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A Model to Facilitate Socio-Cultural Congruent Malaria Care the Training of Health Extension Workers in Ohangwena Region, Namibia

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A Model to Facilitate Socio-Cultural Congruent Malaria Care the Training of Health Extension Workers in Ohangwena Region, Namibia A MODEL TO FACILITATE SOCIO-CULTURAL CONGRUENT MALARIA CARE THE TRAINING OF HEALTH EXTENSION WORKERS IN OHANGWENA REGION, NAMIBIA A THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN PUBLIC HEALTH AT THE UNIVERSITY OF NAMIBIA BY SELMA INGANDIPEWA UUSHONA STUDENT NUMBER: 8901376 NOVEMBER 2019 SUPERVISOR : DR. JACOB SHEEHAMA CO-SUPERVISOR: DR. HERMINE N. IITA DECLARATION I, Selma Ingandipewa Uushona, hereby declare that the content reflect in this book is the true work of research study. The references from other study sources were acknowledged throughout the content of this thesis. This piece of work is new and have never been submitted for degree in higher learning institution in Namibia. The author granted permission to the University of Namibia to reproduce, stored in a retrieval system, or transmitted in any form, this thesis as whole or portion of it where it fit, be it in any means of electronic, mechanical, photocopying or otherwise as long as it is used in approved manner. Signature: -------------------------------------------- Date: 29 November 2019 i ABSTRACT The purpose of this study is to explore and describe the socio-cultural factors that influence Malaria prevention and control, conceptualise the study findings by developing the socio- culturally congruent training model, describe and evaluate it in order to assist trainers to incorporate social and cultural information during their theoretical and practical training of HEWs, to improve their competency. The study is descriptive and exploratory in nature, used convergent parallel design in which both quantitative and qualitative carried equal weight and data are collected at the same time from inception to completion of the study. Approximately 220,683 individuals were impacted by this study . Findings were generated from survey using only one questionnaire which was administered to 402 participants, 8 focus group discussions, and 20 in-depth individual interviews, supported by observations from 20 households and respondents who were 18 years or older. Data obtained from the structured questionnaire and checklist were analysed using the statistical package for social sciences (SPSS), and descriptive statistical analysis was applied to summarize quantitative data into easily identifiable relationships and data interpretation. Qualitative data from interviews were analysed with ATLAS. ti software. Thematic analysis was applied using a coding operation aimed at shortening the diversity of memos, quotation groups, and links into fewer content categories. The result of the study indicated that traditional and cultural methods of Malaria prevention is widely available but not applied. Mosquito nets generally available but not used due to the following reasons: 68.7 percent of the respondents felt that nets were expensive, 12.70% indicated not comfortable with using net just to mention a few. The results also revealed important among the other findings that participants perceived traditional and cultural methods of Malaria prevention is widely ii available but not applied, tumble weed is widely referenced as a herb for Malaria prevention, participants perceived low economic status influence negatively prevention of malaria and access to care, and nets generally available but not affordable and used. The outcome of the study is a Model developed and its operationalization guidelines were established. It is recommended to start training of trainers to facilitate empowerment of Health Extension Workers through collaboration and consultation with relevant authorities to enact integrated curriculum for inclusion of socio-cultural congruent prevention strategy and make it available to donors/NGOs. In addition, the government and funded donor organization to ensure balance in sustain of indigenous knowledge in limited resource setting. Advocate for research collaboration on local traditional practices with social science and western modern care practices by identify local resource used in Malaria prevention. iii DEDICATION This dissertation is dedicated to my husband Teya and our siblings, Inekeela Tangi, Ombili Ongame and Shishani TwahafifwaTukwatha, because of you I know joy and tolerance, I am grateful for your support and it has been amazing to be on this journey with you. iv ACKNOWLEDGEMENTS I would like to thank God the creature for granting me energy and courage to complete this study. My appreciation and gratitude goes to my supervisors Dr J. Sheehama and Dr H N Iita for the guidance, commitment and expertise that contribute to my success and make this dream a reality. I am indebted to the University of Namibia for offering me financial assistance for this study and for granting me permission to conduct research. I thank the Ministry of Health and Social Service and the Director of Ohangwena Health Directorate Mr. John Hango for granting me permission to conduct research with legal support. Many thanks to the Governor and all regional councilors in Ohangwena region, traditional leaders, PHC supervisors, supervisors for HEW at various health facilities for support throughout the time of data collection. My deepest gratitude to participants, HEWs and Head of households for valuable contribution to this study. I am very thankful for Corina Du Toit and the entire African Doctoral Academy team for support and being the sponsor for my accommodation, traveling and attending summer school at the University of Stellenbosch. Your good deeds will never be forgotten, and “may” God bless you forever. To Julia Amadhila, best friend, study mate I appreciated your braveness and kindness, you are a pillar and a source of light during the difficult journey of our study. Thank you for being caring and sharing the bitterness of student life. v Dr Aisheoiwa David, I am honored to have you as a mentor and your word of encouragement make my student life lighter. Many thanks to Wilhelmina, Shangeshiwa, Edwig, Hans, Anna and Fiina for being tolerant and being dedicated to render a helping hand when I was struggling with formatting and computer use. To Mr. Anthony Muganza, I am grateful for being a dedicated statistician for this study. I am indebted to Kefilwe Makhanya for proof reading and grammar editing for this research work. vi LIST OF ACRONYMS FGD Focus Group Discussion GDP Gross Domestic Product GRN Government of the Republic of Namibia HEW Health Extension Worker IRS Indoor Residual Spraying ITN Insecticide Treated Net KAP Knowledge Attitude and Practice LLIN Long lasting insecticidal net MDG Millennium Development Goal MoHSS Ministry of Health and Social Services NSA Namibia Statistics Agency NVDCP National Vector-borne Disease Control Programme SPSS Statistical Package for Social Sciences UNDP United Nations Development Programme UNICEF United Nations Children’s Fund WHO World Health Organisation vii TABLE OF CONTENTS DECLARATION ............................................................................................................................... i ABSTRACT ..................................................................................................................................... ii DEDICATION ................................................................................................................................ iv ACKNOWLEDGEMENTS ............................................................................................................. v LIST OF ACRONYMS .................................................................................................................. vii TABLE OF CONTENTS .............................................................................................................. viii LIST OF TABLES ......................................................................................................................... xv LIST OF FIGURES ....................................................................................................................... xvi LIST OF EQUATIONS ............................................................................................................... xviii CHAPTER ONE ............................................................................................................................... 1 INTRODUCTION AND BACKGROUND TO THE STUDY ........................................................ 1 1.1 Introduction to the Study ............................................................................................ 1 1.2 Background to the Problem ............................................................................................ 5 1.3 Statement of the Research Problem ............................................................................... 7 1.4 Purpose of the study ................................................................................................... 9 1.5 Objectives of the study ................................................................................................... 9 1.6 Significance of the Study ............................................................................................. 10 1.7 Context of the Study ................................................................................................. 12 viii 1.8 Assumptions of the Study......................................................................................... 14 1.9 Framework and Theoretical Basis of the Study ........................................................... 22 1.10 Ethical Measures .............................................................................................................
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