Sistemas de Saúde, Instituto Nacional de Saúde, Ministério da Saúde, Moçambique, Maputo, Mozambique.
US President's Malaria Initiative and Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Maputo, Mozambique.
Malar J. 2019 Jan 25;18(1):27. doi: 10.1186/s12936-019-2653-x.
Malaria control remains a leading health challenge in Mozambique. Indoor residual spraying (IRS) is an effective strategy to control malaria transmission, but there are often barriers to reaching the coverage necessary for attaining maximum community protective effect of IRS. Mozambique recorded a high number of household refusals during the 2016 IRS campaign. This study sought to evaluate household and community factors related to the acceptability of IRS to inform strategies for future campaigns in Mozambique and the region.
A cross-sectional, qualitative study was conducted in eight urban and rural communities in two high malaria burden provinces in Mozambique. Data were collected through in-depth interviews with community members, leaders, sprayers, and representatives of district health directorates; focus group discussions with community members who accepted and who refused IRS during the 2016 campaign; systematic field observations; and informal conversations. Data were systematically coded and analysed using NVIVO-11.
A total of 61 interviews and 12 discussions were conducted. Community participants predominantly described IRS as safe, but many felt that it had limited efficacy. The main factors that participants mentioned as having influenced their IRS acceptance or refusal were: understanding of IRS; community leader level of support; characteristics of IRS programmatic implementation; environmental, political and historical factors. Specifically, IRS acceptance was higher when there was perceived community solidarity through IRS acceptance, desire to reduce the insect population in homes, trust in government and community satisfaction with past IRS campaign effectiveness. Participants who refused were mainly from urban districts and were more educated. The main barriers to acceptance were associated with selection and performance of spray operators, negative experiences from previous campaigns, political-partisan conflicts, difficulty in removing heavy or numerous household assets, and preference for insecticide-treated nets over IRS.
Acceptance of IRS was influenced by diverse operational and contextual factors. As such, future IRS communications in targeted communities should emphasize the importance of high IRS coverage for promoting both familial and community health. Additionally, clear communications and engagement with community leaders during spray operator selection and spray implementation may help reduce barriers to IRS acceptance.
疟疾控制仍然是莫桑比克面临的主要卫生挑战。室内滞留喷洒（IRS）是控制疟疾传播的有效策略，但在达到 IRS 对社区最大保护效果所需的覆盖率方面，往往存在障碍。莫桑比克在 2016 年 IRS 运动中记录了大量家庭拒绝接受 IRS。本研究旨在评估与 IRS 可接受性相关的家庭和社区因素，以为莫桑比克和该地区未来的运动提供策略信息。
在莫桑比克两个疟疾高负担省份的八个城乡社区进行了一项横断面、定性研究。通过对社区成员、领导人、喷雾器操作人员和地区卫生主管部门代表进行深入访谈、对 2016 年 IRS 运动中接受和拒绝 IRS 的社区成员进行焦点小组讨论、系统的实地观察和非正式交谈收集数据。使用 NVIVO-11 对数据进行系统编码和分析。
共进行了 61 次访谈和 12 次讨论。社区参与者主要将 IRS 描述为安全的，但许多人认为其效果有限。参与者提到的影响他们接受或拒绝 IRS 的主要因素包括：对 IRS 的理解；社区领导人的支持程度；IRS 方案实施的特点；环境、政治和历史因素。具体而言，当通过接受 IRS 来实现社区团结、减少家庭中昆虫数量的愿望、对政府的信任以及对过去 IRS 运动效果的社区满意度时，接受 IRS 的比例较高。拒绝 IRS 的参与者主要来自城市地区，受教育程度较高。接受 IRS 的主要障碍与喷雾器操作人员的选择和绩效、前几次运动的负面经历、政治党派冲突、难以移动沉重或大量家庭资产以及对杀虫剂处理过的蚊帐的偏好有关。
IRS 的接受程度受到多种运营和背景因素的影响。因此，未来在目标社区进行 IRS 宣传时，应强调高 IRS 覆盖率对促进家庭和社区健康的重要性。此外，在选择喷雾器操作人员和实施喷雾时，与社区领导人进行明确的沟通和互动，可能有助于减少 IRS 接受的障碍。
