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Knowledge and Compliance with the Use of Insecticide-Treated Nets in Manalu Sangihe Islands Regency of North Sulawesi Indonesia

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Knowledge and Compliance with the Use of Insecticide-Treated Nets in Manalu Sangihe Islands Regency of North Sulawesi Indonesia Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 625 Knowledge and Compliance with the Use of Insecticide-treated Nets in Manalu Sangihe Islands Regency of North Sulawesi Indonesia Chandrayani Simanjorang1,2, Nasrin Kodim3, Umar Fahmi Achmadi4, Tri Yunis Miko5 1Lecturer at Department of Health, State Polytechnic of Nusa Utara, 2Doctoral Studentat Department of Epidemiology, Public Health Faculty of Universitas Indonesia, 3Professor at Department of Epidemiology, Public Health Faculty of Universitas Indonesia, 4Professor at Department of Environmental Health Universitas Indonesia, 5Lecturer at Department of Epidemiology, Public Health Faculty of Universitas Indonesia Abstract Background: Insecticide-treated nets is essential in prevention of malaria parasite transmission and morbidity. Almost in every year, malaria cases always increase. At least in the last 5 years, malaria morbidity rate is so high, with the Annual Parasite Incidence (API) of more than 5 per 1,000 populations; with the highest number of cases occur at the Public Health Center of Manalu Sub-district of South Tabukan, with 226 positive cases. Based on these data, this region has become one of the target areas of netting intervention. Since 2011, insecticide-treated nets have been distributed at Manalu Public Health Center whichas the category of malaria endemic. Each household gets 1 or 2 insecticide-treated nets. If there are pregnant women or infants, they will get extra insecticide-treated nets. Method: This study aims to determine the level of knowledge and compliance of the use of Long lasting insecticidal nets by people who have received the distribution since 2011. This observational study was conducted in Manalu Public Health Center of Sangihe Islands Regency from April to June 2017. Then, an interview was made towards 103 household heads who received insecticide-treated nets. Result: Results of study found that most respondents (98%) had a good knowledge of insecticide-treated nets and were compliant in using of insecticide-treated nets when they slept (83.1%); approximately 96.1% of respondents installed the nets correctly; approximately 85.7% of respondents took care and washed the nets and approximately 93.9% of respondents dried the nets in the sun. Currently, communities in the area own insecticide-treated nets (96.8%) and ordinary insecticide-treated nets (3.2%). Conclusion: Although they have good knowledge of and compliance with the use of insecticide-treated nets, in fact, up to now there are still relatively high cases of malaria endemics (API> 5). Therefore, we need to look for other factors, such as geographical conditions, social conditions, and the age of insecticide- treated nets. Geographical areas in this regency are mostly in form of swamps and beaches (98.1%). This condition can affect many breeding places because most people work as fishermen with activities outside of their homes, from dawn until evening. Age of nets is now about 6 years so it needs a replacement program of insecticide-treated nets by the government to optimally prevent mosquito bites while sleeping at night. Keywords: Knowledge, compliance, insecticide-treated nets, malaria. Introduction population have a high risk of malaria with the highest number is in Africa (47%) and followed by south- Insecticide-treated nets is essential in prevention east Asia (37%). The malaria cases have reached 216 of malaria parasite transmission and morbidity.[1] million cases and 81% of them occurred in Africa with It is estimated that around 1.2 billion of the world’s the mortality rate reaches 655,000 cases (86%).[2] Based 626 Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 on the Indonesian Ministry of Health’s malaria program who are assumed to have more authority in the family. report, in North Sulawesi Province, especially in There’s92 people as male subjects (89.5%), 85 families Sangihe Islands Regency is one of the malaria-endemic have members generally 1-4 members (82.5%). areas that almost every year it experiences cases of Geographical condition of those who live at beach are malaria. In 2013, a report shows that malaria morbidity 101 households (98.1%), families who have children rate (Annual Parasite Incidence) was 5.44 per 1,000 under five are 18 families (17.5%) as well as families populations. At least, number of positive malaria cases who have pregnant women consist of 6 households (6%). that were reported as many as 686 cases. The number of P.falciparum and P.vivax cases is almost the same. Most Table 1. Respondents Distribution Based on of those cases occurred at Manganitu Public Health Characteristics Center (220 cases) and Enemawira Public Health Center Variables n % (174 cases). In 2014 the incidence of malaria dropped to 4.75 per 1,000 populations, with the number of cases Age Group coming from Manalu Public Health Center. Thus, this 15-24 years 4 3,9 district has become one of pockets of endemic malaria 25-44 years 36 35,0 in Sangihe. 45-64 years 51 49,5 In an effort to lower endemic malariaat Manalu 65-78 years 12 11,7 Public Health Center the insecticide-treated nets are distributed with free of charge to all households. Based Number of family members on data from the Health Department, each household 1-4 members 85 82,5 gets one or two insecticide-treated nets in 2011. The 5-8 members 18 17,5 Health Department also conducted an awareness drive through public health centers on the procedure Gender and the installation of nets inside the house. Since the Male 92 89,3 distribution and socialization was done, it has not been Female 11 183,3 known regarding the knowledge and compliance of public in the use of insecticide-treated nets to prevent Village Name malaria. This fact is very important to know, considering Lesabe 42 40,8 the fact that up to 2015, status of a public health center Bentung 31 30,1 with API> 5 /% population relatively has high endemic. Batuwingkung 30 29,1 Method Geographical Condition This study uses descriptive cross-sectional study Beach 52 50,5 design with a structured interview and observation Paddy field 1 1,0 method. This study was conducted at Manalu Public Health Center of South Tabukan Sub-District. The Forest 1 1,0 study was conducted in April-June 2016. Population Swamp 49 47,6 of the study is all households at Manalu Public Health Children under five Center, covering 792 households. Samples are heads of household who obtained insecticide-treated nets. The Exist 18 17,5 number of samples is calculated using the proportion of Not exist 85 82,5 sample 1 of which a sample of 96 households has been Pregnant Women obtained.[12] Exist 6 5,8 Result Not exist 97 94,2 Most of respondents (95.1%) are in the age group of initial elderly category and final elderly category. The majority of respondents understand well and Research subjects in this study are the heads of family install insecticide-treated nets correctly (80%) (Table 2). Indian Journal of Public Health Research & Development, May 2020, Vol. 11, No. 05 627 Table 2. Respondents Distribution Based on the Variable N % Usage Method of Insecticide-treated nets Knowledge Variable N % Good 101 98 Use and install a insecticide-treated net Moderate 2 2 74 80 correctly Lack 0 0 Use a insecticide-treated net but done it 3 3 Use of Insecticide-treated net inccorectly Yes 74 83 Do not use insecticide-treated net 16 17 No 15 17 Total 93 100 Based on netting maintenance procedures, most Discussion of people do the washing method. Meanwhile, drying Proportion of respondents who comply in using is done in the direct sunlight where drying is supposed of insecticide-treated nets while sleeping (slept under to be done in the areas that are not exposed to direct insecticide-treated nets the previous night) is around sunlight. This occurs because in general, people have a 83.1%. This is one of the fives indicators of insecticide- clothesline outside the home. treated nets use based on WHO indicators.[5] These results are not much different from previous study Table 3. Respondents Distribution Based on the in Brazil, India, Ghana that used insecticide-treated Method of Washing of Insecticide-treated nets nets which the proportion was 85.7%, 70%, 91.9% in [6,7,8] Variables N % Vijayakumar’s study and 91.9% in. But Findings made by Farchanny in Sikka regency was lower, Washing of net proportion of respondents who comply in using of Yes 66 85,7 insecticide-treated nets while they sleep is only 40%.[9] No 11 14,3 A high proportion of respondents who comply in using Place of net washing of insecticide-treated nets can be used as an indicator River 15 22,7 of the success of malaria control programs. Compliance in using of insecticide-treated nets is associated with a Gutter 39 59,1 decreased risk of malaria incidence. Residents in Sikka Fish pool 0 0,0 district of NTT province who do not comply in using of Sewer 9 13,6 insecticide-treated nets are risky to suffer malaria 6.16 Other places 3 4,5 times greater.[8] Frequency of usage Knowledge of the community about the insecticide- Every month 13 19,7 treated nets is also noted. Knowledge will affect a Every 2 months 4 6,1 person’s behaviour.[9] People who know insecticide- Every 3 months 45 68,2 treated nets will protect themselves against mosquito Every 4 months 1 1,5 bites malaria and will tend to use insecticide-treated nets while sleeping. This study finds that people that have Every 5 months 0 0,0 been studied have a good knowledge about the use of Every 6 months 3 4,5 insecticide-treated net (98%).
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