Community acceptance of reactive focal mass drug administration and reactive focal vector control using indoor residual spraying, a mixed‐methods study in Zambezi region, Namibia

Kathryn W. Roberts, Cara Smith Gueye, Kimberly Baltzell, Henry Ntuku, Patrick McCreesh, Alysse Maglior, Brooke Whittemore, Petrina Uusiku, Davis Mumbengegwi, Immo Kleinschmidt, Roly Gosling, Michelle S. Hsiang

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there are limited data regarding their community acceptability. Methods: A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus no RAVC, and rfMDA + RAVC versus RACD only. To assess acceptability of these interventions, a mixed-methods study was conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey. Results: In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1372 and 8948 individuals in years 1 and 2, respectively, and refusal rates were low (< 2%). RAVC was offered to few households (n = 72) in year 1. In year 2, RAVC was offered to more households (n = 944) and refusals were < 1%. In the endline survey, 94.3% of 2147 respondents said they would participate in the same intervention again. Conclusions: Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement.

Original languageEnglish (US)
Article number162
JournalMalaria journal
Volume20
Issue number1
DOIs
StatePublished - Dec 2021

Keywords

  • Community acceptability
  • Indoor residual spraying
  • Malaria
  • Malaria elimination
  • Mass drug administration
  • Namibia
  • Plasmodium falciparum
  • Qualitative and Mixed Methods
  • Reactive case detection

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

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