Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
BMC Public Health. 2012 Aug 3;12:606. doi: 10.1186/1471-2458-12-606.
The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence.
Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM.
Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets.
Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms.
在桑给巴尔消除疟疾高度依赖于持续有效地覆盖蚊帐，以避免疟疾死灰复燃。在疟疾发病率显著下降后，利用健康信念模型（HBM）框架探讨了人们对疟疾和蚊帐使用的看法。
在桑给巴尔的北 A 区，对 19 名 5 岁以下儿童的女性和男性看护人进行了 19 次深入访谈。采用演绎内容分析法，识别出有意义的单位，对其进行浓缩、编码，并分配到 HBM 的预定要素。
看护人对疟疾的认识度较高，但现在认为疟疾容易治愈且不常见。除了认为蚊帐能提供疟疾防护这一优势外，蚊帐还被认为在雨季时有用，因为雨季疟疾和蚊子的负担都很高，能避免蚊子骚扰。蚊帐在炎热季节会让人感到不适，这是打断人们持续使用蚊帐的主要障碍。使用蚊帐的主要线索是蚊子密度高，在使用蚊帐时会优先考虑儿童。看护人自我效能感高，认为使用蚊帐并不难。室内滞留喷洒（IRS）被认为是另一种防蚊手段，但没有被认为是蚊帐的替代品。蚊帐价格不断上涨，成为拥有蚊帐的一个障碍。
尽管疟疾发病率有所下降，看护人对疟疾的风险感知也随之降低，但由于蚊帐是防蚊叮咬最有效的手段，其使用仍得到认可。再加上看护人自我效能感高，支持了蚊帐的使用，而季节性因素则打断了持续使用。通过强化蚊帐的好处、使用网眼更大的蚊帐来解决季节性炎热问题，以及通过可持续和负担得起的交付机制确保高蚊帐拥有率，可以进一步提高有效的蚊帐覆盖率。
