Social vulnerability of children aged 5 to 15 years to malaria in Madagascar: 3 anthropological studies LLIN use

Abstract

BackgroundAlthough it is accepted that long lasting insecticide bed net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; malaria prevalence is highest in this age group. The purpose of this article is to summarize recent qualitative studies describing LLIN use among children aged 5–15 years and explore options to increase their use in this age group.MethodsQualitative data from three anthropological studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analyzed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.ResultsA total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN nonuse by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and therefore are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.ConclusionsPerceptions, social practices and regional beliefs regarding LLINs s and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.Trial registrationNot applicable

Factors Associated with the Use of Insecticide-Treated Nets Among Women of Reproductive Age in Mozambique, 2018

“…Different areas in the world also have different socio-cultural beliefs which may in uence use, for example in Loreto, Peru and before the advent of ITNs, the use of hammocks was already integrated into people's habits, as the villagers already slept under hammocks from the beginning, regardless of the season (13,14). And we also nd regions where women play an important role in the acquisition, installation and decision making about which people should sleep under an ITN as is the case in Mali and Nigeria, unlike Timor-Leste where this responsibility is subject to the man, in this case the head of the family (15).…”