Background
Methods
Setting
Study design
Sampling and population
Recruitment
Data collection: interviews
Transcription and data analysis
Results
Demographic characteristics
Variables | N = 20 (%) |
---|---|
Gender | |
Male | 10 (50) |
Female | 10 (50) |
Age | |
18–24 | 6 (30) |
25–34 | 6 (30) |
35–44 | 2 (10) |
45–54 | 3 (15) |
55–64 | 1 (5) |
65–74 | 1 (5) |
≥ 75 | 1 (5) |
Education | |
None completed | 0 (0) |
Primary | 5 (25) |
Secondary | 5 (25) |
Tertiary | 10 (50) |
Occupation | |
Housewife | 5 (25) |
Student | 5 (25) |
Businessman | 4 (20) |
Fisherman | 1 (5) |
Other employed | 3 (15) |
Unemployed | 2 (10) |
Themes
a. A culture of malaria
[P20]I think it is the nature of this place, it is the jungle so mosquitoes are always here
[P13]People cannot avoid the mosquito biting
[KI1]The people here [in Iquitos] think malaria is a very normal disease. People commonly have malaria 5 times in their life if not more.
[KI3]Everyone is born and grows up with malaria here
[P2]I think they [people in Iquitos] don’t do anything to prevent malaria because it is easier for them. Maybe because the disease is always here.
[P14]I think this illness will never end here. In the past there was a lack of knowledge about this illness but even now this disease is increasing more and more.
[P19]Education is very important and is the responsibility of the government to provide people with information. But you have to start by changing attitudes because perhaps people already have the information but don’t do anything with it. Maybe the attitude needs to change.
[P6]Some of the people who I work with had malaria and died due to this illness. They had shivers and headaches but they did nothing to stop it because they thought it was normal to feel this way. But in fact they had malaria and for that reason they died.
[P12][I use bed nets] because it is a habit, it is part of my cultural background, my mother and my grandmother passed this habit on to me.
[P13]In Iquitos it is very common that people use bed nets because it is part of my culture especially in the rural zones
[P16]I need them [bed nets] to sleep, it is what I have always done as part of my background
b. Biting protection dissonance
[KI1]there are certain times for high transmission. The highest is considered between 5 and 9 in the evening.
[P15]And do people use bed nets all the time? IN [Only] at night for sleeping
[P11]At this time I am usually watching the TV but I am not using my bed net.
[P6]Yes it is a problem [that I am not protected at these times] because when I take dinner it is very difficult to eat because I am being bitten by mosquitoes.
Are you usually using your bed nets at this time [between 5pm and 9pm]?
No
Is this a problem?
Yes
And why don’t you use your bed nets at this time?
Because when I watch TV I am in the main room but the bed nets are in the bedroom.
[P13]One day in the past I went to the river to go for a swim and that was the moment I got malaria. At this time the fever, shivers and pain all started.
[KI1]All the people when I visit families in their house do not have much time to listen and they don’t pay attention or practice what I teach. Some people commonly take a shower in the river at 7 o’clock and this is a bad practice but they don’t listen.
c. Malaria prevention as the government’s responsibility
[P16]A person on their own cannot do anything, it is the responsibility of the government on providing information to prevent this illness [malaria].
[P16]People here don’t care about their health, people should focus more on their health…maybe because I have lived in Lima which is a very different context compared to Iquitos. Really I think it is the attitude that people have here though. Here people do not have the attitude to fight this illness [malaria] face to face they just don’t really care.
[P14]The government should do more to prevent malaria. They should provide more information, they should teach us about the treatment and use the community nurses more. We need more information about prevention, the symptoms and medications to treat it.
[P16]People here are very dependent on the government but the government or the community does nothing.
[KI1]People don’t think it is their role to prevent this illness.
[P18]I think every person should take control of their own health.
[P2]I think it [responsibility for malaria prevention] depends on the level of education that people have because those who know about malaria take action themselves. But there are still people that know malaria is a dangerous illness but still they don’t do anything to prevent it. I think education is very important, so the information provided to the family about malaria is important.
[P19]No one is doing anything to eliminate this illness, the nurses the government no one because the illness never goes away. People should try to learn about this illness, but to focus them the person needs to have this illness.
[P17]For me malaria is more important than my neighbours but in the future if one of my neighbours gets malaria then they may try to understand and focus on this problem
[P20]The government should also focus on the rural zones because these people are more exposed to this illness because they are surrounded by the jungle where the mosquito lives.
Do you think the government should be doing more?
Yes yes yes. Especially in the rural areas. These people need more prevention and more attention from the government.
d. Confusion surrounding space-spraying and IRS
[P9]I think fumigation is the best way to prevent malaria
[P13]The fumigation people come to my house 2 or 3 times in a year. I like fumigation because it is a good prevention of malaria.
[P15]The fumigation is only good for 20 min then the mosquitoes appear again.
[P15]I think it is a waste of time really. Because as soon as the fumigation finishes then the mosquitoes appear again.
[P13]I think the government are doing a good job with the fumigation because they do come to my house. This is the only thing the government does to prevent malaria.
e. Persisting misconceptions
[P2]I think malaria lives in the water. For example, if we wash the chicken we are preparing for eating in contaminated water then potentially the eggs of the mosquitoes end up in our stomach. After eating we start to get the pains of malaria. So I think the best ways to prevent malaria are cleanliness and providing information about malaria.
[P6]When you drink water from the river, that is how you get malaria. That is how my parents got malaria.
[P8]I think one of the ways malaria is transmitted is when we drink bad water.
[P7]I think that the rising of the river is very important because the mosquitoes live in this standing water. When it rains then the number of mosquitoes that live in this still water can increase.
[P20]The nurses that teach us about malaria give us information about taking out the rubbish and cleaning our houses, cleanliness is very important to us.
[P10]Cleanliness is the best way to prevent malaria.
[P2]They [the community nurses] tell you about emptying containers with standing water in, how to clean the house and the dishes and to take out the garbage or the rubbish. This is because most often the mosquitoes live in the standing water. I think the best way to prevent malaria is cleanliness and cleaning.
[KI2]Cleanliness is very important because when we visit people’s houses we commonly find dirty houses with garbage and other rubbish. We also find standing, dirty water as well. It is important to remove this and to avoid creating a ‘house for the mosquitoes’ and we need to remove where the mosquitoes live. This is a very important reason why the nurses emphasize cleanliness to avoid still water and rubbish.