Abstract
BackgroundMalaria transmission has declined dramatically in Zanzibar in recent years. Continuing use of preventive measures such as long-lasting insecticidal-treated nets (LLINs), and use of malaria rapid diagnostic tests (RDTs) are essential to prevent malaria resurgence. This study employed qualitative methods to explore community perceptions of malaria risk and adherence to prevention measures in two districts in Zanzibar.MethodsKey informant interviews with 24 primary health care providers and 24 focus group discussions with local residents in Zanzibar districts Wete and Central were conducted during April and May 2012 focusing on perception of malaria risk, current preventive practices used, reasons for using preventive practices and effective strategies for malaria control.ResultsHealth care providers and residents appear to be aware of the decreasing incidence of malaria. Both groups continue the use of malaria preventive practices in this low and seasonal transmission setting. The most important preventive measures identified were LLINs, indoor residual spraying (IRS), and education. Barriers to malaria prevention include: lack of staff at clinics, insufficient number of LLINs distributed, and inadequate malaria education. Reasons for continued use of preventive practices include: fear of malaria returning to high levels, presence of mosquitoes during rainy seasons, and concern about local cases from other villages or imported cases from mainland Tanzania. Mosques, clinics, schools and community meetings were listed as most important sources of education. However, residents express the desire for more education.ConclusionHealth care providers and residents generally reported consistent use of malaria preventive measures. However, maintaining and continuing to reduce malaria transmission will require ongoing education for both health care providers and residents to reinforce the importance of using preventive measures. Successful efforts to reduce malaria in Zanzibar will be jeopardized if residents believe that they are no longer at risk for malaria. In future studies, a year-round evaluation of the perception of malaria risk and use of preventive measures will inform the timing of education and prevention strategies for sustained malaria control.
Highlights
Malaria transmission has declined dramatically in Zanzibar in recent years
Interviews were conducted with 24 practicing health care providers and 24 focus groups were conducted with 134 residents of 12 villages in Central and Wete Districts
The following major themes were identified (Table 1): Theme 1 Health care providers and residents believe they are at risk for malaria, but expressed numerous barriers to care for protecting themselves Health care providers and residents reported that rapid diagnostic tests (RDTs) and ACTs are consistently available at primary health care facilities
Summary
Malaria transmission has declined dramatically in Zanzibar in recent years. Continuing use of preventive measures such as long-lasting insecticidal-treated nets (LLINs), and use of malaria rapid diagnostic tests (RDTs) are essential to prevent malaria resurgence. Use of insecticide-treated nets (ITNs) or long-lasting insecticidal nets (LLINs) ranges widely across districts in Unguja and Pemba [1]. The 2010 Demographic and Health Survey showed 65.9% of children under five years of age and 64.1% of pregnant women sleep underneath an ITN [2]. These numbers indicate a three-fold increase from the 2004–05 survey [4]. In spite of recent improvements in bed net use, further studies are needed to understand reasons a third of children under five years of age and pregnant women are not using bed nets [2]
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