Abstract
BackgroundBehaviour changes in mosquitoes from indoor to outdoor biting result in continuing risk of malaria from outdoor activities, including routine household activities and occasional social and cultural practices and gatherings. This study aimed to identify the range of social and cultural gatherings conducted outdoors and their associated risks for mosquito bites.MethodsA cross-sectional study was conducted in four villages in the Kilombero Valley from November 2015 to March 2016. Observations, focus group discussions, and key informant interviews were conducted. The recorded data were transcribed and translated from Swahili to English. Thematic content analysis was used to identify perspectives on the importance of various social and cultural gatherings that incidentally expose people to mosquito bites and malaria infection.ResultsReligious, cultural and social gatherings involving the wider community are conducted outdoors at night till dawn. Celebrations include life course events, religious and cultural ceremonies, such as Holy Communion, weddings, gatherings at Easter and Christmas, male circumcision, and rituals conducted to please the gods and to remember the dead. These celebrations, at which there is minimal use of interventions to prevent bites, contribute to individual satisfaction and social capital, helping to maintain a cohesive society. Bed net use while sleeping outdoors during mourning is unacceptable, and there is minimal use of other interventions, such as topical repellents. Long sleeve clothes are used for protection from mosquito bites but provide less protection.ConclusionGatherings and celebrations expose people to mosquito bites. Approaches to prevent risks of mosquito bites and disease management need to take into account social, cultural and environmental factors. Area specific interventions may be expensive, yet may be the best approach to reduce risk of infection as endemic countries work towards elimination. Focusing on single interventions will not yield the best outcomes for malaria prevention as social contexts and vector behaviour vary.
Highlights
Behaviour changes in mosquitoes from indoor to outdoor biting result in continuing risk of malaria from outdoor activities, including routine household activities and occasional social and cultural practices and gatherings
Approaches to prevent risks of mosquito bites and disease management need to take into account social, cultural and environmental factors
This reduction has largely been associated with the high coverage of frontline vector control measures, such as long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS) [2], and the widespread use of the malaria rapid diagnostic test (RDT) for prompt diagnosis and increased access to treatment [3,4,5]
Summary
Behaviour changes in mosquitoes from indoor to outdoor biting result in continuing risk of malaria from outdoor activities, including routine household activities and occasional social and cultural practices and gatherings. Social marketing programmes and substantial global investment have improved universal coverage of bed nets and in turn increased personal and community protection [6,7,8,9] Despite these achievements, the burden of malaria remains unacceptably high, with an estimated 216 million cases in 2016 worldwide, 4 million cases above that of from 212 million cases in 2015 [10]. Continued malaria cases and deaths, despite the wide coverage of LLINs and IRS, is associated with insecticide resistance [16,17,18], decrease in bed net use [19], and changes in mosquito biting behaviour and patterns from indoor biting to early outdoor biting, reducing their contact with insecticide treated surfaces [20,21,22,23]. Despite the reported changes in vector’s biting and resting behaviours [40,41,42,43,44,45], in Tanzania, control efforts have neither attended the outdoor transmission segment nor consider the role of social and cultural factors in malaria transmission [46,47,48,49,50]
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