Social and Behavioural Baseline for Guiding Implementation of an Efficacy Trial of Insecticide Impregnated Bed Nets for Malaria Control at Nsukka, Nigeria

Abstract

Insecticide impregnated bed nets are being tested in many tropical areas as a major tool to control malaria. In a few African countries, there is a history of local bed net production and use, while in most others, ownership of commercially-produced nets is rare due to high costs relative to local income. Such variations in pre-existing bed net use behavior must be studied prior to designing new intervention trials. A "baseline" diagnostic study in Nsukka Local Government of Enugu State, Nigeria, found that local beliefs about malaria causation, which include heat from the sun and hard work, may reduce the perceived efficacy of bed nets as an appropriate malaria control action. While the belief that mosquitos can cause malaria increased with level of formal education, the study also documented that educated people simultaneously hold both indigenous and scientific perceptions about malaria. Although the project provided bed nets, curtains and residual house spray for free, long-term sustainability may be influenced by the main constraint to current ownership of a bed net, i.e., cost. Issues, such as concern about feeling hot under the nets, a tendency to sleep outside during the hot dry season, and variations in people's ideas about what constitutes a malaria episode, point to the need to monitor the bed net intervention. This is recommended as a means of learning how people perceive the efficacy of the nets, whether they use them correctly and whether the intervention can be sustained and integrated into local primary health care programs.

Stable endemic malaria in a rainforest community of Southeastern Nigeria

“…Education improves general awareness of disease causation and prevention and it could be that those who have tertiary education had better understanding on how to protect themselves from mosquito bites and disease transmissions. This study corroborates with the findings of [35], who obtained least malaria prevalence among those with tertiary education and attributed this to their high awareness as a result of their educational background. [34] obtained high malaria prevalence among those with primary and non-formal education groups and attributed it to lack of knowledge about malaria infection and prevention.…”

Awareness, possession and use of insecticide‐treated nets for prevention of malaria in children under five in Abeokuta, Nigeria

“…Heat generation being a major reason for low use of ITN has also been recorded as a major limitation 17,18 . The problem of ITN hanging may be solved if manufactures of ITN modify techniques that will make hanging of bednets easier for users, 19 which should include ropes to tie the bed net to the posts.…”

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“…While the Yoruba and Igbo are reported to have three classifications for malaria or fever episodes [6,7] the Bwatiye classified malaria into two as did the Kenyan tribe described by Munguti [8]. It has been demonstrated in many studies and for many illnesses, including river blindness and malaria [9-11], that many African communities are unable to perceive illness as a continuum of symptoms with one mild one giving way to a more severe one.…”