Integrated malaria prevention in rural communities in Uganda: a qualitative feasibility study for a randomised controlled trial

Abstract

Background A randomised controlled trial (RCT) on integrated malaria prevention, which advocates the use of several malaria prevention methods holistically, has been proposed. However, before conducting an RCT, it is recommended that a feasibility study is carried out to provide information to support the main study, particularly for such a complex intervention. Therefore, a feasibility study for an RCT on integrated malaria prevention in Uganda was conducted. Methods The qualitative study carried out in Wakiso District employed focus group discussions (FGDs) and key informant interviews (KIIs) to explore community willingness to participate in the RCT as well as assess stakeholder perspectives on the future study. The participants of the FGDs were community members, while the key informants were selected from malaria stakeholders including Ministry of Health officials, health practitioners, local leaders, district health team members, and community health workers (CHWs). Thematic analysis was employed with the support of NVivo. Results A total of 12 FGDs and 19 KIIs were conducted. Five main themes emerged from the study: malaria prevention practices related to integrated malaria prevention; preferred malaria prevention methods in the integrated approach; potential challenges of integrated malaria prevention; perspectives on the proposed RCT; and sustainability of integrated malaria prevention. Despite a few methods being employed holistically in the community, insecticide-treated nets were the most widely used and preferred method for malaria prevention mainly because they were provided free by the government. The main challenges in the integrated approach were the high cost of some methods such as house screening, and concerns about the potential side effects of insecticide-based methods such as indoor residual spraying. Participants expressed high willingness to participate in the RCT to promote the use of multiple methods in their households and community. Involvement of CHWs during implementation was proposed as a sustainability strategy for the RCT interventions. Conclusion There was high willingness to participate in the proposed RCT on integrated malaria prevention. However, high cost and perceived negative health effects from some methods were identified as potential challenges. The type of methods to be included as well as sustainability mechanisms needs to be considered during the design of the RCT.

Facilitators and barriers to integrated malaria prevention in Wakiso district, Uganda: A photovoice study

“…In our study, many of the participants and community members did not know the importance of using several malaria prevention methods. This finding is similar to previous quantitative studies where few methods were being integrated due to lack of knowledge [ 45 – 47 , 50 ]. Similar to our study, knowledge and use of LLINs was prominent in previous qualitative and quantitative studies including in Kenya and Tanzania [ 40 , 44 , 47 , 49 ].…”

“…This finding is similar to previous quantitative studies where few methods were being integrated due to lack of knowledge [ 45 – 47 , 50 ]. Similar to our study, knowledge and use of LLINs was prominent in previous qualitative and quantitative studies including in Kenya and Tanzania [ 40 , 44 , 47 , 49 ]. Adequate knowledge on LLINs among populations may be attributed to the mass campaigns on use of mosquito nets including by the Ugandan Ministry of Health [ 8 ].…”

“…Support from the government and health workers was seen as another facilitator to integrated malaria prevention in our study. Other quantitative and qualitative studies we have recently conducted documented the importance of government support in malaria prevention especially in rural settings [ 46 , 47 ]. Future provision of free LLINs to the population by MOH is likely to further facilitate use of multiple malaria prevention methods at households.…”

“…Furthermore, some of the malaria prevention methods used such as LLINs (in cases where free ones are not provided by the government), electric mosquito traps, and body repellents were considered as expensive. Views of some malaria prevention methods being unaffordable have been expressed in other qualitative and quantitative studies [ 41 , 45 , 47 , 50 ]. This could be because rural communities have many competing financial priorities yet they are generally poor [ 41 ].…”