Indoor Residual Spraying Coverage and Acceptability Rates to Control
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Int J Infect. 2015 October; 2(4): e31548. doi: 10.17795/iji-31548 Research Article Published online 2015 October 28. Indoor Residual Spraying Coverage and Acceptability Rates to Control Malaria and the Householders’ Reasons of Acceptance or Rejection of Spraying, in South-East of Iran 1,2 2 3,4,* 1 Mohammad Sakeni, Alireza Khorram, Reza Majdzadeh, and Ahmad Raiesi 1School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran 2Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran 3Knowledge Utilization Research Center (KURC), School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran 4Center for Academic and Health Policy (CAHP), Tehran University of Medical Sciences, Tehran, IR Iran *Corresponding author : Reza Majdzadeh, Center for Academic and Health Policy (CAHP), Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166495859, Fax: +98-2166495859, E-mail: [email protected] Received ; Revised ; Accepted 2015 July 20 2015 September 3 2015 September 9. Abstract Background: Indoor residual spraying (IRS), as one of the malaria control techniques, requires high spraying coverage and acceptance rate by householders, to be effective. Objectives: The main aim of the study was to assess the spraying acceptability and coverage rates in relation to acceptance and rejection reasons of the IRS program. Also, the householders’ perception about IRS benefits and satisfaction with the malaria prevention and knowledge of transmission pathways were estimated. Materials and Methods: A cross-sectional survey was performed in endemic districts of Sistan-and Baluchistan province (south-east of Iran), in two years of 2013 and 2014. Data were collected by a validated questionnaire, through interviewing 834 household heads that were randomly selected from 40 villages, of four malarial sub-districts. To analyze the data, chi-squire test was performed, by using SPSS software (Version 18). The significance level was set at P ≤ 0.05. Results: A total of 834 households’ heads were interviewed, with the mean age of 39.5 ± 15.4 years, 73.3% males and 26.7% females. The main sources of information, concerning IRS, were health care workers (51.4%). The IRS coverage and acceptance rates were 96.5% and 94%, respectively. Of the total number of participants, 95.3% of householders associated the disease transmission with mosquito bites and reported the use of insecticidal bed nets (90%) and IRS (74.1%), as important ways of malaria prevention. Conclusions: The study showed that IRS coverage and acceptance rates were relatively high, which is essential in reaching malaria elimination. The information on malaria transmission and knowledge prevention measures showed that householders were, to a certain extent, familiar with the malaria control activities conducted by the health care service. Keywords: Malaria, Delivery of Health Care, Disease Transmission, Infectious, Prevention and Control 1. Background Malaria is one of the greatest public health challenges control malaria on large scale (7), is coating the interior worldwide. Up to one million deaths per year and more of homes, comprising all walls, roofs and other surfaces, than 500 million clinical cases occur in the world (1). In and domestic animal shelters, with chemical insecti- Iran, this disease is one of the major public health prob- cides (5, 7). Several countries, such as Iran (2, 8), have lems and the most important vector-borne infection (2). added an IRS program to their malaria control strategy, In Tanzania, the malaria disease was responsible for up to in line with the WHO recommendations. According to one-third of deaths, in children under the age of 5 years the WHO’s global Malaria program, IRS is recognized as a and for more than one-fifth of deaths, in pregnant wom- major means of malaria vector control, for reducing and en (3). According to the world health organization (WHO) eliminating the malaria transmission (2, 5, 7, 8). Endemic Global Malaria Program, three important interventions, regions can make great advances in malaria elimination, including diagnosis and treatment of malaria cases with by implementing the suitable IRS interventions, for all effective medications, insecticide-treated nets (ITNs) dis- populations at risk of malaria, and preserving these pro- tribution and indoor residual spraying (IRS), are impera- grams over time (9). The IRS is basically responsible for tive for the control and prevention of residents from ma- the success of malaria control programs (2, 8, 9). Multiple laria (4-6). studies have shown the effectiveness and efficacy of IRS, The IRS, as a highly cost-effective intervention (6) to in reducing malaria vectors and preventing transmission Copyright © 2015, Infectious Diseases and Tropical Medicine Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Sakeni M et al. of infection, in the nations where it was performed (4-6, Socio-economic development, such as houses features 8, 10). Living in the IRS-intervention houses has a protec- improvements, is associated with the lower risk of ma- tive effect on transmission of infection (6). For instance, laria outcomes. Studies showed that residents of modern in Zanzibar, IRS reduced the malaria prevalence from 76% houses had lower risk of malaria infection and lower risk to less than 5%, during 1957 - 1967 (9) and also, reduced the of clinical malaria, compared to residents of traditional malaria incidence by more than 90%, in major regions of houses (18). tropical Asia and Southern America, through a combina- The Sistan and Baluchistan province, South-eastern tion of IRS with other measures, during the eradication Iran, is classified as unstable malaria area and has the program (5). In 2010, IRS protected 185 million people (6% highest prevalence of malaria transmission in the coun- of the world population) at risk for malaria infection. try, comprising of nearly 42% - 60% of the whole malaria Although it is still underutilized in the world, the IRS cases occurring in Iran. The IRS intervention program intervention is increasing globally (9). Studies indicated has been implemented in Iran and also in that province, that IRS can be most effective to control malaria by apply- since 2003 (8). Despite the substantial advances in de- ing and expanding the IRS to up to 80% of region’s house- creasing the malaria transmission, over the last years, it holds (5, 8, 11). In several studies from different parts of yet remained a leading public health problem and the the world, the results showed that the IRS coverage rates disease has not been eliminated. varied from 27.8%, in eastern Ethiopia (12), to 95%, in Zan- zibar, Tanzania (13). 2. Objectives The IRS Effectiveness processes requires household ac- ceptance (14) and is deeply associated with willingness The present study was conducted to evaluate the ac- of households to accept the spraying of residual insecti- ceptance of implementation of a house-to-house IRS pro- cides, during the spraying campaign (3). Its acceptability gram, in selected villages of South-eastern Iran districts. varied from location to location (14). For example, in In- Also, householders’ perception about the benefits, futil- donesia, a study showed that approximately all house- ity, satisfaction and dissatisfaction of IRS program were holders reported a willingness to accept IRS for malaria assessed. prevention (15), whereas this rate was 97.6% in Southern Mexico (11), to 29% - 41% throughout the study period, 3. Materials and Methods in rural Mozambique (16). In Hlongwana et al. study, in South Africa, 29.4% of the respondents reported that they 3.1. Study Area disliked certain aspects of spraying, because of the dis- coloring of inner walls of their houses, through spraying The study was conducted during two different time the insecticide (1). periods of years 2013 and 2014, in four main malaria The quality and amount of health information and endemic districts of Sistan and Baluchistan province, education about malaria that are provided to the com- south-east of Iran, bordering the neighboring countries munity to ensure that people perform the preventive of Afghanistan and Pakistan. These districts were chosen measures, are critical factors, which increase the effec- as the study regions, because of the high levels of malaria tiveness of malaria-control interventions (1). Several vector mosquito’s redundancy that was historically ob- studies have reported the good knowledge about the served. malaria transmission (1, 3, 12, 13). In Hlongwana et al. study, about 93% of the respondents had heard about 3.2. Study Design and Population the malaria disease and 84.6% of them correctly related A cross-sectional study model on households was used. the disease to mosquito bites (1). In Gobena et al. study All households in the rural of Konarak, Chabahar, Sarbaz, that evaluated the knowledge of women about malaria, and Saravan districts, south-east of Iran, were included in 85.9% of participants had heard of malaria disease and the study sample. According to the spraying needs assess- 56.1% of them mentioned the malaria transmission ment, these four districts were categorized as epidemio- through mosquito bites (12). logical malaria foci