written by Kim True, Bots 14
Before the heavy rain season, between November and January each year, District Health Management Teams (DHMT) offer free Indoor Residual Spraying (IRS) to households living in malaria-endemic regions of Botswana. The Ministry of Health credits IRS as the key intervention in vector control resulting in a consistent decline in malaria cases over the past decade. In 2013, there was far less IRS coverage and now Botswana is facing an immediate threat of resurgence of malaria cases. The Northwestern District of Chobe was once the leader in IRS uptake, consistently achieving over 90% coverage, but in the 2013-2014 transmission season they only achieved 60% coverage. The village of Kasane and Kazungula, the two most heavily populated residential areas in the district, barely made it above 50% coverage…
… and why is that?
“I’ve heard complaints about skin irritations from IRS.”
“You see, people are refusing to open up their homes for the IRS spray men!”
“What do you mean? No one even came to my house!”
Each time the Chobe DHMT sat down to discuss the way forward, the conversation failed to bring conclusive reasons behind the decline in community uptake of IRS. A consensus was reached that they needed to conduct a household survey prior to the launch of the November 2014 IRS campaign.
The Chobe sun is intense and the thought of a door-to-door survey in 45 degrees Celsius temperatures almost seemed inhumane. The survey had to happen but we needed to modernize the slow pace paper-based surveys in order to collect more data in a shorter period of time. I created a survey using tablet technology which sped up the process immensely.
Over the course of two weeks, 111 households were surveyed (50-Kasane, 61-Kazungula) by me and a community health worker. We asked about community members’ perceptions, experiences and utilization of malaria intervention strategies, including bed net usage and IRS. While the health worker asked survey questions, gave an overview health talk and answered malaria-related questions participants may had, I recorded information on my iPad. Tablet-based data collection, as opposed to paper surveys typically used by the DHMT, enabled data to be recorded in a time and resource-efficient manner, a feature that is extremely crucial for conducting household surveys in the midst of the Sub-Saharan summer.
Information gathered on IRS from the survey conducted in Kasane and Kazungula:
- Despite frequent complaints about skin irritations associated with IRS, only 2% of participants who received IRS last year expressed dissatisfaction with their service.
- Of participants who did not receive IRS last year, 16% stated concerns over preexisting respiratory-related issues (asthma and sinus infections) and 27% stated disinterest in IRS.
- 14% of all survey participants were unaware of the benefits of IRS and/or how IRS contributes to malaria prevention.
- 59% of all survey participants expressed need for specific time/days of the week in order for a household member to be present for the IRS team to enter their homes.
Information gathered from the survey has been used to make necessary changes to the designs of the Chobe DHMT’s malaria intervention strategies and efforts, including IRS schedule and procedures for management of missed opportunities and improved education to address gaps in knowledge on health implications of IRS and health volunteers will address common misconceptions during the district-wide door-to-door sensitization campaign.