RESEARCH PROJECT

UTILIZATION OF INSECTICED-TREATED NETS AMONG FAMILIES WITH UNDER FIVE YEAR OLD CHILDREN IN KISAUNI

STANFORD JAKOUKO

SUPERVISOR: DR. JALAB ASHRAPH

INTRODUCTION

Malaria represents1.4% global burden Africa presents 90%of the global malaria cases 2-7million deaths are attributed to malaria in Africa Worst hit are pregnant women and under 5 year old

children More than quarter death occurs in under fives 30-40%of fevers reported in hospitals are for malaria. In Kenya malaria leads in mortality at 30%

CONTINUATION: INTRODUCTION ITN distribution under Roll back malaria initiative

was launched in a Nigerian summit to combat the menace

It is simple cost effective Nets are distributed to the vulnerable groups i.e.

pregnant women and children under the age of five and improve accessibility

It aimed at reducing the cases by half in 2010 and improve household ownership

It has proved a success as cases of malaria reduced by 17-50%

PROBLEM STATEMENT About 150million ITNs are needed to protect

population at risk in Africa Between 2004-2010 distribution of nets increased

from 6-145m. This decreased to92m and 66m in 2011 and 2012

respectively The number is below the target required to protect

the population at risk Coverage will decrease unless deliveries are

massively increased in subsequent years

OBJECTIVES

General Determine factors affecting utilization of insecticide-

treated nets among families with children under the age five years

OBJECTIVES

Specific objectives Determine community knowledge about insecticide

treated nets Find out the community attitudes towards use of

insecticide treated nets To determine accessibility to insecticide treated

mosquito nets in households with children below five years

RESEARCH QUESTIONS

What is the households knowledge about the insecticide treated nets and their ownership level?

What is the households attitude towards insecticide treated nets use?

What are the factors affecting the use of insecticide treated nets among the households

JUSTIFICATION

Use of ITNs has proven to reduce or prevent malaria Continuous monitoring is a sure way of ensuring

proper use and improving coverage Results from this study will therefore be used to

evaluate the achievements of RBM in the community and improve where necessary

CONCEPTUAL FRAMEWORK

INDEPENDENT VARIABLE

SOCIO-DEMOGRAPHIC

HEALTH INFORMATION

ENVIRONMENTAL FACTORS

UTILIZATION AND OWNERSHIP

METHODOLOGY

Design was be community based cross-sectional study

Both qualitative and quantitative data was collected Stratified purposive random sampling was used Data was collected using a structured questionnaire

and check list to observe

STUDY POPULATION AND AREA

Study was done in Kisauni Mombasa with population of about 350 thousand

It has stable malaria transmission throughout the year being in the lowland

The area was divided in six administrative zones to form strata

SAMPLE FRAME

Households with children below five years They were chosen randomly at a determined

interval using simple random sampling Sample size of 200 was targeted Six strata each provided the portion of the samples

according to population size using k=N∕n

DATA ANALYSIS AND PRESENTATION

Data was entered in the excel package in the computer Analysis was done using the statistical package for

social scientists(SPSS)ETHICAL CONSIDERATIONS Consent from the respondent Cover letter from the college Privacy of respondents Feedback will be given

RESULTS

A total of 178(89%) study subjects have participated in the study. Among these Bamburi, Junda, Magogoni, Mtopanga, Mjambare, Mwakirunge and Shanzu were were 25(14.2%), 31(17.4%), 28(15.7%), 28(15.7%), 28(15.7%), 9( 5%) and 29(16.3%), respectively

. Majority (72.3%) of the respondents were females. The median age of the respondents was 32.5 and the

mean age was 30.5. More than half (64.9%) of respondents were Christian by their religion

SOCIO-DEMOGRAPHIC CHARACTERISTICSCHARACTERISTIC NUMBER PERCENTAGE AGE 18-24 25-34 35-44 45-54 55-80

48 53 41 20 16

27.43022.6119

EDUCATION Illiterate Read and write Primary Secondary Post-secondary

22 76 39 34 6

12.542.922193.4

RELIGION Christian Muslim Others

11561 2

64.934.80.3

CONT.

CHARACTERISTICS NUMBER % INCOME Farm Trade Salary Others

104 13 44 17

58.87.524.69.4

BEDROOM CONDITION Separate Shared with other

90 88

50.749.3

PREVALENCE OF NET OWNERSHIP

108(60.5%) self-reported that they own at least one bed net.

Among these, 2(1.4%) households couldn’t show any bed net during observation of household’s bed nets.

Thus a total of 106 (59.7%) households were observed owning at least one bed net. The assessment done on the number of bed net owned by a household, nearly half (41.2%) of the households own one bed net.

Reasons for non ownership and conditions related to ownership high price of bed net 32(46.2%) respondents 34% were expecting bed net to be distributed free

by government through health centers. Similarly, lack of information was given by 27% of

respondent as a reason for none owning bed net. 54.7% of the household’s mosquito nets were re-

treatable and the remaining were permanently treated bed nets.

none of respondents had re-treated their nets. The major reasons none re-treating bed nets were-

absence of retreating kit supply or availability in the area and others were due to lack of information

Observation for defects

The direct observation of household’s bed net for any defect showed that among household’s bed nets which were observed, 30(28%) were inspected with varying degree of visible defect e.g torn, burn etc./ through the nets.

Number of bed nets in households

 

41.2 %

54%

4.8 %

One

Two

Three

Insecticide Treated Net utilization among < 5 years of age children and conditions related to their bed net

Child utilized ITN previous night (n=108) 38(35.6)

Child sleeping under properly hanged net (n=108) (86.2)

Child sleeping under net with defect (n=116) 26(22.4)

Child sleeping under net which were not retreated (n=116)

45(38.8)

None Compliance of ITN utilization

% 28.5

18.7 %

% 3.8

21.7 %

0

Urban Total Rural Suburban

Knowledge related to malaria transmission and prevention (80.5%) of the respondents have identified that

malaria transmission is caused by Mosquito bite. 15.5% of the respondents believe that malaria

transmission is due to climatic condition in the area. 100 (56.1%) of the respondents cited Insecticide

Treated Nets utilization as one of the priority measure for malaria prevention at household level.

15(8.5%) of the respondents response was traditional measures (drinking locally made alcohol and eating Garlic) as Malaria prevention method.

Knowledge related to ITN mode of actionCHARACTERISTIC NUMBER %

Physical barrier Kills mosquito

11993

66.252.1

Irritate mosquito 14 8.1

Not known 8 4.6

Others 2 1.1

Knowledge related to ITN useWhen to utilize ITNs (n=178) Every night Seasonally When Mosquito Seen in HH Not known

135(75.8) 145(17.6) 30(3.6) 44(5.3)

Any problem if ITN Utilized (n=178)

Yes

No

Not known

17(9.7)

157(88.4)

3(1.9) Lists of the problems (n=17)

Prevent comfort

Cause heat

Lack of enough air

4(22.5) 10(56.3)

3(16.3)

Factors affecting ownership of bed net and its utilization The analysis done why certain group own ITN and

others don’t own has showed that: ownership of bed net varied between places of

residence. It was seen that rural residences were less likely own bed net when compared to urban dwellers.

respondents with health information were about 2 times more owned net than those who had no information

However, there was no significant association that can be demonstrated from the data between educational status and source of income of the respondents.

Factors affecting ownership of ITNs . The assessment done by age of the respondents

has showed that age grouped 18-24 years were about 3 times more knowledgeable than old age group(55 -80. The knowledge was also about 2 times higher among bed net owners than none owners of bed net

Similar assessment with place of residence has showed that rural dwellers were found to be less knowledgeable than urban respondents, where as an association between sex and ITNs knowledge cannot be demonstrated from the data

The assessment done with educational status showed that children from illiterate parents were less likely utilized bed net than under five years of age children from literate parents

CONCLUSION More than half of the children in the area were living in

the household which own at least one bed net. This was found to be much higher and encouraging compared to 3.3% gained in Kenyan DHS preliminary report 2005. On the other hand, the remaining children who survived in the households without a single bed net are the major concern to be addressed

Generally, underutilization of ITN among children under 5 years of age children was strongly associated with the place of residence , educational status and health information of the care givers,

Another area of concern was the factors given for children not utilizing bed net the previous night of survey

Recommendations The free distribution should prioritize vulnerable

groups using good opportunity of Antenatal care clinic and under five immunization program,

household education and regular district level on going survey with great emphasis to Rural and Suburban by health offices. Kisauni health offices can potentially use the existing awareness about cause of malaria and ITNs protection in malaria control program to improve the observed utilization (none compliance) problem.

Supply of re-treating kit should be secured by the ministry of health

Work planACTIVITY MONTHS DATE

Conceptualization of idea

September September

Shaping research idea September September

Literature review October October

Proposal writing October October

presentation November November

Data collection January January

Data analysis April May

Report writing May May

Presentation June 24th june

BUDGETITEM COST (KShs)Stationary 1500Typing/ printing 3000Travels 3000Photocopy 2500Feeding 3000Scanning 1000Binding 400Data processing 4000TOTAL 17400Misclenious 2610

GRAND TOTAL 20010

ENDTHANK YOU