Community knowledge, perceptions and beliefs towards utilization of insecticide treated nets in Busia District, Uganda.
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BACKGROUND: Use of insecticide treated nets (ITNs) is one of the proven effective malaria control methods. One of the major challenges to ITNs utilization has been access to the ITNs. Busia is one of the districts in which ITNs were massively distributed in some of its sub counties with up to over 85% coverage through the Global fund and other partners in February 2007. A preliminary survey conducted in the district found only 46.7% households consistently used the ITNs, reasons for low and inconsistent ITNS utilization were not known despite access to the nets. STUDY OBJECTIVES: The main objective of the study was to assess the community knowledge, perceptions and beliefs towards utilisation of ITNs at household levels. METHODOLOGY: A Cross sectional study employing three stage sampling in two sub counties, selected 275 household heads or their spouses who were interviewed using self administered questionnaires. Eight FGDs and 9KIIs were conducted with constructs of the health belief model. Analysis of quantitative data was done using SPSS 11.5 and qualitative data was analysed manually using qualitative manifest content analysis using a master sheet. RESULTS: There was low knowledge on ITN use, only 10.9% (30/275) had combined knowledge on the importance, use and maintenance of ITNs. About 42.5% (117/275) reported to have used the ITNs immediately after hanging up the net, 21.1% (58/275) washed the nets with a detergent and over half, 50.5% (139/275) of the participants always hung their nets in sunlight after washing. Only 22.5% (62/275) of the respondents reported to have had sensitization on ITNs and their use before receipt of the ITNs. Respondents that reported to have had sensitization about ITNs before their receipt were 3.09 times more likely to have knowledge on ITN use (AOR 3.09; 95%CI I.36-7.05). Households in Busitema sub county were less likely to have knowledge on ITN use (AOR, 0.299; 95%CI= 0.118-0.756). Knowledge gaps on malaria transmission were evident from the FGDs. Community perceptions on severity and susceptibility to malaria were high, but with low risk perception. Mosquito nets were perceived to be beneficial especially against mosquito bites and nuisance than for malaria prevention. Some of the community members were reported to have diverted the nets for other purposes including, trapping white ants and filtering a local brew among others especially in Lunyo Sub County. About 77.5% (213/275) of the respondents had atleast a fear regarding ITN use and also reported a challenge to consistently in ITN use. The perceived barriers to ITN use were issues like, the insecticide in the nets could easily catch fire amongst others. Respondents from Busitema Sub County were less likely to have a perceived barrier to ITN use (AOR, 0.37, 95%CI 0.181-0.76). FGDs and KIIs depicted a strong belief amongst some of the communities that ITNs were unsafe, about 51.4% (142/275) of the respondents did not believe in the safety of the ITNs. Respondents from households that had had under fives by the time of net distribution were 4.05 times more likely to believe in ITN use (OR 4.05, 95% CI 1.25-16.95). CONCLUSIONS: There were knowledge gaps on ITN use, possibly due to inadequate sensitization on ITN use before the massive distribution. This could have partly contributed to the perceived barriers and the strong belief that the ITNs were not safe. The knowledge gap found on ITN maintenance contributed to loss of the insecticide in the nets through improper washing and drying of the nets which led to reduction in effectiveness of the ITNs. The DHT in Busia needs to strengthen community sensitization with emphasis on malaria transmission and ITN use, addressing the knowledge gaps, perceived barriers and negative beliefs. Massive re-treatment of all the ITNs that are still in good condition should be carried out following adequate sensitization.