Integrated approach to malaria prevention at household level in rural communities in Wakiso district, Uganda: impact evaluation of a pilot project.

Rawlance Ndejjo,David Musoke,George Karani,Keith Morris,Miph Boses Musoke,David Guwatudde,Edwinah Atusingwize

doi:10.4314/ahs.v18i4.35

Rawlance Ndejjo, David Musoke + Show 5 more

Open Access

https://doi.org/10.4314/ahs.v18i4.35

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Abstract

The integrated approach to malaria prevention, which advocates for the use of several malaria prevention methods at households, is being explored to complement other existing strategies. We implemented a pilot project that promoted the integrated approach to malaria prevention in two rural communities in Wakiso district, Uganda. This paper presents the impact evaluation findings of the project carried out 2 years after implementation with a focus on changes in knowledge and practices on malaria prevention. The project evaluation was cross-sectional in design and employed both quantitative and qualitative data collection methods. The quantitative survey was conducted among 540 households (household heads being participants) while the qualitative component involved 4 focus group discussions among community health workers (CHWs). Chi-square test was used to compare quantitative results from the evaluation with those of the baseline while thematic analysis was employed for qualitative data. There was a statistically significant positive change in malaria prevention practices in the evaluation compared with the baseline regarding indoor residual spraying (χ2 = 7.9, p = 0.019), mosquito screening of windows and ventilators (χ2 = 62.3, p = 0.001), and closing windows of houses before 6:00 pm (χ2 = 60.2, p < 0.001). The CHWs trained during the project were found to be highly knowledgeable on the various malaria prevention methods in the integrated approach, and continued to promote their use in the community. Findings of the impact evaluation give promise that utilisation of integrated malaria prevention can be enhanced if use of multiple methods is promoted in communities.

Highlights

Malaria continues to cause severe morbidity and mortality in sub-Saharan Africa
This paper presents findings from the impact evaluation of the project that promoted the integrated approach to malaria prevention in two rural communities in Wakiso district, Uganda
This study demonstrates improvement in knowledge in some individual methods as well as practices on malaria prevention following interventions of the pilot project

Summary

Introduction

Malaria continues to cause severe morbidity and mortality in sub-Saharan Africa. In 2015, Uganda ranked fourth among highest malaria burden countries in the WHO African region[1]. To complement existing malaria prevention interventions, other important measures can be used at households to significantly reduce mosquito vectors which transmit malaria These include improving housing quality notably installing screening in ventilators and open eaves to prevent entry of mosquitoes; larval source management; and early closing of windows and doors on houses[4,5,6]. While these malaria prevention methods have been shown to individually contribute to reducing the occurrence of the disease, there is need for more evidence on their use in a holistic approach to complement existing strategies[3].

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