Community perceptions and acceptability of malaria vector control interventions in upper western Ghana

Author: Vitalis Mwinyuri

Mwinyuri, Vitalis, 2019 Community perceptions and acceptability of malaria vector control interventions in upper western Ghana, Flinders University, College of Medicine and Public Health

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Introduction: Malaria is the leading cause of morbidity and mortality in sub-Saharan Africa, including Ghana. The disease persists as a significant public health challenge in the Upper West region of Ghana despite the implementation of vector control interventions such as indoor residual spraying (IRS) and insecticide treated nets (ITNs), which have been proven to be successful interventions elsewhere. In attempts to rationalize the persistence of malaria as a major public health issue and unravel the underlying factors contributing to this endemic disease, researchers have suggested that people's awareness or conceptualisations of malaria plays a critical role in their acceptance of preventive interventions. Although community acceptability is a prerequisite for the successful implementation of vector control interventions, the 69.1% indoor residual spraying coverage in the Upper West region of Ghana is well below the 80% standard minimum coverage required for the effectiveness of IRS interventions. Moreover, despite the relatively high ITN coverage of 77.4% in the region, the level of ITN use (54.5%) is considerably lower. The below standard IRS coverage and low ITN use raise questions about the acceptability of these interventions. There is also a global gap in the academic literature regarding the acceptability of combining IRS and ITN interventions at the household level. This research aims at exploring the facilitators and barriers to malaria control in the Upper West region of Ghana by exploring local community perceptions about malaria and the acceptability of IRS and ITNs.

Methods: A qualitative inquiry was conducted between April 2016 and October 2016, employing focus group discussion and semi-structured interviews. Nine focus groups were conducted with householders at four communities in the selected districts of Wa Municipal and Daffiama-Busie-Issa, and two focus groups were conducted with AGA Mal spray operators. Also, twelve semi-structured interviews were conducted with programme officials; eight with AGA Mal officials and four with Ghana Health Service officials. The data were analysed using framework analysis.

Findings: A total of 105 respondents participated in this study. Several facilitators were identified in relation to the acceptability and implementation of IRS and ITNs, including community understanding about malaria, and the perceived benefits of IRS and ITNs. The health belief model, which provides explanations for individual health behaviour, postulates that the acceptance of an intervention is subject to several factors, including the perceived benefits of the intervention. Householders who perceived IRS and ITNs to be beneficial were motivated to accept the interventions for malaria prevention. Education activities, training and stakeholders’ partnerships were also found to be important facilitators in the implementation of IRS and ITN interventions. These mechanisms are crucial to the outcome of interventions in conformity with the realist evaluation framework approach. The findings also identified significant barriers to the uptake of IRS and ITNs, including, poverty, poor education and structural factors such as religion and communities’ cultural perspectives in the study setting which indicate the role of social determinants of health as barriers to malaria control in Upper Western Ghana and highlight the importance of the social determinants of health framework to this study. Other barriers include operational challenges to Programme implementation such as breakdown of spray equipment and mobility challenges. These findings have implications for the design of malaria control strategies to enhance the acceptability and implementation of IRS and ITNs.

Conclusion: Although some householders deliberately refused to accept or use IRS and ITNs, several other factors were identified that contributed to the non-spraying of some houses and the non-use of ITNs by householders. For example, several Programme implementation related challenges affected the implementation of IRS and ITNs that may have accounted for the low levels of acceptance. These findings have policy and practice significance for improving the acceptance and implementation of IRS and ITN interventions.

Keywords: Malaria, mosquitoes, householders, indoor residual spraying, insecticide treated nets, barriers, facilitators, acceptability, community, Ghana, IRS, ITNs

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Medicine and Public Health
Supervisor: Assoc. Professor Lillian Mwanri