Abstract
BackgroundInsecticide-treated nets (ITNs) and house modifications are proven vector control tools, yet in most regions, full coverage has not been achieved. This study investigates household factors associated with access to ITNs and house modification in Tanzania.MethodsBaseline cross-sectional survey data from previous studies on spatial repellants and indoor residual spray evaluation was analysed from 6757 households in Bagamoyo (60 km north of Dar es Salaam) and 1241 households in Ulanga (a remote rural area in southeast Tanzania), respectively. Regression models were used to estimate the associations between the outcomes: population access to ITNs, access to ITN per sleeping spaces, window screens and closed eaves, and the covariates household size, age, gender, pregnancy, education, house size, house modification (window screens and closed eaves) and wealth.ResultsPopulation access to ITNs (households with one ITN per two people that stayed in the house the previous night of the survey) was 69% (n = 4663) and access to ITNs per sleeping spaces (households with enough ITNs to cover all sleeping spaces used the previous night of the survey) was 45% (n = 3010) in Bagamoyo, 3 years after the last mass campaign. These findings are both lower than the least 80% coverage target of the Tanzania National Malaria Strategic Plan (Tanzania NMSP). In Ulanga, population access to ITNs was 92% (n = 1143) and ITNs per sleeping spaces was 88% (n = 1093), 1 year after the last Universal Coverage Campaign (UCC). Increased household size was significantly associated with lower access to ITNs even shortly after UCC. House modification was common in both areas but influenced by wealth. In Bagamoyo, screened windows were more common than closed eaves (65% vs 13%), whereas in Ulanga more houses had closed eaves than window screens (55% vs 12%).ConclusionPopulation access to ITNs was substantially lower than the targets of the Tanzania NMSP after 3 years and lower among larger households after 1 year following ITN campaign. House modification was common in both areas, associated with wealth. Improved access to ITNs and window screens through subsidies and Behaviour Change Communication (BCC) strategies, especially among large and poor households and those headed by people with a low level of education, could maximize the uptake of a combination of these two interventions.
Highlights
Insecticide-treated nets (ITNs) and house modifications are proven vector control tools, yet in most regions, full coverage has not been achieved
This paper reports the household factors associated with access to ITNs and house modification between two rural populations: one far from and one close to an urban centre, as it is known that access to economic centers affects the economic, education, and health status of populations [16]
Access to one ITN per sleeping space was estimated as 45% [n = 3010]
Summary
Insecticide-treated nets (ITNs) and house modifications are proven vector control tools, yet in most regions, full coverage has not been achieved. House modification provides additional protection from all mosquitoes when people are indoors but not under their ITN [9], The installation of window screens or blocking of eaves (Fig. 1) acts to create barrier against mosquito entry and have been shown to be associated with lower malaria infection [10] and are a control tool for other vector-borne diseases such as dengue [11], arbovirus and lymphatic filariasis [12] They (1) require no active compliance, (2) tend to be long-lasting and (3) protect all members of a household, 4) improving house ventilation and (5) preventing mosquito entry and nuisance [13, 14]. There is evidence of an increasing number of houses with window screens and closed eaves among the urban Tanzanian population especially window screens [13]
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