Community acceptance of reactive focal mass drug administration and reactive focal vector control using indoor residual spraying, a mixed‐methods study in Zambezi region, Namibia

Abstract

Background In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there are limited data regarding their community acceptability. Methods A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus no RAVC, and rfMDA + RAVC versus RACD only. To assess acceptability of these interventions, a mixed-methods study was conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey. Results In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1372 and 8948 individuals in years 1 and 2, respectively, and refusal rates were low (< 2%). RAVC was offered to few households (n = 72) in year 1. In year 2, RAVC was offered to more households (n = 944) and refusals were < 1%. In the endline survey, 94.3% of 2147 respondents said they would participate in the same intervention again. Conclusions Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement.

Implementation and acceptance of government-sponsored malaria control interventions in Meghalaya, India

“…A few studies have reported IRS acceptance to be generally high, including an investigation in Tanzania [58] where about 95% of participants reported agreeing to receiving IRS, primarily because they recognized that mosquitoes transmitted the malaria parasite and the spray reduced mosquito abundance. Another qualitative study in Namibia that evaluated people's acceptance of case-reactive IRS of households [16], virtually all participants accepted the IRS, in part because they perceived the importance of malaria risk, would receive free healthcare with the IRS, and were educated by respectful study team members. Most studies, however, reported extensive reluctance and strong resistance to household IRS, including reports from Ghana [59], Iran [60], and Mozambique [61], for example.…”

Reactive Case Detection and Treatment and Reactive Drug Administration for Reducing Malaria Transmission: A Systematic Review and Meta-Analysis

“…Community acceptance of RACDT was generally high, 39 – 42 with refusal rates of 2% or lower. In Namibia, some “hesitation/resistance” during pretrial interviews was reported, but community engagement and sensitization improved participation ( Supplemental Table 9 ).…”

“…In Namibia, some “hesitation/resistance” during pretrial interviews was reported, but community engagement and sensitization improved participation ( Supplemental Table 9 ). 42 Similarly in Senegal, high RACDT participation was attributed to advanced cascade sensitization, making follow-up appointments for absent members, and conducting return visits to the compound the same or next day. 40 Lack of community confidence in community health workers’ (CHWs’) ability to address diseases other than malaria and community unwillingness to visit CHWs for malaria testing were reported from Zambia.…”

Fine-scale-mapping of Schistosoma haematobium infections at the school and community levels and intermediate host snail abundance in the north of Pemba Island: baseline cross-sectional survey findings before the onset of a 3-year intervention study

“…Focal snail control has been implemented successfully in other settings, such as Egypt and Mali [ 26 , 27 ]. In similar low-prevalence settings for malaria, focal MDA plus vector control have been applied to reduce transmission [ 28 , 29 ] and reactive case detection, and focal MDA against malaria were shown to have a high community acceptance in Namibia [ 28 , 29 ].…”