population. This study will address actual use
of nets within the households with children under five years, rather than net ownership.
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2.4 Theories
The study will be informed by the Health Care Utilization Model also referred to as the generic
behavioural model. It will establish and examine the utilization of ITNs within households with
household members. It will investigate intra household practices, of the ITNs in preventing malaria
among household members. Andersens (1968) generic behavioural model is the most widely adopted
and empirically assessed model of health service utilization. In Andersens original behavioural
model, there are three major categories of health service utilization determinants. These include;
predisposing factors, enabling factors and need factors. The category of predisposing characteristics
will be used to reflect the fact that age brackets are propensity to use services than other. The enabling
factors reflect the fact that while the age group may be predisposed to use health services, they do not
use them unless they are able. Enabling factors include; availability of services, financial resources to
purchase services, health insurance and social network support. The need factors refer to the basic
and direct stimulus for the use of health services. The individual must perceive some need for use of
health services. This depends on perception of severity, total number of days in bed, days missed from
work or school and help from outside for caring. The concept of predisposing characteristics will be
used to assess the relationship between age, household size and main household use to ITNs use.
Enabling factors investigated whether there will be ITNs present in the household for all household
members.
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CHAPTER THREE
RESEARCH METHODOLOGY
3.0 INTRODUCTION
This section discusses research design description of the area of study, the study population, sample,
sampling techniques, data collection instruments, data collection procedures and the method of data
analysis.
This research was a participatory process involving researcher as the facilitator, respondents and a
community health workers.
millet, vegetables and few animals keeping such as goats, cattle and chickens. The study borders
Asembo an area where ITNs randomized trial programM took place (since late 1990s) with regular
net replacement and retreatment schedule involving community leaders, and researchers (Gimnig et
al., 2003b; Gimnig et al., 2003a; Hawley et al., 2003; ter Kuile et al., 2003).
Ward had a population of 40,471 people by 2012, of which 19,615people were Men and 20,856 people
were Women.
3.4 METHODS
3.4.1 DATA COLLECTION
The study used questionnaires compromising both open and closed ended questions based on the
objective of the study. Information was collected on factors listed below.
1. Improper use(determine)
2. The decision maker in the household
3. Other uses other than mosquito prevention and reasons
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CHAPTER 4: FINDINGS
4.1 THE STUDY POPULATION
Averagely, a village has about 100 compounds and 200 households with a population of
approximately 300 to 400 people. The study sampled 24 households in 24 compound with a total
population of 121.
4.2.1Socio-demographic information
The study was conducted in 24 households in Pedo village with a population of 121. Of all the
respondents, 62.5% were female and 37.5% males. The age variation was between 20-90 with most
of them having been educated up to primary school level (54.17%), 16.67% not attended school 25%
attended secondary education and only 4% reached the tertiary level. Farming was the major
economic activity in the area constituting 37.5% followed by farming at 20.83% then fishing and
formal employment each at 8.3%. 25% of the households had no specific source of income giving
reasons that their children support them from town. Table1.
AGE
%GENDER
%EDUCATION LEVEL
%OCCUPATION
20- 90
FEMALE
62.5
NO EDUCATION
16.67
BUSINESS
37.5
MALE
37.5
PRIMARY
54.17
FARMING
20.83
SECONDARY
25
FISHING
8.33
TERTIARY
4.17
FORMALEMPLOYMENT
8.33
NO EMPLOYMENT
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25
16
2 NETS
3 NETS
4NETS
Number of ITNs
17
91.66666667
NOT EFFECTIVE
EFFECTIVE
AGE
TOTAL
MALARIA
MALARIA
CATEGORY
NUMBER
CASES
PROPORTION
Under 5
20 (17.4%)
12 (25.5%)
60%
Above 5
95 (82.6%)
35 (74.5%)
36.80%
0 (0%)
0 (0%)
0%
Pregnant
women
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CAUSES
OF % BELIEF ON CAUSES
MALARIA
TOO
OF MALARIA
MANY
MOSQUITOS
(16/24) 66.7
INEFFECTIVE NETS
(5/24) 20.8
INADEQUATE NETS
(3/24) 12.5
OTHERS
(3/24) 12.5
OF
THOSE
WHO BELIEVED
IN
REASONS
EFFECTIVENESS GIVEN
FOR
EFFECTIVENESS OF
EFFECTIVENES
OF TREATMENT TREATMENT.
OR LACK OF IT.
STILL
NO
(3/23) 13
MEDCATION
GENERAL
RELIEF
YES
(20/23) 87
ON
FEELING
19
% PREVENTION
100
80
60
40
20
0
NETS
REPELANTS
SPRAY
TYPE OF REPELANT
20
16.66666667
83.33333333
MOTHER
FATHER
21
% INTs MISSUSE
16.66666667
12.5
25
29.16666667
54.16666667
BATHROOM
FISHING
SEEDBED/KITCHEN GARDEN
NONE
THE REST
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4.2.9.1 CONCLUSION.
Due to the gap in knowledge on net disposal there is need for the policy makers to come up with
proper education program on disposal methods and their effects on the environment. This will not
only improve the efficacy of ITNs but also empower the community in the fight against malaria by
informing them on the consequences of their actions which to them has not been a big deal due to the
lack of knowledge in the entomological aspect in the fight against malaria.
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RERENCES
1. Eisele TP, Thwing J, Keating J (2011) Claims about the Misuse of Insecticide-Treated
Mosquito Nets: Are These Evidence-Based? PLoS Med 8(4): e1001019.
doi:10.1371/journal.pmed.1001019
2. Terlouw DJ, Morgah K, Wolkon A, Dare A, Dorkenoo A, et al. (2010) Impact of mass
distribution of free long-lasting insecticidal nets on childhood malaria morbidity: the
Togo National Integrated Child Health Campaign. Malar J 9: 199.
3. .Fegan GW, Noor AM, Akhwale WS, Cousens S, Snow RW (2007) Effect of expanded
insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal
study. Lancet 370: 10351039.
4. Shaw S (2 May 2010) In Africa, anti-malaria mosquito nets go unused by recipients.
Los Angeles Times. Available: http://articles.latimes.com/2010/may/02/opinion/laoe-shah-20100502. Accessed 7 March 2011.
5. Butunyi C, Oloo E (2008) Alarm as residents turn mosquito nets into fishing gear. The
Daily Nation. Nairobi: Nation Media Group.http://www.nation.co.ke/News/regional//1070/498840/-/item/1/-/qanexj/-/index.html.
6. Minakawa N, Dida GO, Sonye GO, Futami K, Kaneko S (2008) Unforeseen misuses
of bed nets in fishing villages along Lake Victoria. Malar J 7: 165.
7. Korenromp EL, Miller J, Cibulskis RE, Kabir Cham M, Alnwick D, et al. (2003)
Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by
children under 5 years. Trop Med Int Health 8: 693703.
8. Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, et al. (2003) Impact of
permethrin-treated bed nets on entomologic indices in an area of intense year-round
malaria transmission. Am J Trop Med Hyg 68: 1622.
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APENDICES
Activity
DEC
JAN
7. Collect Data
FEB
26
Payment
community
for
workers
Transportation
Accomodation
upkeep
6000KSH
7000
TOTAL
Ksh.31000
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Date: ____/____/_____
Pregnant
women
7. Can you show me the sleeping spaces you have in this house?
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U5
O5
PREGNANT
Fever [ ]
Vomiting [ ]
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[Yes/No/DK]
Joint pains [ ]
Others specify .
14) What do you think caused malaria?
Inadequate nets [ ]
Too many mosquitoes [ ]
Ineffectiveness of nets [ ]
Others .
15) Did he/she go for treatment?
Yes [ ]
No [ ]
16) If so where did he/she go for treatment?
.
17) Did treatment work?
Yes [ ]
No [ ]
18) How can you tell that it worked?
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24) Are there other ways in which people put ITNs into use other than prevention of
mosquito bites?
Yes [ ]
No [ ]
DK [ ]
25) If yes enumerate with reasons why.
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32
Why?
..
30) Do you think there are categories of people who should always sleep under nets? If
so, who are they? Give reasons for your answer.
Name of interviewer
Signature ...Date
..
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