Integrated approach to malaria prevention in rural communities in Uganda: Experiences, perceptions and practices

 Background:Despite  immense  global  malaria  prevention  efforts,  the  disease  remains  a  major cause  of  morbidity  and  mortality  in  sub-Saharan  Africa. An  integrated  approach  to  malaria prevention, which advocates the use of several malaria prevention measures holistically, is being explored to reduce the occurrence of the disease.Aim: The aim of the thesis was to assess experiences, perceptionsand practices on the integrated approach to malaria prevention in Wakiso district, Uganda.Methods:Study  I was  a  pilot  project  that  promoted the  integratedapproach  and involved 3phases.  Phase  1(baseline)was  cross-sectional,  and determined knowledge  and  practices on malaria  prevention.  Phase  2 (intervention) implemented  an  intervention  on  the  integrated approach.  Phase  3 (evaluation)  was  a  cross-sectional  impact  evaluation of  using the integrated approach.  Study  IIwas  a  clustered  cross-sectional  survey  thatassessed  perceptions,  utilisation and barriers of integrated malaria prevention.Results: The  majority  of  participants  (64.6%)  had  low  knowledge  on  malaria  prevention methods,  with mosquito  nets  (81.7%) most  known. Insecticide-treated  nets were  the  most  used method  with  45.5%of  households  owning  at  least  one  net  (Study  I  phase  1).  The  pilot  project trained  25  community  volunteers,sensitised  over  200  community  members,  and  established40 demonstration households (Study I phase 2).There was improvement in knowledge on removal of  mosquito  breeding  sites  (51%  versus  7%)  in  the  evaluation  in  comparison  withthe  baseline respectively.  Improvement  in  practices inthe  evaluation compared  with  the baselineincluded mosquito screening in windows and ventilators (χ2 = 62.3; p < 0.001). The benefits reported by the  demonstration  households included reduction  in  mosquito  populations  and  occurrence  of malaria  (Study  I  phase  3).  If  trained,  most  participants  (68.6%)  would  use  all  methods in the integrated  approach.  Only  33.0%households  were  using  the  integrated  approach,  which  was associated with reading newspapers (AOR 0.34; 95% CI 0.22 –0.53) (Study II).Conclusion:Stakeholders  involved  in  malaria  control  should  intensify  efforts  of  promoting multiple malaria prevention methods.