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Insecticide Treated Bednets Ownership, Use and Maintenance

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Insecticide Treated Bednets Ownership, Use and Maintenance INSECTICIDE TREATED BEDNETS OWNERSHIP, USE AND MAINTENANCE BEHAVIOUR IN KWALE, MSAMBWENI AND KINANGO DISTRICTS IN KENYA. MAUREEN KHAMBIRA REG NO: P57/10881/08 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF PUBLIC HEALTH IN THE SCHOOL OF PUBLIC HEALTH OF KENYATTA UNIVERSITY. MARCH 2013 INSECTICIDE TREATED BEDNETS OWNERSHIP, USE AND MAINTENANCE BEHAVIOUR IN KWALE, MSAMBWENI AND KINANGO DISTRICTS IN KENYA. MAUREEN KHAMBIRA REG NO: P57/10881/08 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF PUBLIC HEALTH IN THE SCHOOL OF PUBLIC HEALTH OF KENYATTA UNIVERSITY. MARCH 2013 DECLARATION This thesis is my original work and has not been presented for award of degree in any other university. SIGNATURE: ………………………………….. Date: …………………………….. MAUREEN KHAMBIRA Department of Community Health SUPERVISORS: This thesis has been submitted for examination with our approval as supervisors. 1. SIGNATURE…………………………………DATE:…………………………… DR. ISAAC MWANZO Department of Community Health Kenyatta University 2. SIGNATURE: …………………………………DATE: …………………… DR. FRANCIS MUTUKU Department of Environmental Health Emory University DEDICATION To my husband Samuel for his compassionate love and patience, my son Duanne Paul for being my enduring delight, my mom Sabina and my sister Darlene for their adamant support, and all those who encouraged me during this study. ACKNOWLEDGEMENTS I acknowledge with gratitude Emory University for funding my research work. Special thanks goes to Prof. Uriel Kitron for ensuring that the research was uninterrupted. My deepest appreciation goes to my other supervisors, Dr. Isaac Mwanzo and Dr. Francis Mutuku for offering unlimited support, research coordination and facilitation, and for the commitment towards this work. Many thanks to Dr. Eric Muchiri for facilitating the study and Dr. Dunstan Mukoko for guiding me through data analysis steps. My sincere appreciation to Mr. Gichu Kihoro for offering me training in data base design, all the staff of Msambweni-Division of Vector Borne and Neglected Tropical Diseases especially Robin, Ng’ang’a, Christine, Grace, Joyce and Chisongo for their encouragement. Special thanks to the hospital administration for providing valuable information, the field assistants for their cooperation and active participation in data collection and the entire local community for being receptive and kind. TABLE OF CONTENTS Title page………………………………………………………………………………………...i Declaration……………………………………………………………………………………….ii Dedication………………………………………………………………………………………..iii Acknowledgements……………………………………………………………………………...iv Table of Contents………………………………………………………………………………...v List of Tables………………………………………………………………………….................x List of figures……………………………………………………………………………………xii Appendices……………………………………………………………………………………..xiii Abbreviations and Acronyms ………………………………………………………..............xiv Definition of Terms………………………………………………………………….................xv Abstract………………………………………………………………………………………..xvii CHAPTER 1: INTRODUCTION 1.1 Background…………….………………………………………………………................1 1.2 Statement of the problem ………………………………………………………………...3 1.3 Justification………………………………………………………………………………..4 1.4 Research Questions………………………………………………………………………..5 1.5 Null Hypotheses……………………………………………………………………………6 1.6 General Objective…………………………………………………………………………6 1.7 Specific Objectives………………………………………………………………………...6 1.8 Significance of the study ………………………………………………………………….7 CHAPTER 2: LITERATURE REVIEW 2.1. Malaria Epidemiology in Kenya………………………………………………………...8 2.2. Malaria control………………………………………………………………………….9 2.2.1. InsecticideTreated Nets…………………………………………………………..11 2.2.1.1. Coverage of Insecticide Treated Nets……….……………………………13 2.2.1.2. Insecticide treated nets distribution channels and delivery options………………………………………………………………………14 2.2.1.3. Long lasting Insecticide Nets ………..……………………………………17 2.2.1.4. Misuse of Insecticide Treated Nets……….………………………………18 2.2.2. Indoor Residual Spraying………………………………………………………19 CHAPTER 3: MATERIALS AND METHODS 3.1 Study area ……………………………………………………………………………….22 3.2 Study population….……………………………………………………………………..24 3.3 Exclusion criteria……………………………………………………….........................24 3.4 Inclusion criteria…………………………………………………………………………25 3.5 Study design……………………………………………………………………………...25 3.6 Variables…………………………………………………………………………………25 3.7 Sampling and sample size determination……………………………………………...25 3.8 Construction of research instruments and data collection…………………………...27 3.9 Data analysis……………………………………………………………………………..27 3.10 Ethical considerations………………………………………………………………….28 CHAPTER 4: RESULTS 4.1. Socio-demographic characteristics…………………………………………..................29 4.1.1. Household size…………………………………………………………………..29 4.1.2 Sex………………………………………………………………………………...29 4.1.3 Marital status……………………………………………………………………30 4.1.4 Religion…………………………………………………………………………..31 4.1.5 Education level…………………………………………………………………..32 4.1.6 Occupational status of respondents……………………………………………33 4.1.7 Households monthly income…………………………………………………..34 4.2 Ownership and use of bed nets……………………………………………………….....35 4.2.1. Household possession of mosquito nets……………………………………….35 4.2.2. Universal coverage of bed nets within households owning at least one Net………………………………………………………………………….36 4.2.3. Number of nets per household………………………………………………..36 4.2.4. Household net ownership by district........................................................37 4.2.5. Insecticide treated nets / Long Lasting insecticide treated nets Coverage……………………………………………………………………37 4.2.6. Reasons for not owning bed nets……………………………………………...38 4.2.7. Net hanging………………………………………………………………..........39 4.2.8. Frequency of net use…………………………………………………………...39 4.2.9 Reasons for not using bed nets…………………………………………………40 4.2.10. Net ownership and use by category of owners……………………………..40 4.2.11. Net use by household……………………………………………………........41 4.2.12. Mean number of people sleeping under nets per household by district…..41 4.3 Quality and maintenance behaviour of mosquito bed nets…………………………….42 4.3.1 Physical condition of bed nets as determined by presence of holes………….43 4.3.2. Net condition…………………………………………………………………….43 4.3.3. Causes of holes…………………………………………………………….........44 4.3.4. Association between net age and physical condition of nets………………...44 4.3.5. Association between net fabric and physical condition of nets……………...45 4.3.6. Mean number of intact nets per household by district………………………46 4.3.7 Maintenance behaviour of mosquito bed nets …………………………………47 4.3.7.1. Washing frequency last six months………………………………………47 4.3.7.2. Net retreatment…………………………………………………………….48 4.3.7.3. Association between net re-treatment and type of net…………………..48 4.3.7.4. Retreatment insecticide…………………………………………………….49 4.3.7.5. Cost of retreatment insecticide…………………………………………….49 4.3.7.6 Reasons for non-retreatment of bednets…………………………………...50 4.3.7.7. Association between net maintenance behavior and the condition of the net…………………………………………………………………………………...51 4.4 Extent of insecticide treated nets misuse activities …………………………………….52 4.4.1 Proportion of households with net misuses stratified by district……………….55 4.4.2 Coverage of reserve nets and the reasons for accumulation of extra nets……………………………………………............................................55 4.4.3. Comparison of presence of reserve nets in households using or not using nets……………………………………………………………………………………56 CHAPTER 5: DISCUSSION 5.1 Socio-demographic characteristics ……………………………………………………..58 5.2.1 Ownership of bed nets…………………………………………………………………61 5.2.2 Bed net use……………………………………………………………………………...63 5.3.1. Physical condition of bed nets as determined by presence of holes…………………65 5.3.2. Maintenance behaviour of mosquito bed nets………………………………………..66 5.3.3. Association between net maintenance behaviors and the condition of the net…………………………………………………………………………………...68 5.4. Extent of ITN misuse ……………………………..……………………………………..69 CHAPTER 6: CONCLUSIONS AND RECOMMENDATIONS 6.1 Conclusions………………………………………………………………………………72 6.2 Recommendations for policy making and planning…………………………………..74 REFERENCES………………………………………………………………………………….76 APPENDICES ………………………………………………………………………………….83 APPENDIX I: Questionnaire…………………………………………………………………..83 APPENDIX II: Consent form………………………………………………………………….93 LIST OF TABLES TITLE PAGE Table 4.1: Distribution of household residents ………………………………………………29 Table 4.2: Distribution of respondents by sex ………………………………………………..29 Table 4.3: Distribution of respondents by marital status…………………………………….31 Table 4.4: Distribution of respondents by religion…………………………………………...32 Table 4.5 Distribution of respondents by level of education…………………………………33 Table 4.6: Distribution of respondents by type of occupation……………………………….34 Table 4.7: Distribution of households by average monthly income …………………….......35 Table 4.8: Household net ownership…………………………………………………………..36 Table 4.9: Average number of nets per person………………..……………………...………36 Table 4.10. Distribution of households by number of nets owned..…………………………37 Table 4.11. Net ownership by district………………………………………………………….37 Table 4.12. Net coverage by type….…………………………………………………………...38 Table 4.13. Reasons for not owning bed nets…………………………………………………38 Table 4.14. Presence of net hanging over sleeping space………………………………….....39 Table 4.15. Net use frequency….………………………………………………………………39 Table 4.16: Reasons for not using bed nets…………………………………………………...40 Table 4.17: Net ownership and use by category of owners…………………………………..41
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