Identifying community-based solutions that improve insecticide-treated net (ITN)

确定改善驱虫蚊帐 (ITN) 的基于社区的解决方案

• 批准号: 8288665
• 负责人: Kacey C Ernst
• 金额: $ 37.61万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-06 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8288665
• 关键词: Anopheles Genus; Area; Behavioral; Cessation of life; Child; Clinic; Communities; Community Participation; Complex; Cross-Sectional Studies; Cues; Data; Development; Economics; Effectiveness; Environmental Risk Factor; Epidemiologic Methods; Focus Groups; GIS Imaging; Goals; Government; Health; Health Promotion; Home environment; Household; Incidence; Individual; Insecticides; Intervention; Interview; Kenya; Knowledge; Life; Logistics; Malaria; Measures; Mediating; Methods; Outcome; Ownership; Parasites; Participant; Perception; Predisposition; Prevalence; Pyrethrum; Qualitative Methods; Reporting; Research; Resources; Risk; Risk Factors; Self Efficacy; Severities; Site; Sleep; Solutions; Surveys; Translating; Work; base; design; deviant; experience; improved; informant; innovation; member; modifiable risk; prevent; programs; risk perception; social; transmission process; vector control

DESCRIPTION (provided by applicant): Despite dramatic improvements, malaria remains a significant health problem in many regions of the world. As malaria programs move from control to elimination, there is an urgent need to understand barriers to and facilitators of the use of control measures. In this proposal, we focus on the most widely used control measure; bednets in a highland/low transmission and a lowland/high transmission. Our preliminary results indicate that in Kenya roughly 1 in 4 children under 5, the group most vulnerable to malaria, live in households that do not own a bednet. Additionally, even in net owning homes, 1 in 6 children under 5, do not sleep under a net. As Kenya and other programs expand their scope to distribute enough nets to cover all household members, much effort needs to go into understanding the prevalence of and factors related to disuse. The objective of the following proposal is to use qualitative and quantitative methods to determine the prevalence of ownership, misuse and disuse of bednets under field conditions and to identify modifiable risk factors. We will use an ecological approach to assess not only individual level factors that drive bednet ownership and use but the social and environmental context in which these decisions are being made. Following focus group discussions with community members and key informant interviews with health clinic staff, government vector control staff and village and community leaders, we will conduct a cross-sectional survey that examines 1) perceived susceptibility to malaria 2) perceived severity of malaria 3) perceived benefits of ITN use 4) perceived barriers to ITN use 5) cues to action such as health promotion programs and 6) confidence in the subject's self-efficacy with regard to obtaining an ITN and its proper use. We will use remotely-sensed images and GIS to determine how these perceptions and practices vary geographically and if they correspond with actual risk as determined through parallel parasite prevalence surveys and pyrethrum spray catches of Anopheles. From the cross-sectional participants we will identify positive deviants, community members who own and use bednets regularly despite experiencing at least 75% of the factors associated with not owning or using a bednet. In-depth interviews will be conducted to determine their solutions and personal motivators that may be used to improve community bednet ownership and compliance. Our approach is unique in its combination of rich qualitative data and the rigor and generalizability of established epidemiologic methods. Identifying what is already working in a community is more likely to be successfully implemented as a larger intervention. We expect that we will find that individuals who have personal loss due to malaria, have identified solutions to logistical issues with hanging bednets, have a higher perception of risk and who have greater access to household resources will be more likely to own and use a bednet. This research will help drive the development of targeted community-based interventions that should improve ITN ownership and use and ultimately reduce malaria transmission. PUBLIC HEALTH RELEVANCE: Malaria causes an estimated 800,000 deaths each year. Insecticide treated nets (ITN) are the most effective strategy to prevent malaria. This study will advance understanding of barriers and facilitators to ownership and use of ITN in malarious areas. We will use a mixed methods approach to identify simple solutions that will improve ownership and compliance with ITN use in western Kenya.

描述（由申请人提供）：尽管有很大的改善，但在世界许多地区，疟疾仍然是一个重大的健康问题。随着疟疾计划从控制转移到消除，迫切需要了解使用控制措施的障碍和促进者。在此提案中，我们专注于最广泛使用的控制措施。高地/低变速箱和低地/高速变速箱中的床头。我们的初步结果表明，在肯尼亚，大约有四分之一的5岁以下儿童，最容易受到疟疾的群体，生活在不拥有床网的家庭中。此外，即使在净拥有房屋中，也没有在5岁以下的六分之一的儿童中，也不会在网下睡觉。随着肯尼亚和其他计划扩大其范围以分发足够的网以覆盖所有家庭成员，需要做很多努力，需要努力理解与废弃有关的普遍性和因素。以下提案的目的是使用定性和定量方法来确定所有权，滥用和废除床头在现场条件下的流行率，并确定可修改的风险因素。 我们将使用一种生态方法来评估驱动的个人级别因素 床网的所有权和使用，但在做出这些决定的社会和环境环境。在与社区成员进行焦点小组讨论以及与健康诊所工作人员，政府媒介控制人员以及村庄以及社区领导者的关键讨论之后，我们将进行横断面调查，检查1）感知到疟疾的易感性2）疟疾的严重程度3） ITN使用的感知益处4）ITN使用的感知障碍5）诸如健康促进计划之类的行动以及6）对获得ITN及其适当使用的自我效能的信心。我们将使用远程感应的图像和GIS来确定这些感知和实践在地理上如何变化，并且它们是否与通过平行寄生虫患病率调查和Anopheles的吡啶虫喷雾捕获量确定的实际风险相对应。从横截面参与者中，我们将确定积极的偏差，尽管经历了至少有75％的因素，但他们定期拥有和使用床头的社区成员与不拥有或使用床网相关的因素中至少有75％。将进行深入的访谈，以确定其解决方案和个人激励因素，这些解决方案和个人动机可用于改善社区床网的所有权和合规性。 我们的方法在丰富的定性数据以及已建立的流行病学方法的严格性和普遍性的结合中是独一无二的。确定在社区中已经有效的东西更有可能成功地作为更大的干预措施实施。我们希望我们会发现，由于疟疾而造成个人损失的个人，已经确定了挂床的后勤问题的解决方案，对风险的认识更高，并且可以拥有更大的家庭资源的机会，更有可能拥有并使用床网。这项研究将有助于发展有针对性的社区干预措施，以改善ITN所有权并使用并最终减少疟疾传播。 公共卫生相关性：疟疾估计每年死亡800,000人死亡。杀虫剂处理的网（ITN）是预防疟疾的最有效策略。这项研究将使人们对障碍和促进者的了解和在损害地区拥有ITN的所有权和使用。我们将使用一种混合方法来识别简单的解决方案，以提高肯尼亚西部ITN的所有权和遵守情况。