Factors influencing acceptance and utilization of ITNs and IRS as malaria vector control measures in Rakai District, Uganda.

Abstract

Indoor residual spraying (IRS) and insecticide treated nets (ITNs) are the two recommended strategies promoted for scaling up malaria control in Rakai district. The question has been, How acceptable are these methods and how often do households members use bed nets after procurement for effective malaria control? OBJECTIVES: This study assessed the acceptability and level of utilization of IRS and ITNs among households in Rakai district in Uganda. DESIGN: A Cross sectional study involving 303 households selected by stratified random sampling RESULTS: Prevalence of bed nets (40%) at household level in Rakai district was much lower than the national or Rakai District target of 50%. Household ownership of ITNs (14%) was less than half of the total households with bed nets. Consistency in bed net use which was at 67% is influenced by believing that bed nets are effective in preventing malaria (OR=2.68 C1=1.22-5-91), and that nets should be used when mosquitoes are many (OR=0.01 C1=0.00-0.05). Bed net use does not depend on whether a bed net is donated or not (OR= 0.44 C1=0.19-1.02). There was high acceptance of ITNs (93%) and IRS (90%) in Rakai District. However, only 49% of the household that knew about DDT would accept it as a chemical for IRS. Determinants of DDT acceptance as a chemical; for IRS are; believing that DDT is harmful to health, (OR=0.01 C1=0.01 C1=0.00-0.02), inadequate information about DDT (OR= 0.00 C1=0.00-0.01), occurrence of a malaria episode in the household (OR=4.89 C1=1.96-10.27), Knowing other IRS chemicals (0R=4.90 C1=2.10-11.43), and accepting to use ITNs (OR=10.25, C1= 1.55-67.90). Social demographic factors and source of information about DDT were not associated with DDT acceptance. CONCLUSION: Bed nets are not used consistently by all their owners. In addition ITN ownership is very low in Rakai District. However the high level of TINs and IRS acceptance offers an opportunity for scaling up by free distribution of ITNs and spraying to targeted households. RECOMMENDATIONS: To increase consistence in bed net and coverage of IRS with DDT in Rakai District, it is important to address the identified factors mainly through health education focusing on misconceptions on safety, effectiveness and correct use.