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What drives community adherence to indoor residual spraying (IRS) against malaria in Manhiça district, rural Mozambique: a qualitative study

Khátia Munguambe1*, Robert Pool23, Catherine Montgomery4, Carlos Bavo5, Ariel Nhacolo1, Lina Fiosse1, Charfudin Sacoor1, Delino Nhalungo1, Samuel Mabunda6, Eusébio Macete17 and Pedro Alonso12

Author Affiliations

1 Centro de Investigação em Saúde de Manhiça, Rua 12, CP 1929, Manhiça, Mozambique

2 Centro de Reserca en Salud Internacional de Barcelona, Hospital Clinic/Universitat de Barcelona, Roselló 132, 08036 Barcelona, Spain

3 Centre for Global Health and Inequality, University of Amsterdam, OZ Achterburgwal 185, 1012 DK, Amsterdam, the Netherlands

4 Institute for Science, Innovation and Society, Saïd Business School and Oxford Martin School, University of Oxford, Oxford OX1 1HP, UK

5 Centro de Estudos Africanos, Universidade Eduardo Mondlane, Av. J. Nyerere 3453 - Campus Universitário, Maputo, Mozambique

6 Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende 702, CP 257, Maputo, Mozambique

7 National Directorate for Health, Ministry of Health, Av. Eduardo Mondlane/Salvador Allende, CP 264, Maputo, Mozambique

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Malaria Journal 2011, 10:344  doi:10.1186/1475-2875-10-344

Published: 23 November 2011

Abstract

Background

Malaria control remains a challenge in sub-Saharan Africa. In 2006, the World Health Organization (WHO) reinforced the recommendation of indoor residual spraying (IRS) with dichlorodiphenyltrichloroethane (DDT) to reduce malaria transmission. The National Malaria Control Programme has been reporting high coverage rates of IRS in Mozambique. It is important to establish to what extent these rates are a reflection of community acceptability, and to explore the factors associated with adherence, in order to recommend suitable approaches for interventions of this nature.

Objective

To understand the implementation process, reception and acceptability of the IRS program in Manhiça district, Southern Mozambique.

Methods

Qualitative data was collected through in-depth interviews, participant observation of IRS activities, informal interviews, and focus group discussions. Study participants comprised householders, community leaders, health care providers, sprayers, and community members. Qualitative data analysis was based on grounded theory. Secondary data from the Manhiça Demographic Surveillance System was used to complement the qualitative data.

Results

IRS was well received in most neighbourhoods. The overall coverage rates varied between 29% and 41% throughout the study period. The factors related to adherence to IRS were: immediate impact on insects in general, trust and obedience in the health authority, community leaders' influence, and acquaintance with the sprayers. Fighting malaria was not an important motivation for IRS adherence. There was a perception of limited efficacy of IRS against mosquitoes, but this did not affect adherence. Non-adherence to the intervention was mainly due to the unavailability of key householders, disagreement with the procedures, and the perception that spraying increased the burden of insects. Most respondents strongly favoured bed nets over IRS.

Conclusion

The study suggests that the contribution of IRS to malaria and mosquito control is not entirely perceived by the beneficiaries, and that other as cost effective interventions such as insecticide-treated nets are favoured over IRS. Adherence to IRS was found to be influenced by socio-political factors. There is a need to redefine the community sensitization approaches in order to make IRS a genuinely participative, acceptable, and sustainable programme.