SOCIOCULTURAL PERSPECTIVES ON USE AND MISUSE OF INSECTICIDE

TREATED MOSQUITO NETS AMONG PEOPLE LIVING IN RARIEDA SUB-COUNTY,

SIAYA

NAME: OBIENE SAMSON OYUCHO

A dissertation submitted in partial fulfillment for the requirement for a BA in

Anthropology, Department of Anthropology, Moi University, School of Arts and Social
Sciences
Date: 25th February 2016

DECLARATION BY THE CANDIDATE.

I declare that the work presented in this BA dissertation are my own original thoughts and have not
been presented in any other institution for the purposes of grading and that any facts or errors in the
work presented are my own.

NAME: SAMSON OBIENE OYUCHO

REG NO: BA/548/12

Signature..

Date: 25th February 2016

SUPERVISOR: Maurice Kongongo

Supervisor signature:..

ACKNOWLEDGEMENT
2

This dissertation has been undertaken as a partial fulfillment of the Bachelor of Arts Degree
in the Anthropology and human ecology. I wish to acknowledge the Almighty God for His
grace and providence throughout the course. Also acknowledge the community in Pedo
village for accepting to participate in the study.
I would also like to sincerely thank my lecturer Maurice Kongongo and more so the entire
department of Anthropology and Human ecology for the facilitation of dissertation course.
Lastly I would like to pass my gratitude to my parents for their support and encouragement
and my friends and classmates. Their generous contribution towards the success and
completion of my course will be rewarded abundantly.

TABLE OF CONTENTS
3

CHAPTER ONE.
INTRODUCTION.
STATEMENT OF THE
PROBLEM
CHAPTER TWO.
LITERATURE REVIEW
INTRODUCTION
UTILIZATION OF MOSQUITO NETS .
OWNERSHIP VERSUS UTILIZATION OF ITN
ITNS VS MALARIA PREVENTION...

CHAPTER THREE.
RESEARCH
METHODOLOGY...
INTRODUCTION..
RESEARCH
DESIGN
AREA OF
STUDY
METHODS
CHAPTER FOUR
FINDINGS..

CHAPTER FIVE.
CONCLUSIONS AND RECOMMENDATIONS ON HOW TO IMPROVE
THESETUATION
APPENDICES..
CHAPTER ONE
4

INTRODUCTION
1.1 BACKGROUND TO THE PROBLEM.
In spite of mankinds longstanding struggle to control malaria mosquitoes, malaria remains a
foremost threat to individual health (Minakawa et al., 2005). There were approximated 881,000
malaria deaths in 2006, of which 91% were in Africa and 85% were of children under 5 years
(WHO, 2008). P. falciparum is the most serious human malaria parasite and the most common
one in Africa south of the Sahara (Snow et al., 2005).
The main tools in the global fight against malaria vectors are insecticide treated nets (ITNs) and
indoor residual spraying (IRS) which targets adult malaria vectors. Regular and proper use of
ITNs by children can reduce their overall risk of dying by 20% and the number of clinical malaria
occurrence by almost 50% (RBM, 2002). IRS continuous to be the most widely method used in
malaria control and about half of African countries included IRS as part of their malaria control
effort (WHO and UNICEF, 2005). Early studies reported that IRS and ITNs sharply reduce
malaria transmission (Gimnig et al., 2003a; ter Kuile et al., 2003); but they do not eliminate it
entirely; the information on the perception and the ITNs use and the effect of the distance to the
nearest health facility to peruse medical treatment are urgently needed to help understand how to
maintain and reduce vector density and transmission intensity.

1.2 STATEMENT OF THE PROBLEM

Malaria caused about 881,000 malaria deaths in 2006, of which 91% were in Africa and 85% were of
children under 5 years (WHO, 2008). In Kenya, Malaria is the leading cause of morbidity and
mortality accounting for 30-50% of all outpatient attendance and 20% of all admissions to health
facilities. It is also estimated to cause 20% of all deaths in children under five (MOH 2006). An
estimated 170 million working days are therefore lost to the disease each year (MOH 2001) due to
the effects of weakness and inability to work. This therefore causes a strain in the economy of families
and individual as productivity is lowered which in the long run derails the economy of the country at
large. It also has an adverse effect on child education as they are either unable to attend school due to
illness or unable to be taught due to the teachers inability to come to school.
The main efforts put in place to fight and control malaria include indoor residual spraying (IRS) and
insecticide treated nets (ITNs) for vector control targeting, indoor feeding and resting mosquito .Early
studies have shown that IRS and ITNs reduce malaria transmission if used correctly (Gimnig et al.,
5

2003a; ter Kuile et al., 2003). Regular, proper and adherence to ITNs use reduces overall children
risk of mortality by 20% and the number of clinical malaria occurrence by almost 50% (RBM, 2002;
Jane .A. Alai 2013). Despite increased ITNs coverage, malaria prevalence and mortality remain high
this could be due to, lack of adherence and improper use of in which could result into resistance by
the mosquito as reported (ter Kuile et al., 2003)
My study therefore was of the interest to explore the challenges facing ITNs use and the peoples
perceptions on malaria prevention in Pedo village Rarieda Sub County. The findings of this study has
helped to fill in the gap of knowledge on regular, proper and adherence to ITNs use.

1.3 OBJECTIVES OF THE STUDY

1. To determine the inappropriate uses of insecticide treated nets in Pedo village in Rarieda Sub
County.
2. To explain reason why, people living in Pedo village in rarieda sub county put insecticide
treated net into uses which they were not meant for.
3. To find out the perceptions people living in Pedo village have about the efficacy, and effects
of use of insecticide treated nets.
4. To explore gender issues surrounding insecticide treated net use in households in Pedo village
in Rarieda sub county

1.4 RESEARCH QUESTIONS

1. What are some of the inappropriate ways in which people living in Pedo village put
insecticide treated nets into use?
2. What justifications do people living in Pedo village give for inappropriate use of
insecticide treated nets?
3. What beliefs do people living in Pedo village hold about use efficacy and effects of
insecticide treated nets?
1.5. SIGNIFICANCE OF THE STUDY
Malaria is the leading cause of morbidity mortality in Kenya especially along the lake region despite
the increased ITNs and IRS coverage due the collaboration between the Kenyan government and other
partners. However, there are complex factors hindering the efficacy of these interventions which need
to be addressed. Improper and non-adherence to ITNs use reduces its effectiveness. My study is being
6

a social science oriented study looking at peoples perception, the information collected will be useful
in enabling the government and other stakeholders to come up with an informed education program
to enhance proper use of ITNs in the prevention of malaria.

CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION
This chapter deals with the review of the literature. The review will be divided into three; the
Utilization of Mosquito nets, Ownership versus utilization of ITN, ITNs Vs Malaria prevention

2.1 Utilization of Mosquito nets.

A review on community acceptance of bed nets has shown that various factors influence the use of
bed nets, including cultural, behavioral and demographic factors, ethnicity, accessibility, gender
relations and seasonality of malaria. Several authors have concluded that although ITNs are effective,
local perceptions, acceptance and use of ITNs, as well as use of other preventive methods, are
invaluable in malaria control programs (Winch et al 8 1997). In a study carried out in Western Kenya,
community reactions were assessed before the introduction of permethrin-treated bed nets. Although
malaria was found to be an important disease, ITNs were believed to be only partially beneficial
because of the perception that malaria had multiple causes, and further to this, fear was expressed that
chemicals used to treat ITNs were associated with use of family planning (Alaii et al 2003). Excessive
heat was often cited as a reason for not deploying the childs ITN. Other important reasons for nonadherence were disruption of sleeping arrangements, indicating that ITNs were not readily redeployed
in the face of shifting sleeping patterns due to visitors, funerals, house construction and other events.
Lack of motivation and technical problems like room to hang childs net also affects consistency in
utilization of an ITN. In a study carried out in Mukono District, it was emphasized that the cost of
ITNs followed by their non-availability were constraints to their use, half of participants in all the 10
focal group discussions (FGDs) thought that chemicals used to treat the nets were very harmful to
adults, children and pregnant women (Mbonye et al 2005). The difference between treated and nontreated nets was also not known. People believed that all nets were treated with a chemical. Over half
of the participants in all FGDs seemed to believe that ITNs are treated with chemicals which affect
pregnant women, especially their breathing and that if the chemicals can kill mosquitoes instantly,
they can also kill people. This perception was held by non-users mainly, although users also believed
that it in addition causes feeling of excessive heat and suffocation at night due to use of ITNs (Mbonye
at al 2005). This study investigated the caregivers in households ITNs use the previous night with
over five and children under five. The government of Kenya has carried out the mass net distribution
in this county. All this is done to ensure 80% coverage of its residents. However, in Tanzania and
8

other African countries including Uganda, there are no by laws which address the common practice
of men sleeping under the only net in the household even though children under five are the most at
risk from malaria (Marslend 2006). This accounts for the continued high child mortality rates due to
malaria in sub-Saharan Africa. To improve accessibility to ITNs by target population in rural areas,
distribution is carried out mainly through national health services (Fixed post and outreach mobile
team) in Djibouti. However, NGOs and Community based association are involved in ITN promotion
and distribution in the peri-urban and urban areas. In the study conducted in Mukono district about
preventing malaria in pregnancy, participants knew that mosquito nets were a useful preventive
measure against malaria and that pregnant women and children were supposed to sleep under nets
since they are the most vulnerable groups. However the availability and use of nets in this community
was found to be very low. Over three quarters of participants in all the FGDs and key informant
interviews reported that very few people in the community use mosquito nets (Mbonyi et al 2005).
This study therefore seeks to establish why utilization is still low specifically among the under-fives.
In the same study, another constraint to ITNs access was the cost and uncaring husbands. Over three
quarters of women in this study complained that men did not care about the health of their wives and
their children. Men were reported not to prioritize the issue of health. Women thought that men use
their money on items like alcohol and forget about buying nutritious foods and providing health care
to their families. Women participants at Kimenyedde sub-county said that they fear to buy mosquito
nets because their husband 11 would question them about the source of the money. This is because
women in this community are not expected to have money, or if they have money, the husbands feel
obliged to know its source. More than half of the women participants in all the FGDs expressed fear
that if a woman bought a net, the husbands would suspect that she got the money from another man
(Mbonyi et al 2005). This study specifically investigated affordability of ITNs to under-fives within
the household setting which was not covered in the previous studies.

2.2 Ownership versus utilization of ITN

Two important RBM indicators for monitoring progress towards the set target are the proportion of
households which own one or more nets and the proportion of under-five children who sleep under a
net. Net ownership is important to assess the effectiveness of the distribution channels of the RBM
program and suggest program modifications where there are lapses. However, utilization is the crucial
indicator that can generate the desired epidemiological impact (Macintyre 2006). Few studies have
examined the difference between the two indicators. A meta-analysis of household surveys on net
utilization and ownership found a wide gap between net possession and use. ITN ownership was
found to be between 0.1 percent and 28.5 percent, while use among children less than five years of
9

age ranged between 0 percent and 16 percent (Korenromp 2003). This is still unacceptably very low
to have an impact on reduction of malaria episodes among the under-fives. Equality is a major issue
in ITN ownership. Net ownership has been found to be lowest among the poorest households
(UNICEF 2005); thus possibly linking possession to the cost of the net (Guyatt 2002). Authors of a
study conducted on the effect of lowering cost on nets and netting materials predict that reducing cost
on insecticides and ITNs from 42 percent to 0 percent and the cost on netting materials from 40
percent to 5 percent would increase demand for ITNs by 927 percent (Simon 2002). Wiseman et al
reported a significant association between good access roads to the community and net ownership
(Wiseman 2007). Perceived risk of malaria and benefits of the nets by the population also drive
demand. Onwujekwe et al, in a Nigerian study, found that households with a recent attack of malaria
and those with higher willingness to pay were more likely to purchase a 12 net than their counterparts
(Onwejekwe et al 2003). Such communities have a perceived need for utilizing ITNs. Utilization has,
however, been found to vary with seasons of the year and acceptability of the nets in terms of size,
colour and shape. Binka et al showed that the time of the year during which the nets are delivered
affects use. In their study, 99 percent of the net recipients were found to use the nets during rainy
season, while only 20 percent used it during the dry season (Binka et al 1997). Demographic
characteristics like age, education, size of household and ethnicity also influence use of bed nets.
Some studies show that children are less likely to use nets, particularly in rural areas, while others
found no significant association between age and net use. My study explored more demographic
characteristics like age, size of household and main household use as a determining factor to the net
use.

2.3 ITNs Vs Malaria prevention

The lives of 400,000 children could be saved every year if African children under five sleep under
ITNs (Africa Health 2000). Mosquito nets if properly used and maintained can provide a physical
barrier to hungry mosquitoes and provide 46 percent protection against malaria (RBM, 2001). There
are positive effects of insecticide treated nets in reducing the mortality and morbidity of children
under five years of age and yet usage remains low. ITNs reduce malaria morbidity and mortality, but
use is limited. A number of studies have found out that ITNs provide varying degrees of protection
against malaria morbidity. In a trial of untreated bed nets in the Gambia, nets were found to reduce
the number of infective bites but not enough to reduce morbidity from malaria (Snow et al 1988).
Malaria decreases with the use of ITNs. The main reason for this is that mosquitoes are not only kept
10

away from the sleeping people, but would die when they come into contact with the insecticide. In
subsequent studies, it was demonstrated further that use of ITNs in pregnancy reduces maternal
parasitaemia, anemia and premature deliveries, increases mean birth weight and subsequently reduces
neonatal and infant mortality (Dolan et al 1993). This shows that the role of ITNs among the underfive in protecting them against malaria should not be ignored. ITNs have a mean protective efficacy
against malaria episodes of approximately 50 percent in highly endemic areas of Africa (Langeler and
Snow 2004). They have also been found to reduce overall mortality among children by 63 percent in
villages using impregnated nets. A recent review has similarly shown that ITNs are highly effective
in reducing morbidity and mortality from malaria. Bed nets given to pregnant women have been found
to be protective to women and their children against malaria in both high and low malaria transmission
areas of Kenya (Guyatt and Ochola 2003). To monitor progress toward Abuja targets, RBM developed
indicators using the number of under-5s or pregnant women from all households, including those that
do not own nets, as the denominator. This indicator is appropriate for looking at nationwide progress
toward Abuja targets, but the resulting percentage is necessarily constrained by the percent of
households owning a net. However, these indicators are general; they do not reveal intra-household
net-use patterns which the current study plan explore. Few studies look only among net-owning
households and analyze if and by whom nets are used, which requires measuring use by under-5s
compared to that of other household members. A few studies do address some aspects of intrahousehold net use, with one in the Gambia concluding that vulnerable groups were more likely than
other family members to use a net (DAlessandro et al 1994). It also found a small margin, adults
used nets more than children (but defined children as under 10 years of age. A study based on
secondary analyses of the Demographic and Health Survey in Uganda concluded that young children
were sleeping under a net only because their mothers were using the net (Mugisha et al 2003). Several
other studies focusing on who uses the household net were intervention studies where nets were given
free to those living in a research area in Kenya (Alaii et al 2003) or to pregnant women attending
antenatal clinics in Kenya, or where nets were acquired via vouchers distributed to pregnant women
in Tanzania (Tami at al 2006). The first found that adults were slightly more likely than young
children to be using the net; and the last 2 found that nets were being used by the groups targeted by
the intervention: pregnant women and infants. Because these are intervention sites, however, we do
not know whether these findings apply to the general population. This study will address actual use
of nets within the households with children under five years, rather than net ownership.

11

2.4 Theories
The study will be informed by the Health Care Utilization Model also referred to as the generic
behavioural model. It will establish and examine the utilization of ITNs within households with
household members. It will investigate intra household practices, of the ITNs in preventing malaria
among household members. Andersens (1968) generic behavioural model is the most widely adopted
and empirically assessed model of health service utilization. In Andersens original behavioural
model, there are three major categories of health service utilization determinants. These include;
predisposing factors, enabling factors and need factors. The category of predisposing characteristics
will be used to reflect the fact that age brackets are propensity to use services than other. The enabling
factors reflect the fact that while the age group may be predisposed to use health services, they do not
use them unless they are able. Enabling factors include; availability of services, financial resources to
purchase services, health insurance and social network support. The need factors refer to the basic
and direct stimulus for the use of health services. The individual must perceive some need for use of
health services. This depends on perception of severity, total number of days in bed, days missed from
work or school and help from outside for caring. The concept of predisposing characteristics will be
used to assess the relationship between age, household size and main household use to ITNs use.
Enabling factors investigated whether there will be ITNs present in the household for all household
members.

12

CHAPTER THREE
RESEARCH METHODOLOGY

3.0 INTRODUCTION
This section discusses research design description of the area of study, the study population, sample,
sampling techniques, data collection instruments, data collection procedures and the method of data
analysis.
This research was a participatory process involving researcher as the facilitator, respondents and a
community health workers.

3.1 RESEARCH DESIGN

The research design was cross- sectional, where all residents of the selected villages were targeted.
Cross-sectional design being a short time achieving type of study, involved studying different people
at the same time to get a quick picture of utilization of ITNs in the household at that particular time.
Qualitative methods were used to establish the peoples perceptions on malaria intervention. It was
also used to show association between the social demographic characteristics of the household and
utilization of ITNs within the household.

3.2 AREA OF STUDY

The study was conducted in Pedo village in Rarieda Sub-County; Siaya County, located 80km west
of Kisumu city along the shores of Lake Victoria.
The topography of the area is characterized by gentle rolling hills and many temporary streams that
are flooded during the rain seasons and flow into Lake Victoria. Rainfall is seasonally bimodal, with
the heaviest rains falling from March through May and the shorter rains occurring in November and
December. Total annual rainfall average is 1200mm per year while average daily temperature range
from 19 -29 C. The main malaria vectors in this area are An. gambiae Giles and An. funestus Giles
(Gimnig et al., 2003b). Most residents are members of the Luo ethinic group. The population of the
study area is scattered among family compounds which are defined as one or more houses (usually 35 houses). Houses are grouped into compounds of related family members and separated by farmland.
Most inhabitants practice subsistence farming with maize the staple crop. Other crops are sorghum,
13

millet, vegetables and few animals keeping such as goats, cattle and chickens. The study borders
Asembo an area where ITNs randomized trial programM took place (since late 1990s) with regular
net replacement and retreatment schedule involving community leaders, and researchers (Gimnig et
al., 2003b; Gimnig et al., 2003a; Hawley et al., 2003; ter Kuile et al., 2003).
Ward had a population of 40,471 people by 2012, of which 19,615people were Men and 20,856 people
were Women.

3.4 METHODS
3.4.1 DATA COLLECTION
The study used questionnaires compromising both open and closed ended questions based on the
objective of the study. Information was collected on factors listed below.
1. Improper use(determine)
2. The decision maker in the household
3. Other uses other than mosquito prevention and reasons

3.4.2 Sampling for the survey

Non probability systematic random sampling method was used

3.4.3 Data Cleaning and Entry

Data was collected using a semi structured questionnaire and entered in Microsoft excel software
observing confidentiality while handling the information from the respondents by storing the
questionnaire in a locked cabinet and a password known only to the researcher for the entered data.

14

3.4.4 Data Analysis

The data was analyzed using statistical package for social sciences (SPSS). Descriptive statistics and
analysis of frequency/contingency tables and charts have been used to demonstrate association of
variables. Significance test has been calculated at assigned confidence intervals of 95%.

3.4.5 Data Presentation

The result obtained has been presented in a report detailing the aims, methods, results (using graphs
charts and tables), discussions and conclusions.
Stakeholders including Ministry of Health, Ministry of Planning and Development and other

15

CHAPTER 4: FINDINGS
4.1 THE STUDY POPULATION
Averagely, a village has about 100 compounds and 200 households with a population of
approximately 300 to 400 people. The study sampled 24 households in 24 compound with a total
population of 121.

4.2.1Socio-demographic information
The study was conducted in 24 households in Pedo village with a population of 121. Of all the
respondents, 62.5% were female and 37.5% males. The age variation was between 20-90 with most
of them having been educated up to primary school level (54.17%), 16.67% not attended school 25%
attended secondary education and only 4% reached the tertiary level. Farming was the major
economic activity in the area constituting 37.5% followed by farming at 20.83% then fishing and
formal employment each at 8.3%. 25% of the households had no specific source of income giving
reasons that their children support them from town. Table1.

AGE

%GENDER

%EDUCATION LEVEL

%OCCUPATION

20- 90

FEMALE

62.5

NO EDUCATION

16.67

BUSINESS

37.5

MALE

37.5

PRIMARY

54.17

FARMING

20.83

SECONDARY

25

FISHING

8.33

TERTIARY

4.17

FORMALEMPLOYMENT

8.33

NO EMPLOYMENT

25

25

Table 1: social demographics

4.2.2 ITNs household ownership
All members we considered the residence of the household in which they slept. The respondents were
also asked the number of treated nets they had in the household; net ownership per household is
represented in Figure 1. The mean ITNs per household was 2.83; 29.2% of the households had 1 net
while 45.8% own 2 nets and 12.5% own 3 and 4 nets in the households

16

Proportion household ITNs ownership

figure1: household net ownership%

100
90
80
70
60
50
40
30
20
10
0
1 NET

2 NETS

3 NETS

4NETS

Number of ITNs

4.2.3 Belief in net effectiveness

The respondents also were asked their perceptions on ITNs effectiveness in the fight against malaria.
92% of the people in Pedo village believe in ITNs to be effective in protection against malaria and
8% percent stated that they were not effective. The main reasons given for the effectiveness were that
it acts as a barrier 77.3% (17/22), repels mosquitos 13.6% (3/22) and prevent malaria transmission
9.1%(2/22), while the only reason mentioned why ITNs are note effective was that mosquito can bites
even before going to bed 100% (2/2).

17

Figure 2: belief on ITNs effectiveness

%beliefs on ITNs effectiveness

8.333333333

91.66666667

NOT EFFECTIVE

EFFECTIVE

4.2.4 Malaria cases

During the survey, the respondents were asked the number of the household members who had
suffered from malaria in the past one month. Malaria cases were high, 87.5% a percentage. The
proportion reported to have experienced malaria within the previous months was higher in under 5
60% as compared to those above 5 36.8%:table 2.

AGE

TOTAL

MALARIA

MALARIA

CATEGORY

NUMBER

CASES

PROPORTION

Under 5

20 (17.4%)

12 (25.5%)

60%

Above 5

95 (82.6%)

35 (74.5%)

36.80%

0 (0%)

0 (0%)

0%

Pregnant
women

TABE 2: Malaria cases

18

4.2.5 Causes of malaria and response to treatment.

An enquiry was also made on the causes of malaria, the effectiveness of treatment and some of the
reasons the respondents had on the effectiveness of the treatment.66.7% felt that too many mosquitos
was the main cause of malaria while 20.8% thought it was due to ineffectiveness of the nets and 12.5%
urged that there was inadequacy of nets. 87% of the respondents felt that treatment of malaria had
worked siting a feeling of relief and resumption of normal lifestyle as a reason for feeling the
medication had worked. 13% however couldnt ascertain whether the medication had worked because
they were still on medication Table 3 and 4.

CAUSES

OF % BELIEF ON CAUSES

MALARIA
TOO

OF MALARIA
MANY

MOSQUITOS

(16/24) 66.7

INEFFECTIVE NETS

(5/24) 20.8

INADEQUATE NETS

(3/24) 12.5

OTHERS

(3/24) 12.5

Table 3: causes of malaria.

%

OF

THOSE

WHO BELIEVED
IN

REASONS

EFFECTIVENESS GIVEN

FOR

EFFECTIVENESS OF

EFFECTIVENES

OF TREATMENT TREATMENT.

OR LACK OF IT.
STILL

NO

(3/23) 13

MEDCATION
GENERAL
RELIEF

YES

(20/23) 87

ON

FEELING

Table 4: response to treatment.

19

4.2.6 Malaria prevention strategies

On the question of the malaria prevention methods used in the area of stude,95.8%said nets was the
best way they knew that they could use in malaria prevention, 8.3% used repellants for malaria
prevention while 4.1% said that they occasionally used sprays to stop the spread of malaria as shown
in figure 3.

Figure 3; malaria prevention strategies.

% PREVENTION

100
80
60
40
20
0
NETS

REPELANTS

SPRAY

TYPE OF REPELANT

4.2.7 Decision maker and its use

An enquiry was made to determine the decision maker on ITNs use within the household. In 83.3%
of the households, the decision was the mothers with a general view that the sleeping distribution
and sickness were her concern while in 16.7% the decision was the fathers holding that he was the
head of the household and has an overall decision on matters within household.

20

Figure 4: Decision maker and ITNs use

DECISION MAKERS ON ITNs USE

16.66666667

83.33333333

MOTHER

FATHER

4.2.8 Perception on improper net use

The respondents were asked their opinion on the improper uses of ITNs. Of all the respondents, 66.7%
(16/24) mentioned cases of improper ITNs use. 16.7% mentioned bathroom construction, 25% fishing
/ sun drying fish and 54.2% fencing kitchen gardens using ITNs as improper use As shown in figures
2,3, 4 and 5. The participants who mentioned any of the improper use of ITNs were also asked the
reasons for the improper ITNs uses. They unanimous view that the old and too torn nets can be used
for other purposes as mentioned above and secondly, there is no proper disposal procedure for them
100% (16/16) Figures 5,6&7.

21

Figure 5: improper net uses

% INTs MISSUSE
16.66666667
12.5
25

29.16666667

54.16666667

BATHROOM

FISHING

SEEDBED/KITCHEN GARDEN

NONE

THE REST

Figure 6: ITNs used to cover bathroom.

22

figure 7: ITNs used in drying omena

23

4.2.9 DISCUSSION AND CONCLUSION

From the results above its evident that inappropriate uses of ITNs is still a common problem and this
goes a long way in affecting the general efficacy. It can however be concluded that the main cause of
the inappropriate ITNs use is due to lack of proper education on disposal and its effects on the
environment. 70.8% of all the respondents in this study had a view that the nets can be put to other
uses other than disposing which shows that they have little education on the effects of releasing the
insecticides used on treating the ITNs to the mosquito habitats and the environment. Gender also plays
a key role in the efficacy of nets as in almost 83.3% of the households net use was solely left to the
mother rather than being a general concern of all the household members. This could impact
negatively on the fight against malaria if the mothers are not present in the household hence less
likelihood of the family members sleeping under ITNs. The participants had a positive belief on the
effectiveness of ITNs in the protection against malaria with a general view that nets are a success as
a burrier of mosquitos at night. This therefore shows that beliefs play a minimal role of about 8.7%
in the negative influence of ITNs efficacy which could be due to the long presence of ITNs in the
study area.

4.2.9.1 CONCLUSION.
Due to the gap in knowledge on net disposal there is need for the policy makers to come up with
proper education program on disposal methods and their effects on the environment. This will not
only improve the efficacy of ITNs but also empower the community in the fight against malaria by
informing them on the consequences of their actions which to them has not been a big deal due to the
lack of knowledge in the entomological aspect in the fight against malaria.

24

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2. Terlouw DJ, Morgah K, Wolkon A, Dare A, Dorkenoo A, et al. (2010) Impact of mass
distribution of free long-lasting insecticidal nets on childhood malaria morbidity: the
Togo National Integrated Child Health Campaign. Malar J 9: 199.
3. .Fegan GW, Noor AM, Akhwale WS, Cousens S, Snow RW (2007) Effect of expanded
insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal
study. Lancet 370: 10351039.
4. Shaw S (2 May 2010) In Africa, anti-malaria mosquito nets go unused by recipients.
Los Angeles Times. Available: http://articles.latimes.com/2010/may/02/opinion/laoe-shah-20100502. Accessed 7 March 2011.
5. Butunyi C, Oloo E (2008) Alarm as residents turn mosquito nets into fishing gear. The
Daily Nation. Nairobi: Nation Media Group.http://www.nation.co.ke/News/regional//1070/498840/-/item/1/-/qanexj/-/index.html.
6. Minakawa N, Dida GO, Sonye GO, Futami K, Kaneko S (2008) Unforeseen misuses
of bed nets in fishing villages along Lake Victoria. Malar J 7: 165.
7. Korenromp EL, Miller J, Cibulskis RE, Kabir Cham M, Alnwick D, et al. (2003)
Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by
children under 5 years. Trop Med Int Health 8: 693703.
8. Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, et al. (2003) Impact of
permethrin-treated bed nets on entomologic indices in an area of intense year-round
malaria transmission. Am J Trop Med Hyg 68: 1622.

25

APENDICES

APENDIX I: WORK SCHEDULE

Activity

DEC

JAN

1. Finalizing research proposal

2. Seeking permission from Ministry of Health

4. Develop Research tools

5. Incorporation of experts comments

6. Pre-test and review the tools

7. Collect Data

8. Analyze Data and write report

9. Submit first draft of report

10. Incorporation of feedback or comments

11. Submission of final report

FEB

12. Disseminate and publicize findings

13. Monitoring and evaluation

26

APPENDIX II: Budget.

Payment
community

for

4 days of work with 1CHW per village

16000KSH

health @500KSH per day for per CHW per day

workers
Transportation
Accomodation
upkeep

3000KSH car hire for 2 days

and 5000 rent

6000KSH

7000

500 meals per day for 8 days

TOTAL

Ksh.31000

27

APPENDIX III: QUESTIONNAIRE

SOCIOCULTURAL PERSPECTIVES ON USE AND MISUSE OF INSECTICIDE

TREATED MOSQUITO NETS AMONG PEOPLE LIVING IN PEDO VILLAGE,
RARIEDA SUB-COUNTY, SIAYA

1. Study Area: ______________

2. Comp No: ______

Date: ____/____/_____

3. Name of Selected Household Respondent: _________________________No. of

Houses: _______

4. Respondent Age? ___________Respondent Gender _________ highest Educational

level___________

5. Main Respondent income Economic activities _____________________

6. How many people slept in the house last night?

Under 5 (0-5yrs) Over 5 (>5)

Pregnant
women

7. Can you show me the sleeping spaces you have in this house?

28

Bed___________ Mat ___________ Others

(specify)_____________________________________

8. Do you have bed net (s) in this household?[Yes/No] ___

9. If no, why not
Cost
Too Hot
Few Mosquitoes
Others (specify)_________________________________________________________
10. If yes, how many nets do you have? ____________
11. Has any household member had malaria in the past one month
__________
12. If yes, who was he/she?
M

U5

O5

PREGNANT

13) What were the symptoms?

Headache [

Fever [ ]
Vomiting [ ]

29

[Yes/No/DK]

Joint pains [ ]
Others specify .
14) What do you think caused malaria?
Inadequate nets [ ]
Too many mosquitoes [ ]
Ineffectiveness of nets [ ]
Others .
15) Did he/she go for treatment?
Yes [ ]
No [ ]
16) If so where did he/she go for treatment?
.
17) Did treatment work?
Yes [ ]
No [ ]
18) How can you tell that it worked?

19) If no, why do you think it didnt work?

30

20) What else was done, if treatment didnt work?

21) What are the different ways of preventing malaria?

Nets [ ]
Spraying [ ]
Others specify
22) Do you think nets can be effective in preventing malaria?
Yes [ ]
No [ ]
23) If yes, explain. If No, explain.

24) Are there other ways in which people put ITNs into use other than prevention of
mosquito bites?
Yes [ ]
No [ ]
DK [ ]
25) If yes enumerate with reasons why.

31

26) Who makes decisions on net use in this household?

Father [ ]
Mother [ ]
Others [ ]
27) Why is he/she the decision maker?

28) Who decides/provides resources for purchase of nets in this household?

Father [ ]
Mother [ ]
Others [ ]
29) Does this have an impact on who is to prioritize when nets are few? How?
Yes [ ]
No [ ]
30) Who is given priority of use when there are not enough nets for everybody in the
household?
Parents [ ]
Children [ ]
Others [ ]

32

Why?

..
30) Do you think there are categories of people who should always sleep under nets? If
so, who are they? Give reasons for your answer.

Thank the interviewee for his/her participation

Name of interviewer

Signature ...Date

..

33

34