Background
Methods
Study area
Sampling procedure and sample size determination
Data collection
Data management and analysis
Results
Socio-demographic characteristics of the study participants
Variable | Frequency (n) | Percentage (%) |
---|---|---|
Age | ||
≤ 22 | 110 | 17.2 |
> 22 | 530 | 82.8 |
Gender | ||
Male | 486 | 75.9 |
Female | 154 | 24.1 |
Parish | ||
Lwala | 292 | 45.6 |
Mulanda | 154 | 24.1 |
Mwelo | 194 | 30.3 |
Marital status | ||
Single | 70 | 10.9 |
Married | 499 | 77.9 |
Widowed | 71 | 11.1 |
Religion | ||
Anglican | 330 | 51.6 |
Catholic | 250 | 39.1 |
Moslem | 9 | 1.4 |
Pentecostal | 51 | 7.9 |
Education | ||
None | 73 | 11.4 |
Primary | 461 | 72.0 |
Secondary | 88 | 13.7 |
Tertiary | 18 | 2.8 |
Occupation | ||
Farmer | 575 | 89.8 |
Others | 65 | 10.2 |
Wealth status | ||
Poor | 195 | 30.5 |
Middle | 221 | 34.5 |
Rich | 224 | 35.0 |
Uptake of IRS in the first round of spray
(Spray operator).“During the first round of spray, there were households in my community that were not sprayed. The household heads refused us to spray there houses, claiming the chemical being used causes cancer, may kill their domestic animals and may spoil their food. The community members were also scared of the future side effects which in the long run would affect them and their children.”
(Spray operator).“Some houses were closed and occupants were not at home during the time of house spraying, when we came back the following day, the household members’ claimed they were in the gardens far from their homes. We also realized that they just did not want their houses to be sprayed because they did not allow us to enter and spray after all, even when they knew that we were to come and spray their houses.”
Willingness to take up IRS in the next round of spray
(KI: Village Health Team).“I think the best way of passing out IRS information to the communities is by the local leaders addressing communities in public functions like burials. It would also be better to use institutional leaders like in schools, churches and cultural institutions.”
Bi-variable analysis
Individual factors associated with willingness to take up IRS
Variable | Willingness to take up IRS in next round | COR | 95% CI | p value | |
---|---|---|---|---|---|
No (%) | Yes (%) | ||||
Level of education | |||||
None | 32 (23.9) | 41 (8.1) | 1 | ||
Primary | 83 (61.9) | 378 (74.7) | 3.5 | (2.11–5.98) | < 0.001a |
Secondary and above | 19 (14.2) | 87 (17.2) | 3.6 | (1.81–7.04) | < 0.001a |
Age | |||||
≤ 22 | 50 (37.8) | 60 (11.8) | 1 | ||
> 22 | 83 (62.4) | 447 (88.2) | 4.6 | (2.99–7.24) | < 0.001a |
Sex | |||||
Male | 98 (73.1) | 388 (76.7) | 1 | ||
Female | 36 (26.9) | 118 (23.3) | 0.8 | (0.54–1.28) | 0.394 |
Occupation | |||||
Farmer | 120 (89.5) | 455 (89.9) | 1 | ||
Others | 14 (10.5) | 51 (10.1) | 0.9 | (0.51–1.79) | 0.900 |
Residence (parish) | |||||
Mulanda | 21 (15.7) | 133 (26.3) | 1 | ||
Lwala | 75 (56.0) | 217 (42.9) | 0.4 | (0.27–0.78) | 0.004a |
Mwelo | 38 (28.4) | 156 (30.8) | 0.6 | (0.36–1.16) | 0.144 |
Religion | |||||
Anglican | 77 (57.5) | 253 (50.0) | 1 | ||
Catholic | 35 (26.1) | 215 (42.5) | 1.8 | (1.21–2.89) | 0.005a |
Others | 22 (16.4) | 38 (7.5) | 0.5 | (0.29–0.94) | 0.031a |
Wealth status | |||||
Poor | 27 (20.3) | 168 (33.1) | 1 | ||
Middle | 49 (36.8) | 172 (33.9) | 0.6 | (0.34–0.94) | 0.030a |
Rich | 57 (42.9) | 167 (32.9) | 0.5 | (0.28–0.28) | 0.003a |
Family type | |||||
Monogamous | 113 (89.0) | 402 (86.3) | 1 | ||
Polygamous | 14 (11.0) | 64 (13.7) | 1.3 | (0.69–2.38) | 0.424 |
Family size | |||||
≤ 5 members | 99 (73.9) | 364 (71.9) | 1 | ||
More than 5 members | 35 (26.1) | 142 (28.1) | 1.1 | (0.71–1.69) | 0.655 |
House floor material | |||||
Natural floor (dung) | 118 (88.1) | 452 (89.3) | 1 | ||
Finished floor (cemented) | 16 (11.9) | 54 (10.7) | 0.9 | (0.49–1.59) | 0.676 |
House roof material | |||||
Natural roof (thatched) | 73 (54.9) | 222 (43.9) | 1 | ||
Finished (iron sheets) | 61 (45.1) | 284 (56.1) | 1.5 | (1.04–2.24) | 0.029a |
House wall material | |||||
Natural walls | 84 (62.7) | 289 (57.1) | 1 | ||
Finished (bricks, cement) | 50 (37.3) | 217 (42.9) | 1.3 | (0.85–1.87) | 0.245 |
Took up IRS in first round | |||||
Yes | 98 (73.1) | 478 (94.5) | 1 | ||
No | 36 (26.9) | 28 (5.5) | 0.2 | (0.09–0.27) | < 0.001a |
Source of information about IRS | |||||
Community leaders | 102 (761) | 420 (83.0) | 1 | ||
Health workers | 20 (14.9) | 59 (11.7) | 0.5 | (0.27–1.14) | 0.097 |
Others | 12 (8.9) | 27 (5.3) | 0.7 | (0.41–1.24) | 0.236 |
Knew the chemical used in IRS | |||||
Yes | 11 (8.3) | 27 (5.3) | 1 | ||
No | 121 (91.7) | 478 (94.7) | 1.6 | (0.78–3.33) | 0.201 |
Knew frequency of spraying | |||||
Yes | 90 (67.2) | 363 (71.5) | 1 | ||
No | 44 (32.8) | 144 (28.5) | 0.3 | (0.28–0.46) | < 0.001a |
Reason for spraying | |||||
To kill mosquitoes | 32 (23.9) | 297 (58.7) | 1 | ||
To kill other insects | 29 (21.6) | 119 (23.5) | 0.4 | (0.26–0.76) | 0.003a |
Don’t know | 73 (54.5) | 90 (17.8) | 0.1 | (0.08–0.21) | < 0.001a |
Knowledge of IRS | |||||
Knowledgeable | 31 (23.1) | 212 (49.9) | 1 | ||
Not knowledgeable | 103 (76.9) | 294 (58.1) | 0.4 | (0.27–0.65) | < 0.001a |
(KI: Malaria focal person).“We used local leaders, religious and cultural leaders in the communities to tell people in about the re-spraying phases of IRS. I am sure everyone is aware that after six months, the spray operators would come back to spray their houses.”
(KI: Village Health Team).“Some people now fall back and refuse their houses to be sprayed because they wonder why when houses are sprayed, if a hen eats a dead cockroach that died due to the spray chemical, the hen also dies.”
(Malaria focal person).“There is need for more sensitization of communities using community and church leaders. There is also need of dialoging with the communities to using local councils, village health teams and church leaders. This is because these people are respected in the communities”
Enabling factors associated with willingness to take up IRS
Variable | Willingness to take up IRS in next round | COR | 95% CI | p value | |
---|---|---|---|---|---|
No (%) | Yes (%) | ||||
Believed that IRS reduces nuisance of mosquitoes | |||||
Agree | 109 (81.3) | 497 (98.2) | 1 | ||
Disagree | 25 (18.7) | 9 (1.8) | 0.3 | (0.19–0.42) | < 0.001a |
Believed that IRS reduces chances of getting malaria | |||||
Agree | 110 (82.1) | 495 (97.8) | 1 | ||
Disagree | 24 (17.9) | 11 (2.2) | 0.3 | (0.22–0.46) | < 0.001a |
Believed that IRS reduces chances of getting malaria | |||||
Agree | 42 (31.8) | 57 (11.3) | 1 | ||
Disagree | 90 (68.2) | 449 (88.7) | 1.9 | (1.52–2.41) | < 0.001a |
Believed that chemicals used in IRS pollute environment | |||||
Agree | 30 (22.4) | 33 (6.5) | 1 | ||
Disagree | 104 (77.6) | 473 (93.5) | 2.0 | (1.55–2.66) | < 0.001a |
Had children under 5 years | |||||
Yes | 75 (53.0) | 242 (47.9) | 1 | ||
No | 63 (47.0) | 263 (52.1) | 1.2 | (0.84–1.79) | 0.298 |
Preferred method of preventing malaria | |||||
IRS | 7 (5.2) | 31 (6.1) | 1 | ||
ITN | 127 (94.8) | 475 (93.9) | 0.8 | (0.36–1.96) | 0.695 |
Believed that IRS is useful | |||||
Useful | 61 (45.5) | 314 (62.1) | 1 | ||
Fairly useful | 49 (36.6) | 182 (35.9) | 0.7 | (0.47–1.09) | 0.126 |
Not useful | 24 (17.9) | 10 (2.0) | 0.1 | (0.04–0.18) | < 0.001a |
Household had a pregnant woman | |||||
Yes | 12 (9.0) | 32 (6.3) | 1 | ||
No | 122 (91.0) | 474 (93.7) | 1.4 | (0.73–2.91) | 0.287 |
Member of household had malaria a month prior interview | |||||
Yes | 64 (47.8) | 240 (47.6) | 1 | ||
No | 70 (52.2) | 264 (52.4) | 1.0 | (0.69–1.47) | 0.977 |
Source of malaria treatment | |||||
VHT | 15 (22.4) | 29 (12.2) | 1 | ||
Public health center | 42 (62.7) | 177 (74.7) | 2.2 | (1.07–4.43) | 0.031a |
Private health center | 10 (14.9) | 31 (13.1) | 1.6 | (0.62–4.13) | 0.328 |
(KI: Community leader).“Initially there was a lot of fear about IRS in our communities following what people suffered in northern Uganda after the chemicals were sprayed nodding disease started.”
(KI: Malaria focal person).“The negative perceptions about IRS could affect community willingness to take up IRS in next rounds of spray. There is need to address the communities about these negative perceptions about IRS through community dialogues using village health teams, local NGO’s and CBO’s, community and local leaders to ensure all household accept a their houses to be sprayed in the next round.”
Health systems factors associated with willingness to take up IRS
Variable | Willingness to take up IRS in next round | COR | 95% CI | p value | |
---|---|---|---|---|---|
No (%) | Yes (%) | ||||
Distance to nearest health centre | |||||
≤ 5 km | 129 (96.3) | 469 (92.7) | 1 | ||
> 5 km | 5 (3.7) | 37 (7.3) | 0.1 | (0.78–5.28) | 0.144 |
Means of transport to health centre | |||||
Walking | 85 (63.4) | 442 (87.4) | 1 | ||
Bicycle | 23 (17.2) | 47 (9.3) | 0.4 | (0.39–0.68) | 0.001a |
Other means | 26 (19.4) | 17 (3.36) | 0.2 | (0.06–0.24) | < 0.001a |
Had a community medicine distributor | |||||
Yes | 91 (67.9) | 363 (71.7) | 1 | ||
No | 36 (26.9) | 115 (22.7) | 0.8 | (0.52–1.24) | 0.322 |
Don’t know/not sure | 7 (5.2) | 28 (5.5) | 1.0 | (0.42–2.37) | 0.995 |
Number of mosquito nets in a household | |||||
Two or less | 55 (41.0) | 280 (55.3) | 1 | ||
More than two | 79.9 (58.9) | 226 (44.7) | 0.6 | (0.38–0.83) | 0.003a |
Source of IRS information | |||||
Community leaders | 102 (77.3) | 420 (83.2) | 1 | ||
Others | 30 (22.3) | 85 (16.8) | 0.7 | (0.43–1.09) | 0.118 |
(KI: Sub-county chief).“The district, after the first round of spray, conducted dissemination exercises to review performance of every sub county. The district went ahead and gathered feedback from the exercise of what transpired, lessons learned and how to improve uptake in the subsequent sprays. There is need for community and religious leaders to address communities during public gatherings like burials and marriage ceremonies.”
Multivariable analysis
Variable | UOR | 95% CI | p value | AOR | 95% CI | p value | |||
---|---|---|---|---|---|---|---|---|---|
Level of education | |||||||||
None | 1 | 1 | |||||||
Primary | 3.5 | (2.11–5.98) | < 0.001a | 1.4 | (0.69–2.73) | 0.362 | |||
Secondary and above | 3.6 | (1.81–7.04) | < 0.001a | 1.5 | (0.66–3.56) | 0.316 | |||
Age | |||||||||
≤ 22 | 1 | 1 | |||||||
23–35 | 1.5 | (0.89–2.59) | 0.126 | 1.3 | (0.72–2.46) | 0.361 | |||
> 35 | 1.9 | (1.19–3.12) | 0.007 | 1.9 | (1.08–3.51) | 0.026a | |||
Residence (parish) | |||||||||
Mulanda | 1 | 1 | |||||||
Lwala | 0.4 | (0.27–0.78) | 0.004a | 0.8 | (0.45–1.42) | 0.443 | |||
Mwelo | 0.6 | (0.36–1.16) | 0.144 | 1.2 | (0.63–2.27) | 0.592 | |||
Religion | |||||||||
Anglican | 1 | 1 | |||||||
Catholic | 1.8 | (1.21–2.89) | 0.005a | 1.0 | (0.65–1.67) | 0.863 | |||
Others | 0.5 | (0.29–0.94) | 0.031a | 1.4 | (0.64–3.04) | 0.396 | |||
Wealth status | |||||||||
Poor | 1 | 1 | |||||||
Middle | 0.6 | (0.34–0.94) | 0.030a | 0.5 | (0.27–0.98) | 0.043a | |||
Rich | 0.5 | (0.28–0.28) | 0.003a | 0.4 | (0.17–1.14) | 0.091 | |||
Source of IRS information | |||||||||
Community leaders | 1 | 1 | |||||||
Health workers | 0.5 | (0.27–1.14) | 0.097 | 0.8 | (0.32–1.90) | 0.580 | |||
Others | 0.7 | (0.41–1.24) | 0.236 | 0.7 | (0.33–1.41) | 0.303 | |||
Took IRS in first round | |||||||||
Yes | 1 | 1 | |||||||
No | 0.2 | (0.09–0.27) | < 0.001a | 0.1 | (0.06–0.23) | <0.001a | |||
Knew frequency of spraying | |||||||||
Yes | 1 | 1 | |||||||
No | 0.3 | (0.28–0.46) | < 0.001a | 0.9 | (0.55–1.51) | 0.714 | |||
Reason for conducting IRS | |||||||||
To kill mosquitoes | 1 | 1 | |||||||
To kill other insects | 0.4 | (0.26–0.76) | 0.003a | 0.4 | (0.24–0.78) | 0.005a | |||
Don’t know | 0.1 | (0.08–0.21) | < 0.001a | 0.2 | (0.12–0.35) | < 0.001a | |||
Believed IRS has health effects | |||||||||
Agree | 1 | 1 | |||||||
Disagree | 1.9 | (1.52–2.41) | < 0.001 | 1.1 | (0.65–1.73) | 0.815 | |||
Believed chemicals used will pollute the environment | |||||||||
Agree | 1 | 1 | |||||||
Disagree | 2.0 | (1.55–2.66) | < 0.001 | 1.2 | (0.69–2.16) | 0.482 | |||
Number of mosquito nets in the household | |||||||||
Two or less | 1 | 1 | |||||||
More than two | 0.6 | (0.38–0.83) | 0.003a | 0.82 | (0.52–1.30) | 0.404 | |||
House roof materials | |||||||||
Grass thatched | 1 | 1 | |||||||
Iron sheets | 1.5 | (1.04–2.24) | 0.029a | 2.2 | (1.03–4.73) | 0.042a |