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

描述（由申请人提供）：尽管有了显著的改善，但疟疾在世界许多地区仍然是一个重大的健康问题。随着疟疾项目从控制走向消除，迫切需要了解使用控制措施的障碍和促进因素。在本提案中，我们侧重于最广泛使用的控制措施;在高地/低传播和低地/高传播中使用蚊帐。我们的初步结果表明，在肯尼亚，大约四分之一的五岁以下儿童，最容易感染疟疾的群体，生活在没有蚊帐的家庭中。此外，即使在拥有蚊帐的家庭中，六分之一的五岁以下儿童也没有睡在蚊帐下。随着肯尼亚和其他方案扩大其范围，分发足够的蚊帐，以覆盖所有家庭成员，需要作出很大努力，了解与停用有关的流行情况和因素。以下提议的目的是利用定性和定量方法，确定在实地条件下蚊帐的拥有、滥用和停用的普遍程度，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因素， 蚊帐的拥有和使用，而是作出这些决定的社会和环境背景。在与社区成员进行重点小组讨论，并与卫生诊所工作人员、政府病媒控制工作人员以及村庄和社区领导人进行关键信息访谈之后，我们将进行一项横断面调查，检查1）对疟疾的易感性的感知2）对疟疾的严重性的感知3）对使用驱虫蚊帐的好处的感知4）对使用驱虫蚊帐的障碍的感知5）行动的线索，如健康促进计划和6）受试者对获得ITN及其正确使用的自我效能的信心。我们将使用遥感图像和地理信息系统，以确定这些看法和做法如何在地理上有所不同，如果他们对应的实际风险，通过平行的寄生虫流行调查和除虫菊喷雾捕捉按蚊确定。从横截面的参与者，我们将确定积极的越轨行为，社区成员谁拥有和使用蚊帐定期尽管经历了至少75%的因素与不拥有或使用蚊帐。将进行深入访谈，以确定他们的解决办法和个人动机，可用于改善社区蚊帐拥有率和遵守情况。 我们的方法是独特的，它结合了丰富的定性数据和严谨性和普遍性的流行病学方法。确定在社区中已经起作用的措施更有可能作为一项更大的干预措施成功实施。我们预计，我们将发现，那些因疟疾而遭受个人损失、已找到悬挂蚊帐后勤问题的解决办法、对风险有更高的认识以及更容易获得家庭资源的人，将更有可能拥有和使用蚊帐。这项研究将有助于推动有针对性的社区干预措施的发展，这些干预措施将改善驱虫蚊帐的拥有和使用，并最终减少疟疾传播。 公共卫生相关性：据估计，疟疾每年造成80万人死亡。驱虫蚊帐是预防疟疾的最有效战略。这项研究将增进对疟疾流行地区拥有和使用驱虫蚊帐的障碍和促进因素的了解。我们将使用混合方法的方法，以确定简单的解决方案，将提高所有权和遵守在肯尼亚西部使用驱虫蚊帐。

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.