AN OBSERVATIONAL STUDY TO EVALUATE THE UTILIZATION OF INSECTICIDE TREATED MOSQUITO NETS BY NATIVES OF MIFUMI VILLAGE Presented by MIFUMI COBES STUDENT TEAM College of Health Sciences, Makerere University

Research Team (All MBChB III students) Daniel Ssebadduka Doreen Agnes Nambazira Peris Mbatha Mutuku Ronald Ogwal Acleo Sebuliba Christopher Lwanga Bernard Maumbe

Outline of Presentation Key word Introduction Problem Statement Justification Objectives Methods Study variables Results Limitations Conclusion Recommendations

Key Word Utilization This refers to the act of using. However in this study, the term was reserved to mean availability, status and appropriate use of the insecticide treated mosquito nets

Introduction At least 300 million cases and 1 million deaths are estimated to result from Malaria each year with more than 90% of these occurring in Africa. (Abebe Animut et al, 2001) According to Uganda’s Malaria Control Strategic Plan, the use of Insecticide-treated nets (ITNs) is one of the key strategies indicated and or prescribed for the prevention of malaria. (ITN Policy by MOH) Consistent use of ITNS can reduce malarial transmission by up to 90% and avert as much as 44% of all-cause mortality among children under five years of age (Baume et al 2008)

Introduction Cont’d The 2009 World Malaria Report, indicates that from 2006 to 2008, the Ministry of Health Uganda distributed 5,894,863 long lasting insecticide nets to various households countrywide. (37% operational coverage). Furthermore, the report indicates an increasing number of household ITN ownership from 7% in 2004 to 26% in In 2008, Uganda had a 25% household ownership of the ITNs. In June 2006 to December 2009, Mifumi Health Centre III, within Kirewa Sub county in Tororo district, distributed 350 ITNs to 170 households within its catchment area. (Mifumi H/C records)

Introduction cont’d: Regarding Mifumi Village In Kirewa Sub county (Tororo district), an area of 6sq.km with a clustered form of settlement and an estimated population of 650 Households (COBES Report 2010) The clustered homesteads have at least 2 grass thatched huts, each with 2-5 individuals/household Most individuals are peasants The topography of Mifumi is generally flat with tall trees, shrubs and many bushy environments It’s surrounded by swamps but is generally accessible

Problem Statement Despite the above intervention, Malaria continues to be the leading cause of morbidity and mortality among the natives of Mifumi Village as evidenced by the high numbers of malarial cases (Mifumi H/C HMIS) The impact of utilization of the ITNs has never been assessed and this remains a challenge for service providers and policy makers Thus, little is known about the utilization of the distributed ITNs among the natives of Mifumi Village residing in the malaria prone area.

Justification Currently there’s no sufficient data to back up decisions by policy makers and service providers to support the continuous distribution of ITNs in Mifumi Information obtained from this study may help address in part the current gaps regarding utilization of ITNs in this village and also provide some useful insights

Objectives To briefly describe household details of the respondents To establish the availability of the ITNs To describe the state of the ITNs To assess how the ITNs are being utilized

Methods Observational study. Study period of six days between April and May 2010 All the 170 households that had received the 350 ITNs were consecutively recruited into the study Data collected using a digital and paper between 8pm-10pm each day, then uploaded on lap top for analysis. Ethical considerations were followed. Consent was sought from natives during a consultative meeting. Data was analyzed using SPSS version 17

DIGITAL PEN AND DIGITAL PAPERS

Study Variables Brief Household details Availability of the ITNs Status of the ITNs Utilization of the ITNs

Results 1. Brief household details CategoryNumber of respondents YESNOUNOBSERVED Household in bushy environment 78(45.9%)91(53.5%)1(0.6%) Household has at least two bedrooms 65(38.2%)104(61.2%)1 (0.6%) Household has more than five members 66 (38.8%)103 (60.6%)1 (0.6%) Household surrounded by swamps and ponds 31 (18.2%)129 (75.9%)10 (5.9%) Presence of water traps 29 (17.1%)115 (67.6%)26 (15.3%) Household has children below five years 127 (74.7%)43 (25.3%)0 (0%) Household having expectant mother 17 (10%)152 (89.4%)1 (0.6%)

Availability of the ITNs 2. Availability of the mosquito nets CategoryNumber of respondents YESNOUNOBSERVED Mosquito net available 168 (98.8%)2 (1.2%)0 (0%) Available and in active use 156 (91.8%)14 (8.2%)0 (0%) Each household member with a mosquito net 28 (16.5%)136 (80%)6 (3.5%) Household using only one mosquito net 73 (42.9%)94 (55.3%)3 (1.8%)

Status of the ITN Category Number of respondents YESNOUNOBSERVED Mosquito net fully intact93 (54.7%)71 (41.8%)6 (3.5%) Net has repairable damage57 (33.5%)99 (58.2%)14 (8.2%) Net damaged beyond repair24 (14.1%)134 (78.8%)12 (7.1%) Net appears repaired15 (8.8%)147 (86.5%)8 (4.7%)

SHOWCASE ON FIELDWORK

Utilization of the ITNs CategoryNumber of respondents YESNOUNOBSERVED All household members use mosquito net 125 (73.5%)41(24.1%)4 (2.4%) Net used by only children 6 (3.5%)157 (92.4%)7 (4.1%) Nets used by only adults 38 (22.4%)127 (74.7%)5 (2.9%) Nets shared by both children and adults 66 (38.8%)97 (57.1%)7 (4.1%) Net tied and hung appropriately 132 (77.6%)35 (20.6%)3 (1.8%) Net tucked under the mattress 90 (52.9%)73 (42.9%)7 (4.1%) Net appears clean and presentable 131 (77.1%)33 (19.4%)6 (3.5%) Net appears dirty 33 (19.4%)131 (77.1%)6 (3.5%) Damaged net in use 71 (41.8%)82 (48.2%)17 (10%) Net spread by dusk 74 (43.5%)91 (53.5%)5 (2.9%) Net used for other purposes 6 (3.5%)126 (74.1%)38 (22.4%)

Limitations of the study Delays in hanging of the ITNs despite their existence in some few households could have comprised the observational study. Limited scope of information obtained since the study was entirely observational

Conclusion Generally, it is evident that households in Mifumi Village endeavor to use mosquito nets and to clear their surroundings of stagnant water in broken pots and plastic bowls as well as bushes It is also apparent that a great number of households hang up their nets appropriately and a majority of nets were in active use. Much as bed nets are in use, malaria prevalence remains high. This could due attributed to the fact that a good number of nets were damaged, some even beyond repair; and there is a general tendency to spread the nets after dusk. Furthermore, mosquito nets are shared among households. It was observed that in a good number of households, a single torn net was shared among 2-3 children under five.

Acknowledgement College of Health Sciences-Makerere University MIFUMI Healthnest National Library of Medicine, USA Mifumi Health Centre III staff The natives of Mifumi Village

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