Tizifa Tinashe A, Gowelo Steven, Kabaghe Alinune N, McCann Robert S, Malenga Tumaini, Nkhata Richard M, Kadama Asante, Chapeta Yankho, Takken Willem, Phiri Kamija S, van Vugt Michele, van den Berg Henk, Manda-Taylor Lucinda
Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands.
School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
PLOS Glob Public Health. 2022 Jul 14;2(7):e0000627. doi: 10.1371/journal.pgph.0000627. eCollection 2022.
House improvement (HI) refers to the full screening or closing of openings such as windows, doors, and eaves, as well as the installation of ceilings, to reduce mosquito-human contact indoors. HI is a viable supplementary intervention that reduces malaria transmission further than the existing strategies alone. In Malawi, HI has not been widely implemented and evaluated for malaria control. Concerns about lack of local evidence, durability in different epidemiological and cultural settings, and the cost of large-scale implementation are among the reasons the strategy is not utilised in many low-income countries. This study assessed community perceptions, experiences, and acceptability of community-led HI in Chikwawa district, southern Malawi. This was a qualitative study where separate focus group discussions were conducted with members from the general community (n = 3); health animators (n = 3); and HI committee members (n = 3). In-depth interviews were conducted with community members (n = 20), and key-informant interviews were conducted with health surveillance assistants and chiefs (n = 23). All interviews were transcribed and coded before performing a thematic content analysis to identify the main themes. Coded data were analysed using Nvivo 12 Plus software. Study participants had a thorough understanding of HI. Participants expressed satisfaction with HI, and they reported enabling factors to HI acceptability, such as the reduction in malaria cases in their villages and the safety and effectiveness of HI use. Participants also reported barriers to effective HI implementation, such as the unavailability and inaccessibility of some HI materials, as well as excessive heat and darkness in HI houses compared to non-HI houses. Participants indicated that they were willing to sustain the intervention but expressed the need for strategies to address barriers to ensure the effectiveness of HI. Our results showed the high knowledge and acceptability of HI by participants in the study area. Intensive and continued health education and community engagement on the significance of HI could help overcome the barriers and improve the acceptability and sustainability of the intervention.
房屋改造（HI）是指对窗户、门和屋檐等开口进行全面遮蔽或封闭，以及安装天花板，以减少室内蚊虫与人的接触。房屋改造是一种可行的补充干预措施，比现有策略单独实施能进一步减少疟疾传播。在马拉维，房屋改造尚未广泛实施用于疟疾控制，也未进行评估。对缺乏当地证据、在不同流行病学和文化背景下的耐久性以及大规模实施成本的担忧，是该策略在许多低收入国家未被采用的部分原因。本研究评估了马拉维南部奇夸瓦区社区主导的房屋改造的社区认知、经验和可接受性。这是一项定性研究，分别与普通社区成员（n = 3）、健康促进者（n = 3）和房屋改造委员会成员（n = 3）进行了焦点小组讨论。对社区成员（n = 20）进行了深入访谈，对健康监测助理和酋长（n = 23）进行了关键信息访谈。所有访谈在进行主题内容分析以确定主要主题之前都进行了转录和编码。使用Nvivo 12 Plus软件对编码数据进行分析。研究参与者对房屋改造有深入了解。参与者对房屋改造表示满意，并报告了房屋改造可接受性的促成因素，如他们村庄疟疾病例减少以及房屋改造使用的安全性和有效性。参与者还报告了房屋改造有效实施的障碍，如一些房屋改造材料无法获得和难以获取，以及与未进行房屋改造的房屋相比，进行房屋改造的房屋过热和光线昏暗。参与者表示他们愿意维持该干预措施，但表示需要采取策略来解决障碍，以确保房屋改造的有效性。我们的结果表明研究区域的参与者对房屋改造有较高的认知度和可接受性。就房屋改造的重要性开展强化和持续的健康教育以及社区参与，有助于克服障碍，提高干预措施的可接受性和可持续性。
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