Abstract
BackgroundDespite the implementation of the World Health Organisation’s recommended indoor residual spraying (IRS) intervention in the upper west region of Ghana to reduce malaria morbidity and mortality, the uptake of this intervention remains low. This study explores the facilitators and barriers to the acceptability and community uptake of indoor residual spraying in a highly endemic region of Ghana.MethodsThe health belief model (HBM) and realist evaluation framework were used to inform the study. A qualitative enquiry was conducted between April to October 2016. Data were collected through focus group discussions and semi-structured interviews with program stakeholders including community members, AngloGold Ashanti malaria control (AGA Mal) spray operators, and AGA Mal officials.ResultsA total of 101 people participated in the study. Considerable barriers to community acceptance of indoor residual spraying (IRS) were found, including, dislike of spray insecticides, inadequate information, religious and cultural beliefs, perceived low efficacy of IRS, difficulties with packing, unprofessional conduct of IRS spray operators, and other operational barriers to spraying. Facilitators of IRS uptake included a perceived effectiveness of IRS in preventing malaria and reducing mosquito bites, incidental benefits, respect for authority, training and capacity building, and sensitization activities.ConclusionThe numerous barriers to indoor residual spraying acceptance and implications show that acceptance levels could be improved. However, measures are required to address householders’ concerns and streamline operational barriers to increase community uptake of indoor residual spraying.
Highlights
Despite the implementation of the World Health Organisation’s recommended indoor residual spraying (IRS) intervention in the upper west region of Ghana to reduce malaria morbidity and mortality, the uptake of this intervention remains low
Almost half (48%) of the household participants had no formal education and 82% of householders were employed in the informal sectors, farming
Because non-spraying did not always stem from deliberate refusals, this implies that the level of indoor residual spraying (IRS) acceptance could be improved if adequate measures are put in place to address householders’ concerns and streamline operational barriers
Summary
Despite the implementation of the World Health Organisation’s recommended indoor residual spraying (IRS) intervention in the upper west region of Ghana to reduce malaria morbidity and mortality, the uptake of this intervention remains low. This study explores the facilitators and barriers to the acceptability and community uptake of indoor residual spraying in a highly endemic region of Ghana. Malaria is a disease that is endemic in tropical countries, in Sub-Saharan Africa. Ghana is one of the African countries where malaria is endemic, and the entire population is at risk of infection [3]. Malaria is more endemic in the northern part of Ghana, in the upper western part of the country where a prevalence of 51% was recorded among children of ages 6–59 months [4]. The effects of malaria go beyond health consequences to encompass a reduction in productivity and income loss, which significantly contributes to the slow rate of socioeconomic progress in Africa [5]
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