Identifying community-based solutions that improve insecticide-treated net (ITN)

确定改善驱虫蚊帐 (ITN) 的基于社区的解决方案

• 批准号: 8288665
• 负责人: Kacey C Ernst
• 金额: $ 37.61万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-06 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8288665
• 关键词: Anopheles Genus; Area; Behavioral; Cessation of life; Child; Clinic; Communities; Community Participation; Complex; Cross-Sectional Studies; Cues; Data; Development; Economics; Effectiveness; Environmental Risk Factor; Epidemiologic Methods; Focus Groups; GIS Imaging; Goals; Government; Health; Health Promotion; Home environment; Household; Incidence; Individual; Insecticides; Intervention; Interview; Kenya; Knowledge; Life; Logistics; Malaria; Measures; Mediating; Methods; Outcome; Ownership; Parasites; Participant; Perception; Predisposition; Prevalence; Pyrethrum; Qualitative Methods; Reporting; Research; Resources; Risk; Risk Factors; Self Efficacy; Severities; Site; Sleep; Solutions; Surveys; Translating; Work; base; design; deviant; experience; improved; informant; innovation; member; modifiable risk; prevent; programs; risk perception; social; transmission process; vector control

DESCRIPTION (provided by applicant): Despite dramatic improvements, malaria remains a significant health problem in many regions of the world. As malaria programs move from control to elimination, there is an urgent need to understand barriers to and facilitators of the use of control measures. In this proposal, we focus on the most widely used control measure; bednets in a highland/low transmission and a lowland/high transmission. Our preliminary results indicate that in Kenya roughly 1 in 4 children under 5, the group most vulnerable to malaria, live in households that do not own a bednet. Additionally, even in net owning homes, 1 in 6 children under 5, do not sleep under a net. As Kenya and other programs expand their scope to distribute enough nets to cover all household members, much effort needs to go into understanding the prevalence of and factors related to disuse. The objective of the following proposal is to use qualitative and quantitative methods to determine the prevalence of ownership, misuse and disuse of bednets under field conditions and to identify modifiable risk factors. We will use an ecological approach to assess not only individual level factors that drive bednet ownership and use but the social and environmental context in which these decisions are being made. Following focus group discussions with community members and key informant interviews with health clinic staff, government vector control staff and village and community leaders, we will conduct a cross-sectional survey that examines 1) perceived susceptibility to malaria 2) perceived severity of malaria 3) perceived benefits of ITN use 4) perceived barriers to ITN use 5) cues to action such as health promotion programs and 6) confidence in the subject's self-efficacy with regard to obtaining an ITN and its proper use. We will use remotely-sensed images and GIS to determine how these perceptions and practices vary geographically and if they correspond with actual risk as determined through parallel parasite prevalence surveys and pyrethrum spray catches of Anopheles. From the cross-sectional participants we will identify positive deviants, community members who own and use bednets regularly despite experiencing at least 75% of the factors associated with not owning or using a bednet. In-depth interviews will be conducted to determine their solutions and personal motivators that may be used to improve community bednet ownership and compliance. Our approach is unique in its combination of rich qualitative data and the rigor and generalizability of established epidemiologic methods. Identifying what is already working in a community is more likely to be successfully implemented as a larger intervention. We expect that we will find that individuals who have personal loss due to malaria, have identified solutions to logistical issues with hanging bednets, have a higher perception of risk and who have greater access to household resources will be more likely to own and use a bednet. This research will help drive the development of targeted community-based interventions that should improve ITN ownership and use and ultimately reduce malaria transmission. PUBLIC HEALTH RELEVANCE: Malaria causes an estimated 800,000 deaths each year. Insecticide treated nets (ITN) are the most effective strategy to prevent malaria. This study will advance understanding of barriers and facilitators to ownership and use of ITN in malarious areas. We will use a mixed methods approach to identify simple solutions that will improve ownership and compliance with ITN use in western Kenya.

描述(申请人提供)：尽管有了显著的改善，疟疾在世界许多地区仍然是一个严重的健康问题。随着疟疾规划从控制转向消除，迫切需要了解使用控制措施的障碍和促进者。在这项建议中，我们将重点放在最广泛使用的控制措施：高地/低传播和低地/高传播的蚊帐。我们的初步结果表明，在肯尼亚，大约每4名5岁以下儿童中就有1名生活在没有蚊帐的家庭中，这是最容易感染疟疾的群体。此外，即使是在拥有净值住房的家庭中，每6名5岁以下儿童中也有1人没有睡在蚊帐下。随着肯尼亚和其他项目扩大其范围，分发足够的蚊帐覆盖所有家庭成员，需要付出很大努力来了解不使用蚊帐的流行率和相关因素。以下提案的目的是使用定性和定量方法来确定在实地条件下蚊帐的所有权、误用和废弃情况，并查明可改变的风险因素。我们将使用生态方法来评估不仅是个人层面的驱动因素 蚊帐的所有权和使用，而不是作出这些决定的社会和环境背景。在与社区成员的焦点小组讨论以及与卫生所工作人员、政府病媒控制工作人员以及村庄和社区领导人的主要线人访谈之后，我们将进行一项横断面调查，检查1)感知疟疾易感性2)感知疟疾的严重性3)感知使用ITN的好处4)感知ITN使用的障碍5)行动的提示，如健康促进计划和6)受试者在获得ITN及其正确使用方面的自我效能的信心。我们将使用遥感图像和地理信息系统来确定这些认知和做法在地理上是如何变化的，以及它们是否符合通过平行的寄生虫流行调查和除虫菊酯喷雾捕获的按蚊确定的实际风险。从横断面参与者中，我们将发现积极的偏离者，即经常拥有和使用蚊帐的社区成员，尽管他们经历了至少75%与不拥有或使用蚊帐相关的因素。将进行深入访谈，以确定他们的解决方案和个人激励因素，以改善社区蚊帐的所有权和合规性。我们的方法是独特的，因为它结合了丰富的定性数据和已建立的流行病学方法的严密性和普适性。确定社区中已经起作用的是什么，更有可能作为更大的干预措施成功实施。我们预计，我们将发现，那些因疟疾造成个人损失、已经找到解决悬挂蚊帐后勤问题的解决办法、对风险有更高认识以及更容易获得家庭资源的个人将更有可能拥有和使用蚊帐。这项研究将有助于推动以社区为基础的针对性干预措施的发展，这些干预措施应改善ITN的所有权和使用，并最终减少疟疾传播。 与公共卫生相关：据估计，疟疾每年造成80万人死亡。驱虫蚊帐(ITN)是预防疟疾的最有效战略。这项研究将促进对在疟疾地区拥有和使用ITN的障碍和促进者的理解。我们将使用混合方法确定简单的解决方案，这些解决方案将改善肯尼亚西部对ITN使用的所有权和合规性。