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Household Knowledge and Practices Concerning Malaria and Indoor

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Household Knowledge and Practices Concerning Malaria and Indoor Madani et al. Parasites & Vectors (2017) 10:600 DOI 10.1186/s13071-017-2548-z RESEARCH Open Access Household knowledge and practices concerning malaria and indoor residual spraying in an endemic area earmarked for malaria elimination in Iran Abdoulhossain Madani1, Moussa Soleimani-Ahmadi1,2*, Sayed Hossein Davoodi3, Alireza Sanei-Dehkordi2, Seyed Aghil Jaberhashemi4, Mehdi Zare5 and Teamur Aghamolaei1 Abstract Background: Indoor residual spraying of insecticide (IRS) is a key intervention for reducing the burden of malaria infection. Effectiveness and success of this strategy are to a considerable extent dependent on knowledge and practice of the target community regarding the IRS. Iran has entered the malaria elimination phase, and IRS has been considered as the main strategy for malaria vector control. Therefore, this study was conducted to determine the household knowledge and practices about malaria and IRS in Bashagard County, one of the malaria-endemic areas in the southeast of Iran. Methods: A community-based cross-sectional survey was conducted among 420 households in Bashagard County. The participants who were selected using a two-stage randomized cluster sampling procedure were subjected to a tested structured questionnaire. During the survey, direct observations were made concerning the use of IRS as well as housing conditions. The data were coded and analysed using SPSS version 19. Results: Knowledge levels about malaria as a disease and the mosquito as its vector were high and of equal magnitude (85.5% and 85.4%, respectively), while knowledge levels of IRS were even higher (91.6%). The main source of households’ information about malaria and IRS was primarily community health workers (73.3%). Despite positive perceptions towards IRS only 26.7% of respondents had sprayed their houses which is lower than the WHO targeted coverage of 80%. Respiratory disorders and headache (33.3%), food contamination (24.9%), discolouring of inner house walls (17.7%), difficulty in furniture’s movement (13.8%), and unpleasant odour (10.4%) were the main reasons for IRS refusal. Conclusion: There is a discrepancy between knowledge about symptoms and the transmission route of malaria and control practices related to IRS use. Therefore, IRS campaigns accompanied with education for behaviour change should be considered to ensure householders’ participation and cooperation in the IRS programme. Moreover, continuous evaluation and monitoring of IRS as well as conducting more surveys on knowledge, attitude, and practices are recommended to improve malaria control measures and to identify indicators for effective, successful, and sustainable malaria elimination programme. Keywords: Malaria, Knowledge, Practices, Household, Indoor residual spraying, Iran * Correspondence: [email protected]; [email protected] 1Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran 2Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, P.O. Box: 79145-3838, Bandar Abbas, Iran Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Madani et al. Parasites & Vectors (2017) 10:600 Page 2 of 9 Background According to the recent reports, almost all areas of Malaria remains a major contributor to worldwide disease Iran are considered as malaria-free, except some regions burden and is currently endemic in 91 countries [1]. In in the south-east of the country which are still consid- 2015, approximately 212 million new cases of malaria ered as endemic malaria area [1, 14]. Bashagard is one of were diagnosed, and about 429,000 people died from the malaria-endemic regions in this area with two sea- malaria worldwide [1]. sonal peaks in autumn and spring. In this county 1406 In Iran, the malaria eradication campaign was initiated cases of malaria were reported during 2008–2015, out of in 1951 and changed to malaria control in 1985 as a result which 1394 (99.15%) and 12 (0.85%) cases were attrib- of constraints and challenges [2]. Iran has been in the uted to Plasmodium vivax and P. falciparum, respect- current elimination phase since 2010. In 2009, the number ively (Bashagard Health Center, unpublished data, 2015). of malaria cases in Iran were 6122, and it was reduced to Six species including Anopheles stephensi, An. fluviatilis, 720 in 2015 [1, 3]. An. dthali, An. culicifacies, An. superpictus and An. pul- Iran, as in other malaria-endemic countries, has employed cherrimus have been reported as malaria vectors in this effective vector control measures including indoor residual County [15, 16]. One of the WHO recommended stra- spraying (IRS), long-lasting insecticidal nets (LLINs), and tegic approaches for malaria elimination by the use of application of larvicides as the main vector control inter- indoor residual spraying programmes which are highly ventions [4–6]. Challenges to the elimination of malaria in dependent on pyrethroid insecticides [4]. Regarding this low socioeconomic areas, such as Bashagard County, recommendation, IRS has been focused on, by Iranian include the inability to sustain control programmes due to Ministry of Health and Medical Education as the main community perceptions and practice for malaria control. component of the malaria vector control intervention Promotion of community participation through health strategy [7]. The target of National Malaria Control education and communication programmes can be consid- Programme is to cover at least 85% of all targeted house- ered as a strategy against these challenges. holds to achieve community coverage sufficient to inter- IRS is the large-scale application of insecticides to rupt transmission of malaria [1]. spray the interior of homes for killing mosquitoes. It Community participation is the key component of remains one of the main components of the malaria con- malaria elimination programmes, and improved commu- trol strategy, which aims to prevent parasite transmission nity knowledge of malaria control methods can promote through interventions targeting Anopheline vectors [7, 8]. preventive practices against malaria [14, 17]. To achieve IRS has been employed to eliminate malaria from different efficient IRS coverage, a key factor is identifying and malaria endemic areas including Europe, Asia, Latin addressing the behavioural factors that may lead to IRS America, and Africa [9]. National malaria control pro- refusal. Increasing the community knowledge about grammes in the 91 endemic countries reported that 106 malaria and IRS will lead to behavioural changes which million people worldwide were protected by IRS in 2015 would help in designing sustainable malaria control pro- [1]. Several factors which influence the effectiveness of grammes [13]. In line with assuring for sustainability of IRS interventions include spraying coverage, type of the malaria elimination programme in Iran, this study insecticide, type and situation of houses, community was conducted to determine the community knowledge awareness and cooperation, household acceptance, and and practice about malaria and IRS, as a preventive informing the households about the programme benefits strategy, in Bashagard County, southeast of Iran. and spraying time during the spraying campaign [10]. Spraying coverage is also dependent on the household’s Methods perception of the effectiveness of IRS programme against Study area mosquitoes and other nuisance insects, as well as the Bashagard County is located between 26°04′–26°58′N number and intensity of unwanted side effects [8]. The latitudes and 57°23′–59°02′E longitudes in Hormozgan perceived side effects of indoor insecticide spraying can province, southeastern Iran, with an estimated population decrease the acceptance of these types of interventions of 40,037 individuals in 2015. The climate in Bashagard is [11]. It is thus necessary to understand community know- categorized as tropical dry, with mean annual temperature ledge about house spraying for the IRS programmes to be of 28.4 °C ranging from 18.8 °C to 37.4 °C, and a relative successful [12]. humidity between 18 and 38%. The average annual rainfall Previous studies have demonstrated that communities is about 251 mm (Fig. 1). Water bodies such as rivers and have positive expectations when interventions such as streams normally exist in the area. The county is mostly IRS are introduced [8, 11]. However, they may refuse mountainous and hilly, with scattered population inhab- IRS due to their concerns about IRS with regards to che- ited mainly close to rivers. The villages are small and rela- micals being a health hazard or doubts about its effect- tively difficult to access with a low population who live in iveness [11, 13]. houses made of cement blocks and shelters (Fig. 2). Madani et al. Parasites & Vectors (2017) 10:600 Page 3 of 9 Sample size calculation Assuming expected knowledge
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