Katuutu Hilda
Katuutu Hilda
Katuutu Hilda
KATUUTU HILDA
2013-BNS-TU-021
NOVEMBER 2016
1
DECLARATION
I declare that the work contained in this research report is mine and has never been presented before
any academic institution for any award.
KATUUTU HILDA
Signature ………………….……………………………
Date…………….……………………………………….
i
APPROVAL
This research report titled, “Knowledge, attitude and practices towards utilization of insecticide
treated mosquito nets in prevention of malaria among the residents of Namuwongo Zones A and
B”, was under my supervision as the University supervisor. It is now ready for submission.
Signature ……………………..………………………
Date………………..……………..…………………..
ii
DEDICATION
I dedicate this work to my parents Mr. and Mrs. Kawamara Mishac, my brother Kawamara Ronnie,
niece Kawamara Ariana and friend Baliremwa Sandra.
iii
ACKNOWLEDGEMENT
I thank my parents Mr. and Mrs. Kawamara Mishac and my brother Kawamara Ronnie for all the
financial and material support in my life and throughout this course. I also give a standing ovation
to their parental love to me. They have really been a cordial compliment to my life.
I applaud the efforts of my workplace superior Professor Tumwine Stanley for his parental,
administrative and moral guidance that have positively contributed to my success in my work and
study life.
I am grateful to my supervisor Mr. Kajjabwangu Ronald for his tireless efforts and enthusiasm that
have always encouraged me to carry on with this study. His advice was both parental and educative
which guided me positively in this study.
I appreciate the efforts of my friends and classmates; Baliremwa Sandra, Namusisi Zulaika, Batani
John, Birungi Patience and Wembabazi Hannah. They have been very instrumental in the
completion of this course. Their advice was very vital in overcoming the different challenges during
the course of study.
I acknowledge all the authors from whom the information that backed this study was got. Thank
you a lot for the efforts. God bless you all.
iv
TABLE OF CONTENTS
Declaration ............................................................................................................................................ i
Approval .............................................................................................................................................. ii
Acknowledgement .............................................................................................................................. iv
CHAPTER ONE
2.2.1 Knowledge of residents towards utilization of mosquito nets in prevention of malaria ............ 7
2.2.2 Attitude of residents towards utilization of mosquito nets in prevention of malaria ................ 12
v
2.2.3 Practices of residents towards utilization of mosquito nets in prevention of malaria .............. 19
4.2 Findings on the knowledge of respondents towards the utilization of ITNs in the prevention of
malaria................................................................................................................................................ 34
4.3 Findings on the attitude towards the utilization of ITNs in the prevention of malaria ................ 35
4.4 Findings on the practices of respondents towards the utilization of ITNs in the prevention of
malaria................................................................................................................................................ 37
REFERENCES .................................................................................................................................. 53
APPENDICES ................................................................................................................................... 53
vii
LIST OF FIGURES
viii
LIST OF TABLES
Table 2: Knowledge of respondents towards the utilization of ITNs in the prevention of malaria
N=276 ................................................................................................................................................ 34
Table 3: Knowledge of respondents towards the utilization of ITNs in the prevention of malaria ... 35
Table 4: Findings on the attitude towards the utilization of ITNs in the prevention of malaria ........ 36
Table 5: Findings on the attitude towards the utilization of ITNs in the prevention of malaria ........ 37
Table 6: Practices of respondents towards the utilization of ITNs in the prevention of malaria ....... 38
ix
OPERATIONAL DEFINITIONS
Attitude - This was the perception of respondents about the use of ITNs in the
prevention of malaria. It can be positive or negative.
Knowledge - This was the level of understanding respondents had on the use of ITNs in
the prevention of malaria.
Practice - This meant the different ways how respondents used ITNs in the prevention
of malaria.
x
ABBREVIATION OF TERMS
DDT - Dichlorodiphenyltrichloroethane
SP - Sulfadoxine - Pyrimethamine
xi
ABSTRACT
In several African settings, ITNs reduced the death of children less than 5 years by about 20%
(WHO, 2014). In Sub Saharan Africa (SSA), more than one malaria case occurred per 1000 which
accounted for 90% of global death and ITN use was less than 35% by 2014 in the region. This
indicates poor rate of ITNs use.
The main aim of the study was to assess knowledge, attitude and practices towards utilization of
insecticide treated mosquito nets in prevention of malaria among the residents of Namuwongo
Zones A and B.
The study employed a descriptive cross sectional study using quantitative method of data collection.
A total of 276 respondents were randomly selected and data was collected using interview guided
questionnaires.
The study found relatively good knowledge about ITNs use where; majority 259(94%) of the
respondents had ever heard of ITNs, and 243(88%) knew they were used to prevent malaria. A
slack awareness was evident where 179(65%) thought that shops and markets were the best places
to get ITNs while 193(70%) wrongly thought that ITNs were not retreatable.
Attitudes were generally negative, because majority believed that; 171(62%) it was not important to
sleep under an ITN every day, 160(58%) mosquitoes could still bite through ITNs, 152(55%) ITNs
could make it difficult for them to get up during the night, 171(62%) it took much time to tuck the
net each night, 166(60%) ITNs could lead to suffocation, 201(73%) ITNs had bad odour and
178(64%) drugs used to retreat ITNs were unsafe.
Practices were poor since; 152(85%) did not always check for holes in their ITNs, 120(67%)
displayed ITNs at time of convenience, 110(61%) did not have ITNs on all beds, 168(94%) never
retreated their ITNs and 118(66%) had untidy ITNs, 129(72%) households had no ITN hangs,
132(74%) had unfavourable sleeping arrangements to enable good display of ITNs, 104(58%) had
ITNs with holes, in 107(60%) households, ITNs were not folded and 113(63%) of the respondents
could not make a good illustration of ITN display.
In conclusion, respondents had fairly good knowledge about ITNs use, but with negative attitude
which could have led to the poor practice. The researcher therefore suggests that; government
should reinforce education to the public on the importance of ITN use in prevention of malaria so as
to change the attitude which will in turn improve on practice.
xii
CHAPTER ONE
1.0 Introduction
This chapter presents the background, problem statement, purpose, specific objectives, research
questions, significance and conceptual framework of the study.
1.1 Background
Insecticide-treated mosquito nets (ITNs) are a form of personal protection that repel and prevent
mosquito bites that would cause malaria (World Health Organization (WHO), 2012). Malaria is an
intermittent and remittent fever caused by a protozoan parasite that invades the red blood cells and
is transmitted by infected female anopheles mosquitoes in many tropical and subtropical regions
(Terefe, Ayanto and Gurmano, 2015).
ITN is one of the most effective and cost friendly malaria prevention measures (WHO, 2013a). This
is because it reduced malaria cases by 18% (262 to 214 million) and deaths from an estimated
839,000 in 2000 to 438 000 in 2015, a decline of 48% worldwide (WHO, 2015). Of these, 90%
deaths occurred in Africa (where ITNs were not properly used), 7% in South-East Asia and 2% in
Eastern Mediterranean Region (WHO, 2015). Malaria costs an estimated $12 billion in lost
productivity in Africa (Terefe et al., 2015) which made it imperative to study the utilization of
ITNs.
Globally the actual use of ITNs was 70-73% where 85% was in urban areas and 57% to 73% in
rural areas (WHO, 2014). In North America, ITNs use was 98% (WHO, 2012), in Latin America ie;
Guatemala, Chile and Bolivia, ITNs use was less than 50% in 2014 (Obol, Atim and Moi, 2013a).
In Asia, ITN use generally was at 68% where; in Saud Arabia, India, China, Japan and Korea, it
ranged between 65 and 88%. In Indonesia, Bangladesh, Kazakhstan and Turkmenistan, ITN use was
less than 50% (WHO, 2013b) and 90% in China malaria risky areas (China Centre for Diseases
Control and Prevention, 2011).
In Africa, ITNs reduced the death of children under 5 years by about 20% (WHO, 2014). Sub
Saharan Africa (SSA) had less than 35% ITN use, less than 5% of children slept under ITNs
(Sangare et al., 2012). Malaria accounted for 60% of outpatient visits, 30% of hospitalizations
among children under 5 years of age, and 11% maternal mortality (Vijayakumar et al., 2009) and
only 55% of the population accessed ITNs by 2014 (WHO, 2015).
1
In West Africa, ITN coverage was; Sierra Leone (87.6%), Togo (96.7%) and in the „Horn of Africa;
Ethiopia, Eritrea and Somalia (91%) (Bennett, 2014). The gap was; in 2014, an estimated 269
million of the 834 million (32.3%) people at risk of malaria in Sub-Saharan Africa lived in
households without any ITNs (WHO, 2015). Household ITN access was 56% in 2014 and 67% in
2015, usage was 46% in 2014, 55% in 2015 among children under 5 years (WHO, 2015). Up to 3.8
billion dollars could be saved over 10 years by increasing the lifespan of nets from 3 years to 5
years (Uganda Malaria Indicator Survey (UMIS), 2012).
In East Africa, ITNs use was 30-50% and below 5% in rural areas (Abol et al., 2013). In Tanzania,
ITNs use was less than 35% (Mazigo et al., 2010), in Kenya malaria was estimated at 18% of
outpatient consultations and 6% of hospital admissions, about 80% of the population was at risk for
malaria due to low ITN use, 27% (about 12 million people) lived in areas of epidemic and seasonal
malaria transmission. Uganda ranked 3rd in malaria deaths in Africa with 52% in children (Obol,
Atim and Moi, 2013a). ITNs use was 35% in households, 43% in children under age 5, and 47% in
pregnant women, 10% in the rest of the population (WHO, 2014). There were 28% of households
who had at least one net for every two people (UDHS, 2011) and only 8% of households had three
or more ITNs which fell far short of the 2010 target of 50% (UBOS, 2010).
ITNs use in Namuwongo Zone was low basing on evidence that over 60% of hospital visits to
Kisugu Health Centre III located in Namuwongo were malaria cases. This made it necessary for the
researcher to carry out this study to assess the knowledge, attitude and practices of the community
members towards the utilization of ITNs in the prevention of malaria since it is the most cost
effective method of malaria control as per the standard of living of people in the area.
The Ministry of Health distributes ITNs free of charge to all people especially the vulnerable groups
that included children under 5 years and pregnant mothers in their communities (MOH, 2012).
There were two methods for malaria control especially during pregnancy. These were
2
chemoprophylaxis using sulfadoxine - pyrimethamine (SP) and ITN use (MOH, 2014). Despite
those efforts, malaria was still prevalent.
If ITN use is not given adequate attention; outpatient burden, hospital admissions and inpatient
deaths may increase in the area and other parts of the country with the same problem. A positive
move may enhance the social and economic development of communities. This thus attracted the
researcher to carry out this study to contribute to sustainable control of the disease.
ii. To assess the attitude of Lower Namuwongo Zone residents towards utilization of mosquito
nets in prevention of malaria.
iii. To examine the practices of Lower Namuwongo Zone residents towards utilization of
mosquito nets in prevention of malaria.
ii. What is the attitude of Lower Namuwongo Zone residents towards utilization of mosquito nets
in prevention of malaria?
iii. What are the practices of Lower Namuwongo Zone residents towards utilization of mosquito
nets in prevention of malaria?
3
1.6 Significance of the study
The study findings will help the Ministry of Health get more information about ITNs utilization and
this will assist in allocating adequate resources aimed at increasing ITNs coverage and use. This
will include delivering more free of charge ITNs to communities most especially those most hit by
malaria.
The ministry will also base on the results to reinforce information dissemination about the
prevention of malaria through ITN utilization. This could be through empowering residents‟
knowledge, attitude and practices towards mosquito net use in malaria prevention by using the
different mass media channels; such as televisions, radios and newspapers.
The study findings will be based upon by policy makers to design appropriate policies that will help
to increase mosquito net use. For instance, giving free mosquito nets to every malaria patient
discharged from the health centres and following them up in their communities to ensure proper
ITNs use.
Also the findings will help the health care service providers assess the level of knowledge, attitude
and practices of patients towards mosquito net use in the prevention of malaria and apply the
necessary help. This could be through advising them about better ways of using ITNs; such as when
the net should be displayed, how it should be hanged, when and how to be retreated among other
issues. This will improve service delivery thus clients satisfaction.
Society members who will access study findings will have better awareness about the knowledge,
attitude and practice gaps that hinder them to effectively use ITNs to prevent malaria. This will be
based upon to adapt the recommended knowledge, attitude and practice for better malaria
prevention.
Results will be a source of reference that will help other researchers, students and other individuals
who may undertake similar studies about ITNs use and malaria prevention.
Findings will help the researcher to identify the level of knowledge, attitude and practices of the
community members towards ITNs use which information will be based on to know the general
population utilization of ITNs. It will be upon this that the researcher will develop recommendations
that will be suitable to increase ITN use in the study area.
4
1.7 Conceptual framework of the study
Figure 1: Conceptual Framework of the study
Independent Variable Dependent Variable Independent Variable
Knowledge and attitude towards ITN utilization were the independent variables that led to practice
which was the dependent variable.
Indicators of knowledge were; ITNs use was one of the most effective malaria control methods,
regularity of sensitization about ITN use, sources and mode of information dissemination about
ITNs use, information about where to procure good ITNs, source of ITNs and retreating drugs,
awareness of maintenance of ITNs, knowledge about ITNs lifespan, familiarity with retreating
drugs and their importance, and characteristics of ITNs (repelling and barring mosquitoes).
Indicators of attitude were; belief that malaria could be prevented by sleeping under ITNs, cultural-
social perception of ITNs, perception about drugs for retreating ITNs, a mind-set that ITNs caused
5
suffocation, a thought that mosquitoes could still pass through ITNs, a feeling that ITNs caused skin
itching, preference to the source where ITNs were acquired from, a belief that retreating chemical
were poisonous, a mind-set that ITNs were sold at unfair prices and sensitivity to odour.
Indicators of practice were; possession of ITNs, maintenance of ITNs, way of displaying ITNs,
effective and regular use of ITNs, time of displaying ITNs, actual retreating of ITNs and periods of
retreating, way of drying ITNs after wash and folding of ITNs after sleep.
6
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction
This chapter presents information reviewed from acknowledged studies by scholars, researchers,
reporters and academicians among others. This was cited in relation to study specific objectives that
included; examining the level of knowledge, assessing the attitude and practices of residents
towards utilization of mosquito nets in prevention of malaria.
In developing countries, malaria problem became more critical with the development of multi-drug
resistance in P. falciparum, vector resistance of Dichlorodiphenyltrichloroethane (DDT) and Organo
Phosphorous (OP) compounds of insecticides (WHO, 2015).
This development made the governments to direct their efforts to developing vector control
programs. These included; selective spraying, personal protection methods including Insecticide
Treated Nets (ITNs) that could be carried out by the communities themselves within the primary
health care system in conformity with the global malaria control strategy of WHO and environment
protection strategies (Myat et al., 2014). There was inadequate time and funding to study the
behaviour of vector mosquitoes and vector resistance to insecticide. So, locally appropriate vector
control strategy was needed to allow cost effective vector control. ITNs were considered as an
added tool in combating malaria since it was very effective, had very negligible adverse effects and
cost friendly (Njau et al., 2013).
7
ITNs and knew ITNs as one of the most effective malaria preventive strategy if used regularly
(Evlampidou et al., 2013). They knew ITNs were supposed to be retreated after some use and could
properly illustrate how to hang an ITN.
8
2.2.1.1.5 Knowledge about how to use ITNs
Audrey et al. (2009) in a study done in central Africa on free distribution of insecticide treated bed
nets to pregnant women in Kinshasa, Democratic Republic of Congo (DRC) revealed that, majority
of the respondents had good knowledge on the practices that influenced the durability of ITNs.
They knew that having good sleeping arrangements, proper hangs, and well furnished houses
favored the durability of ITN and vice versa. This was because they knew the basic requirements for
effective ITNs use which knowledge was acquired from the health education talks during hospital
visits.
9
retreating an ITN. They did not know ITNs were supposed to be retreated between 6 to 9 months or
after 10 to 20 washes.
In a study on knowledge, attitudes and practices on malaria prevention in project areas of malaria
centres of OVHA (Orissa Voluntary Health Association) carried out in Pakistan, out of 256
respondents, majority 221(86.3%) had low knowledge about ITNs use. The 221 respondents did not
use ITNs and presented low knowledge about ITNs utilization. Majority 69(31.2%) did not use
ITNs because they did not know about them, 67(30.3%) did not have ITNs (Dutta, 2012). They did
not know the right places from where to buy ITNs. Majority thought that a genuine ITN can be
acquired from any where such as markets. All the respondents reported that they had inadequate
sensitization and education about ITNs partially due to unreliability of health care services in rural
areas.
2.2.1.2.4 Misuse
Minakawa et al. (2008) in a study on unforeseen misuses of bed nets in fishing villages along Lake
Victoria posed low knowledge about the use of ITNs. They revealed that, there were weaknesses in
information dissemination and communication activities in some areas near water bodies during
ITNs distribution campaigns. This lowered the value that community members placed on the correct
use of nets as some thought that even if they do not sleep under ITNs, they would not suffer from
malaria.
10
2.2.1.2.4 Life span of ITNs
In a study in Gambia, on awareness and knowledge about Insecticide Treated Nets (ITNs) amongst
pregnant mothers, knowledge about ITNs use was relatively low. Out of 256 respondents studied,
166 (64.8%) had heard about ITNs. Among them, 54.7% did not know the life span of ITNs.
Although 174 (68%) of the respondents had heard about ITN tablets, most of the respondents did
not know where they could buy the tablets for retreating the ITNs (83.6%) (Runsewe-Abiodun et al,
2012). Also in a study in Oromia and Amhara regional states, Ethiopia, some respondents never
knew where to procure ITNs from as illustrated by 32.5%, and 38(8.7%) of the respondents did not
think that they needed ITNs (Baume et al., 2009).
In a study on free distribution of insecticide treated bed nets in Kinshasa, majority of the
respondents had low knowledge on the durability of ITNs because they could not actually tell the
life-span of ITNs. Majority revealed that it could last for 3 months while the least 28.1% reported 6-
9 months which was a low lifespan yet it could last beyond one year according to WHO standards
(Audrey et al., 2009).
11
2.2.1.2.7 Light threatens mosquitoes
In a study about the utilization of insecticide treated nets in households with children under 5 years
in Muhorro Sub County, Kibaale District, Uganda, respondents had low knowledge on utilization of
ITNs in the prevention of malaria. They thought that, sleeping in a room with electricity would not
necessitate them to use ITNs because mosquitoes would be scared away by the light and heat
(Bashinyora, 2010).
2.2.2.1 Believed that it was comfortable for the to sleep under ITNs
In a descriptive study on the assessment of knowledge, attitude and practice about malaria and ITNs
utilization among pregnant women in Shashogo District, Southern Ethiopia, Fuge, Ayanta and
Gurnamo (2015) showed that, attitude towards ITNs use was positive. It was found out that, 70% of
the respondents perceived ITNs use was comfortable and saved them from malaria infection.
Majority who had suffered from malaria in the recent past revealed that ITNs use was not as a
discomfort as suffering from malaria.
Nkondjio et al. (2013) in a study on the impact of cyfluthrin (Solfac EW050) impregnated bed nets
on malaria transmission in the city of Mbandjock, Cameroon found out that, majority of the
12
respondents who had receive enough education about ITNs use knew that ITNs, if used properly
could not lead to suffocation. They revealed that ITN users who suffocated had other health
complications.
13
believed that no mosquito could pass through an ITN in good condition. Majority 96% of the
respondents who possessed ITNs were willing to continue using them (Obol et al., 2013b).
14
2.2.2.10 Itching of ITNs
It was believed that ITNs itched some of the users. A study in Piron, Mali, on use of Insecticide
treated nets following a malaria education intervention by Rhee et al. (2005) observed that, majority
of the respondents had negative attitudes towards ITNs use among children. They believed that they
itched them and caused excessive heat which made them cry. The parents were disturbed by the
noise which disrupted their sleep. So they left them to sleep without ITNs which portrayed negative
attitude.
2.2.2.12 A feeling that one has enough information about ITNs use
A prospective study by Skarbinski et al. (2011) on the impact of health facility-based insecticide
treated bed net distribution in Malawi, found out that respondents showed poor attitude towards
acquiring additional information about ITNs use. This was because they did not need any more
information about malaria because they had heard it before. This was not good attitude because
malaria prevention trends change over time and thus the need to always get updated information.
In a study that assessed the level of knowledge, attitude and practices of pregnant women
concerning the use of ITNs in Anambra State, South-east Nigeria, majority of the respondents
refused to use ITNs due to misconceptions from their neighbours which led to negative attitude.
These included suffocation, skin itching and irritation (Ukibe et al., 2014). Similar findings were in
a study carried out in Bhutan where respondents reported itching after using ITNs (Zangypo et al.,
2011). Itching from the use of ITNs could result from the chemical components or as a
manifestation of hypersensitivity reaction from the physical component of the nets.
15
2.2.2.13 Increased Heat
A study on international population movements and regional Plasmodium falciparum Malaria
elimination strategies done in Ghana, found negative perceptions about sleeping under a bed net
among the respondents. These included; too much heat at night was due to sleeping under ITNs,
mosquitoes could still bite through ITNs and bed nets could not allow in enough air which led to
suffocation (Tatem and Smith, 2010). However, most of the respondents that gave such answers
based their fears on rumours and misconceptions hence negative attitude.
Iwashita et al. (2010) in a study on sleeping arrangement and house structure effect on bed net use
in villages along Lake Victoria, revealed that majority of the respondents had poor attitude on the
use of ITNs. Majority thought that ITNs increased bed temperatures and this was a general problem
in most homesteads in the study which was feared to increase if they slept under ITNs.
According to Ukibe et al. (2014) in a study in Anambra state, South-East Nigeria, findings showed
negative attitude. Out of 420 respondents who owned nets, 235 (56%) refused to use them. They
had a mind-set that, they had inadequate space to hang nets, their houses had door and window nets
16
thus did not need any other nets, ITNs did not work (Kilian et al., 2013), nets caused itching, heard
ITNs killed someone as also reported by Isah and Nwobodo (2009).
According to Magha et al. (2013) in nationwide studies on ownership and use of ITNs in Sub
Saharan Africa, there were high doubts about the effectiveness of ITNs in the prevention of malaria.
Participants mentioned that some people slept under mosquito nets but their children still died of
17
malaria. They revealed that, whether mosquito nets helped in the prevention of malaria or not
remained a myth to them.
2.2.2.23 A perception that some people are too strong for ITNs
Some respondents especially males believed that they were too strong to be infected by malaria
which did not necessitate them to use ITNs as observed in a study in Eastern Rwanda by Kateera et
18
al. (2015). This showed a negative attitude towards ITNs use. As a result, they believed that
sleeping under ITNs daily was not necessary which predisposed them to malaria infection.
19
94% used and regularly washed them. They used them all seasons through even if mosquitoes were
not plenty.
In a study on use of insecticide treated nets by pregnant women and associated factors in a pre-
dominantly rural population in northern Ethiopia, practice on use of bed nets and ITNs was reported
to be high. Mebrahtom and Wakgari (2008) revealed that, 97.7% of the respondents owned bed nets
and 94% were sleeping inside the nets and took enough time to hang them properly. ITNs use was
more among pregnant mothers who knew the importance of ITNs right from the information given
during antenatal care.
21
washed ITNs twice in a year. This made them very dirty and uncomfortable to sleep in. This
increased the chances of malaria infection among people in malaria infested areas.
2.2.3.13 Hanging
Findings from two cross-sectional surveys in thirteen malaria endemic districts of Bangladesh
entitled, „free distribution of insecticidal bed nets improved possession and preferential use by
households‟ carried out by Ahmed et al. (2011) found out that, 51% of the respondents did not own
ITNs and 71% did not sleep under ITNs the night before data collection and 75% reported irregular
use of ITNs. They did not use ITNs because they felt inconvenienced with the daily hanging of
ITNs yet not all days mosquitoes were plenty.
22
2.2.3.15 Number of ITNs in the household
Still in Iran, Hanafi-Bojd (2011) in a study on the knowledge, attitudes and practices regarding
malaria control in an endemic area of southern Iran Asia, despite a high bed net coverage, over 25%
of members reported not to have slept under a bed net the night before the survey. Some males
irregularly used ITNs because they had fewer nets compared to the number of household members.
Household socio-economic status, number of bed nets, type and amount of sleeping spaces were
key determinants of bed net use (Wiseman et al., 2007).
Yukich et al. (2009) in a study on costs and cost-effectiveness of vector control in Eritrea using
insecticide-treated bed nets noted that, 93 % of the houses visited had no ceiling, structures onto
23
which nets were usually hung. It was plausible that lack of a place to hang or a need to improvise,
such as by tying a long string from wall to wall onto which a net could be secured as well as
difficulty in securing nets around floor-based sleeping arrangements, were some reasons for reduced
likelihood of bed net use. Lack of bed net hangings increased the likelihood of poor bed net use.
24
2.2.3.23 Time of display
Matovu et al. (2009) in a study on equitability of bed net ownership and utilization in Tanzania
reported that, in homes that used candles, ITNs easily developed holes. This was because they
easily caught fire as these people were preparing their beds for sleep. Some respondents preferred
displaying their ITNs during the day when they had good sight of their beds than in the dark during
night when they did not have reliable sources of light. This was dangerous because it provided
chance for mosquitoes to hide in the nets.
In conclusion, majority of the respondents in the above studies had good knowledge about ITNs in
prevention of malaria, however they had negative attitude towards ITNs use which translated into
poor practice thus high malaria prevalence despite health sector measures that included distribution
of free ITNs.
25
CHAPTER THREE: METHODOLOGY
3.0 Introduction
This chapter includes; research design, source of data, study setting, sample size calculation,
sampling technique, sampling procedure, study variables, inclusion criteria, exclusion criteria, data
collection techniques, data collection instruments and measurement, data collection procedure, data
analysis, quality control, dissemination of the study results, ethical issues and limitations of the
study.
Descriptive cross sectional study design helped the researcher to collect data at a point in time about
the current use of ITNs in Namuwongo Zones A and B using interview guide questionnaires. The
study was carried out from 2nd July to 16th July 2016. This eventually enabled the researcher to
describe findings about knowledge, attitude and practices of respondents on the utilization of ITNs
with frequencies.
3.2.1 Primary data; Here information was derived directly from the respondents by use of
structured interviews using structured interview guided questionnaires and observation checklist.
The researcher observed the study participants for a period of 2 weeks during which the study was
carried out.
3.2.2 Secondary data; This was information from acknowledged studies in relation to the study.
These mainly included; on-line journals, electronic books, library books, research dissertations,
learning websites, etc.
26
divided into seven zones namely: Industrial Area View, Go-Down, Kasanvu, Namuwongo A,
Namuwongo B, Kanyogoga/Masengere and Yoweri Kaguta (YOKA). These zones had over 20,000
people living in very confined spaces, averaging 2 rooms for a family of at least 4 members
(Tenywa, 2013).
The area was bordered by Lugogo to the north, Nakawa to the northeast, Kiswa and Bugoloobi to
the east, Muyenga to the southeast, Kisugu and Kabalagala to the south, Kibuli to the west and
Kololo to the northwest (Kamukama, 2012). The neighborhood is located approximately 6
kilometres (3.7 mi), by road, southeast of the Kampala City. The coordinates of Namuwongo are:
0°18'29.0"N 32°36'44.0"E (Latitude: 0.308050; Longitude: 32.612223) (Nasasira, 2014).
n= 892
1 + 892(0.05x0.05)
n= 892
1+ 892(0.0025)
27
n= 892
1+ 2.23
n= 892
3.23
n= 276 respondents
3.6 Sampling
3.6.1 Sampling Technique
The study used probability sampling to select respondents where every individual in the population
had an equal chance of being selected. The researcher used simple random sampling to select the
respondents from their homes. This method was very fair, unbiased and easy to carry out.
Indicators of knowledge were; ITNs use was one of the most effective malaria control method,
Regularity of sensitization about ITN use, sources and mode of information dissemination about
ITNs use, information about where to procure good ITNs, source of ITNs and retreating drugs,
awareness of maintenance of ITNs, knowledge about ITNs lifespan, familiarity with retreating
drugs and their importance, and identifying the characteristics of ITNs (repelling and barring
mosquitoes.
Indicators of attitude were; a belief that malaria could be prevented by sleeping under ITNs,
cultural-social perception of ITNs, perception about drugs for retreating ITNs, a mind-set that ITNs
caused suffocation, a thought that mosquitoes could still pass through ITNs, a feeling that ITNs
28
caused skin itching, preference to the source where ITNs were acquired from, a belief that retreating
chemical are poisonous, a mind-set that ITNs are sold at unfair prices and sensitivity to odour.
Indicators of practice were; possession of ITNs, maintenance of ITNs, way of displaying ITNs,
effective and regular use of ITNs, time of displaying ITNs, actual retreating of ITNs and periods of
retreating, way of drying of ITNs after wash and folding of ITNs after sleep.
29
In homes where one of the two was found, the local administrator introduced the researcher and the
latter informed the home member of the study and its purpose then sought for the consent to
participate in the study. Strict confidentiality to all information received was assured to the
respondents before interviewing. Members who consented were interviewed and then moved to the
next household.
30
mosquito net use. The questionnaire was administered to different respondents to which helped to
validate the responses from the questions according to the objectives. After the assessment of the
interview guided questionnaire, the necessary adjustments were made bearing in mind the
objectives of the study. Then a Content Validity Index (CVI) was computed using the following
formula.
31
3.15 Limitations of the study
The researcher faced the following challenges during the course of the study
Some respondents withheld information regarding mosquito net use because they feared being
ashamed of improper ITNs use.
Poor weather conditions disturbed the researcher during home to home data collection. This
prolonged the time of study completion.
Study completion was delayed by the reluctance of some respondents to answer the required
questions in time.
32
CHAPTER FOUR: RESULTS
4.0 Introduction
This chapter presents the findings of the study based on the specific objectives that included;
assessing knowledge, attitude and practices of community members in Namuwongo Zones A and B
in the utilization of ITNs in the prevention of malaria in the study area.
33
Out of the 276 respondents that participated in the study, majority; 206(75%) were females,
100(36%) were between 18 and 30 years, 168(61%) were married, 179(65%) were housewives, and
124(45%) had primary level of education.
4.2 Findings on the knowledge of respondents towards the utilization of ITNs in the
prevention of malaria
Table 2: Knowledge of respondents towards the utilization of ITNs in the prevention of malaria
N=276
Indicators Category Frequenc Percent
y
Respondents had ever heard of Yes 259 94
ITNs No 17 6
Source of information about ITN Health workers and 74 79
use community leaders
Family members and 20 21
friends
Had routine education about ITN Yes 52 19
use in their communities No 224 81
Uses of ITNs Prevention of malaria 243 88
For fishing, wedding,
33 12
covering crops etc.
Best sources of ITNs Shops, markets 179 65
Pharmacy, Drug shop, and
97 35
health centre
Characteristics of a good ITN Should cover the whole bed,
sized holes to block 226 82
mosquitoes, repel mosquitoes
Majority 259(94%) of the respondents had ever heard of ITNs, 177(64%) were educated about
ITNs, 243(88%) knew that ITNs were used to prevent malaria, 179(65%) thought that shops and
markets were the best places to get ITNs, and 193(70%) never knew that ITNs were retreatable.
34
4.2.1 Measure of the independent variables (slept under ITNs in the last seven days before the
study)
The study found out that out of 276 respondents that were included in the study, 179 respondents
regularly used ITNs while 97 never regularly used them. The researcher decided to measure the
utilization of ITNs in the prevention of malaria by comparing those who slept under ITNs in the last
seven days before the study against those that didn‟t.
H-ITN Had slept under ITNs in the last seven days before the study
35
NH-ITN Never slept under ITNs in the last seven days before the study
Bivariate analysis from the table above shows that respondents‟ knowledge towards helmet was
highly associated with its use. Findings showed that, the following factors were significant; could
make good display of ITNs (P=0.0000), characteristics of a good ITN (P=0.0000), when should an
ITN be displayed (P=0.0000), it was necessary to fold an ITN (P=0.0000) and routine education
about ITN use in their communities (P=0.0076), awareness about life span of an ITN (P=0.0000)
and uses of ITNs (P=0.0356). However, knowing the best sources of ITNs and having knowledge
about retreating ITNs were not significant factors in the use of ITNs.
4.3 Findings on the attitude towards the utilization of ITNs in the prevention of malaria
Table 4: Findings on the attitude towards the utilization of ITNs in the prevention of malaria
N=276
36
Majority 243(88%) of the respondents agreed that ITNs were beneficial, 265(96%) believed ITNs
prevented against mosquito bites, 235(85%) agreed that ITNs should be free of charge and
255(92%) said ITNs should be sold at affordable prices.
However, some respondents had negative attitudes towards ITNs use in the prevention of malaria,
where; 171(62%) believed that it was not important to sleep under an ITN every day, 254(92%) did
not believe that ITNs prevented annoyance from mosquitoes, 160(58%) had a mind-set that
mosquitoes could still bite through ITNs, 152(55%) believed ITNs could make it difficult for them
to get up during the night, 171(62%) believed that it took much time to tuck the net each night,
166(60%) believed that ITNs could lead to suffocation, 201(73%) were irritated by the ITN odour,
and 178(64%) believed that drugs used to retreat ITNs were unsafe.
Table 5: Findings on the attitude towards the utilization of ITNs in the prevention of malaria
N=276
Attitude
Slept under Never Total P-value
ITNs slept
under
ITNs
ITNs as one of the most Yes 170 70 240 87 1.84562E-07
effective tools in No 09 27 36 13 (0.0000)
malaria prevention
Everybody should Yes 76 15 91 33 7.62355E-07
sleep under an ITN No 93 82 185 67 (0.0000)
ITNs could not lead to Yes 89 21 110 40 3.618E-06
suffocation No 90 76 166 60 (0.0000)
Thought that drugs Yes 108 08 116 42 3.57486E-17
used to retreat were No 71 89 (0.0000)
160 58
safe
179 97 276 100
The study found out that ITNs were among the most effective tools in malaria prevention
240(87%) with a significance level of (P=0.0000), they also believed that everybody should
sleep under an ITN 185(67%) (P=0.0000), they 166(60%) wrongly believed that ITNs could
lead to suffocation (P=0.0000) AND 160(58%) of the respondents believed that drugs used to
retreat ITNs were unsafe (P=0.0000)
37
4.4 Findings on the practices of respondents towards the utilization of ITNs in the prevention
of malaria
Table 6: Practices of respondents towards the utilization of ITNs in the prevention of malaria
N=276
38
Majority 179(65%) currently slept under ITNs at the time of the study, 72(40%) of the
respondents got ITNs from shops, 70(39%) had slept under ITNs for months, 140(78%) washed
their ITNs, 152(85%) did not always check for holes in their ITNs, 120(67%) displayed ITNs at
time of convenience, 110(61%) did not have ITNs on all beds, 98(55%) households ITNs were
not only on children‟s beds but even on other beds, 168(94%) never retreated their ITNs and
washing was done after months as reported by 63 (45%).
There were 179 respondents out of 276 who slept under ITNs in the last seven days before the
study. In 129(72%) households had no ITN hangs, 132(74%) had unfavorable sleeping
arrangements to enable good display of ITNs, 104(58%) had ITNs with holes, in 98(55%)
households, ITNs had holes and were mended, 118(66%) had untidy ITNs, in 107(60%)
households, ITNs were not folded and 113(63%) could not make a good illustration of ITN
display.
39
CHAPTER FIVE: DISCUSSION OF RESULTS
5.0 Introduction
This chapter presents the discussions of results. They are based on study findings in relation to the
study specific objectives.
Routine education about ITN use was one of the significant factors (P=0.0076). Majority 259(94%)
of the respondents had ever heard of insecticide treated mosquito nets and 243(88%) knew that they
were used to prevent malaria. This implied good knowledge on use of ITNs because ideally an ITN
is designed to prevent malaria by acting as a barrier to mosquitoes during sleep. Since malaria is
caused by parasites spread by anopheles mosquitoes through biting, use of ITNs prevents mosquito
biting and thus malaria prevention. Respondents who had that knowledge had higher chances of
avoiding malaria infection compared to others who never had. Similarly, Evlampidou et al. (2013)
in a study in Evrotas, Laconia, Greece, also found out that respondents had high knowledge about
ITNs as one of the most effective malaria preventive strategies if used regularly. However, the
results are not in line with a study carried out by Luyiga (2013) in Uganda among districts of
Mukono, Jinja, Mbarara and Arua, who found relatively low knowledge about ITNs use as an
effective way to prevent malaria. Nearly half (51.7%) of the urban respondents did not know that
the use of nets was the most effective way to prevent malaria.
Policy implication: despite the fact that most respondents knew that ITNs were used to prevent
malaria, the Ministry of health should ensure that all community members know about the different
malaria preventive measures because malaria is the commonest illness in Uganda.
40
Being aware of the time an ITN should be displayed was associated with utilization of ITNs
(P=0.0000). Majority 234(84%) knew the time when an ITN should be displayed. Most of the
respondents with ITNs knew that an ITN should be displayed when one is entering the bed which
was right knowledge.
Policy implication: Having good knowledge about the time and way of displaying the ITNs should
be a government initiative through the different health talks through the health care service
providers.
Having facts about the necessity of folding ITNs was highly associated with the utilization of ITNs
in the prevention of malaria (0.0000). This was due to the fact they had received education about the
utilization of ITNs. Knowing that an ITN should be folded implied that the users realized its
importance where it would be kept free of ITNs.
Most of the respondents could explain how to display an ITN which was good knowledge about the
utilization of ITN. This was associated with ITN use (P=0.0000). This was because most of them
had received education about ITN use thus knew how to use them.
Policy implication: the Ministry of Health should disseminate information about ITN use through
printing brochures, flyers, calendars, and magazines among other media so that people can learn
how to display ITNs.
There were 193(70%) of the respondents who never knew that ITNs were retreatable and 53(64%)
thought that ITNs were supposed to be washed more than 20 times before retreating which was low
knowledge. Retreating and minimum washing (between 10 to 20 times before retreating within six
months) could maintain ITNs with properties that repel mosquitoes and thus minimize mosquito
bites. If an ITN is frequently washed, it loses its tone making it easy to get torn and at the same
time, loses drugs that repel mosquitoes. Similarly, in a study done in Myanmar, San et al. (2013)
found out that majority of the respondents had low knowledge about retreating ITNs though most of
them had ever heard of ITN tablets. Also 83.6% did not know where they could buy the ITN tablets
because they had received inadequate training on ITNs use. Also in a study by Luyiga (2013) in
Uganda among districts of Mukono, Jinja, Mbarara and Arua, found out that, some respondents
from low income families never knew that ITNs were retreatable. However, Evlampidou et al.
(2013) in a study done in Greece, found out that respondents knew that ITNs were supposed to be
retreated after some time of use and could properly illustrate how to hang an ITN.
41
Majority 179(65%) of the respondents thought that shops and markets were the best places from
where to buy ITNs. This showed low knowledge which could lead respondents to buy ITNs of poor
quality because not all shops and markets sell genuine products. Also majority of the shop keepers
do not have adequate knowledge on the products they sell, thus they could lack facts about the good
ITNs and how to use them. Further still, shops and markets have different products and if put
together with ITNs could reduce their efficacy and thus lower their quality to perform the desire
purpose. Similarly, Dutta (2012) noted that respondents did not know the right places from where to
buy ITNs. Majority thought that a genuine ITN can be acquired from any where such as usual
markets. However, in a study done in Sierra Leone in West Africa, Bennett et al. (2012) found that,
majority 66.7% knew the right places where to buy ITNs from. They knew ITNs could be bought
from pharmacies where there were health workers who could educate them about their right use.
Policy implication: Despite the fact that the government ensures provision of ITNs to the vulnerable
people such as children and pregnant mothers in health facilities, the health care providers should
also take the initiative to always provide free of charge ITNs in communities and even have
subsidized ITNs in health facilities under the cost sharing program in health care. The government
should also regulate on the laws regarding importation of ITNs basing on their quality. Also ITNs
should be produced locally to save the amount of money spent on importing them since malaria is a
problem that will not stop in Uganda since mosquito breeding is very difficult to control.
5.1.2 Discussion of findings on the attitude towards the utilization of ITNs in the prevention of
malaria
The study found out that ITNs were among the most effective tools in malaria prevention 240(87%)
with a significance level of (P=0.0000), they also believed that everybody should sleep under an
ITN 185(67%) (P=0.0000), they 166(60%) wrongly believed that ITNs could lead to suffocation
(P=0.0000) and 160(58%) of the respondents believed that drugs used to retreat ITNs were unsafe
(P=0.0000)
Majority 265(96%) of the respondents believed that ITNs prevented against mosquito bites and
243(88%) agreed that they were beneficial to the users and believed that everybody should sleep
under an ITN 185(67%) (P=0.0000). This was positive attitude because ITNs repelled and barred
mosquitoes from reaching the users during sleep. There was low malaria incidence among
respondents who were currently using ITNs as compared to others who never used them. This
implied that they had less expenditure and more time for work compared to those who had malaria.
42
Similarly in a study in Shashogo District, Southern Ethiopia, Fuge et al. (2015) found positive
attitudes towards ITNs use whereby 70% of the respondents perceived ITN use as beneficial
because it saved them from malaria infection. In contrary Ukibe et al. (2014) in a study in Anambra
state, South-East Nigeria, findings showed negative attitude on the effectiveness of ITNs as they
believed that mosquitoes could still bite through ITNs.
Policy implication: the government should emphasis on disseminating information on the need for
everyone to regularly use ITNs because they are effective in prevention of malaria. The government
should also ensure that good quality ITNs that do not easily tear are allowed on the market. This
will attract the public to develop positive attitude towards their use.
A good number of respondents 235(85%) agreed that ITNs should be free of charge or be sold at
affordable prices so that every community member gets access to them. This indicated positive
attitude because this would attract more community members to possess and use ITNs. Similarly, in
a study done in Sierra Leone, Eisele et al. (2009) in a cross-national analysis of 15 survey datasets,
having sufficient intra-household access to an ITN, defined having more than one ITN per two
household occupants, as a strong determinant of individual use of ITNs. Households in Sierra Leone
with more than 5 people were less likely to have sufficient ITNs to occupant ratios though they
were free of charge. In contrary a study carried out in Ethiopia by Fuge (2015) showed that, ITNs
were sold at unfair prices and this could potentially have discouraged them from buying ITNs.
Policy implication: despite the fact that the government freely distributes ITNs to the public, a few
people access them and it done on an irregular basis. There are malpractices in the distribution
program where a single person can get more than 5 ITNs while there are people that go without any
which all jeopardize malaria prevention program.
Poor attitude was shown where 171(62%) did not believe that it was important to sleep under an
ITN every day and 254(92%) did not believe that ITNs could prevent annoyance from mosquitoes.
To ensure effective malaria prevention, ITNs should be properly used daily to minimize chances of
mosquito bites. Irregular use of ITNs led to malaria infection which blame was shifted to quality of
ITNs which was not ideally right. In relation, a study done in Eastern Rwanda by Kateera et al.
(2015) showed that majority of the male respondents had negative attitude towards ITNs use. This
was because they believed that sleeping under ITN was not necessary because they were too strong
to get malaria from mosquito bites. Also Singh et al. (2013) in nationwide studies on ownership and
43
use of ITNs in Sub Saharan Africa, found high doubts about the effectiveness of ITNs in the
prevention of malaria. Participants mentioned that some people slept under mosquito nets but their
children died of malaria. However, a study in Nigeria, Runsewe-Abiodun et al. (2013) revealed that
majority 139 (54.3%) perceived that malaria could be prevented if one slept inside a mosquito net,
221(86.7%) believed that sleeping inside an ITN at night reduced mosquito bites and 192(75%)
expressed willingness to buy ITNs if they did not get one for free.
Suffocation was among the most feared side effects of sleeping under an ITN as reported by
166(60%) respondents (P=0.0000). Medically, an ITN is designed to allow enough fresh air to
enable good respiration. It could be that respondents, who suffocated when they used ITNs, had
other health complications or never followed the proper instructions of using an ITN. Similar
findings by Khumbulani et al. (2009) in a study carried out in Swaziland showed that, different
people were allergic to different things in their environment where smell was one of the major
allergies people had. On the contrary, Antonio-Nkondjio et al. (2013) in a study done in the city of
Mbandjock, Cameroon found out that, majority of the respondents who had received enough
education about ITNs use knew that if used properly, ITNs could not lead to suffocation. They
revealed that ITN users who suffocated had other health complications.
Policy implication; the government should ensure that they make enough research about the
complaints such as inadequate aeration of the ITNs and suffocation to discover the cause of the
problem because ideally suffocation is not one of the challenges an ITN user expected to find. It
could be that these people use them wrongly which causes them complications.
Most 160(58%) of the respondents believed that drugs used to retreat ITNs were unsafe (P=0.0000).
They thought that if the drugs can repel a stubborn mosquito, then what of human life. They
believed that drugs could cause lung cancer and other respiratory difficulties. This was negative
attitude because the drugs were tested and proven safe for use. The same findings were found in a
study done in Northern Uganda by Obol et al. (2013) who showed that, respondents never regularly
used ITNs because they believed that the drugs used to treat and retreat them had dangerous
chemical components to their lives which were thought to cause cancer. On the contrary, Runsewe-
Abiodun et al. (2013) in a study done in Ogun State, Western- Nigeria, found a positive attitude
about ITNs and malaria prevention. Out of 256 respondents, 192(75%) expressed willingness to buy
ITNs if they did not get one for free and also knew that the drugs used to retreat ITNs were safe.
44
Policy implication: the Ministry of health should ensure that should make enough sensitization
about the benefits of sleeping under treated ITNs and should be made aware of the safety of the
drugs used to retreat them. This could be through public sensitization from health care providers so
that the general public develops confidence in them.
Negative attitudes still prevailed where 160(58%) of the respondents thought that mosquitoes could
still bite through ITNs. This could be true in cases when an ITN is not well displayed., but when a
mosquito net is well displayed and is in good condition, mosquitoes cannot have chances into the
net thus have no access to the user to bite them and predispose them to malaria infection. It could be
that, those who that believed mosquitoes could still bite through ITNs did not have well displayed
net or their nets were in poor conditions (having holes). In contrast, in a study carried out in Gulu;
Obol et al. (2013b) found out that up to 95% of the respondents believed ITNs prevented mosquito
bites and no mosquito could bite through an ITN which is well displayed.
Policy implication: the government should educate the public about the quality of ITNs they should
buy if they fail to get one for free. They should also ensure proper handling so that they did not
develop holes that users might blame on the quality of ITNs.
Further still, 171(62%) of the respondents minded about the time they spent to tuck the net each
night while others found it inconveniencing to wake up at night if they had slept under an ITN. This
was poor attitude which indicated laziness because it takes very little time to tuck an ITN or to get
out of it during the night. This could have led to reluctance to display the net thus provided
mosquitoes chance to sneak into the net and bite them. Similarly, a study done in Bangladesh by
Ahmed et al. (2011) found that, majority 66.7% felt inconvenienced with the daily hanging of ITNs
yet mosquitoes were not plenty every day. Tucking the net at night was an inconvenience to many
respondents who had ITNs. On the contrary, Kulkarni et al. (2010) in a study done in Madagascar,
showed positive attitude regarding the effectiveness of regular and correct ITNs use. Respondents
were worried that they might become seriously ill with malaria if they did not use ITNs regularly
and correctly. They also revealed that it did not take much time to tuck a net to prevent mosquitoes
from entering the net.
Policy implication: the healthcare sector should disseminate information on the best ways users should tuck
their ITNs so that they do not allow mosquitoes inside.
45
Up to 201(73%) of the respondents believed that ITNs had a bad odour. ITN drugs were given a
scent that could not irritate the user. It could be that respondents who were inconvenienced by the
odour of ITNs were just allergic to it. This created fear among ITNs users which could have
contributed to their low use thus high malaria prevalence. Similarly, Zewdneh et al. (2011) in a
study done in Sri Lanka found out that most of the respondents had a mind-set that the drugs used to
treat the nets were unsafe and could easily suffocate them to death which was negative attitude. The
odour from ITNs caused some people to vomit or get sleepless nights which made them
uncomfortable and hated sleeping under ITNs. However, in a study done in central Uganda,
Wanzira et al. (2013) found out that ITNs were manufactured with a good scent that could attract
people to use them. This was because earlier ITNs were complained of having bad odour that could
at times lead to vomiting.
Policy implication; ITNs should be designed with a good scent that may not cause nausea and
vomiting among the users. This may attract more people complaining of bad odour to utilize ITNs
regularly
5.1.3 Discussion of findings on the practices of respondents towards the utilization of ITNs in
the prevention of malaria.
Majority 198(75%) of the respondents reported that they had ever used ITNs and 179(65%) were
currently sleeping under them. This indicated good practice because regular use of ITNs prevented
mosquito bites. It could be from the benefits of not having suffered from malaria in the recent past
when they used ITNs. In contrast, Ukibe et al. (2014) in a study in Anambra state, South-East
Nigeria, showed that out of 420 respondents who owned nets, 235 (56%) refused to use them.
However, Kulkarni et al. (2010) in a study done in Madagascar, showed good practice regarding the
effectiveness of regular and correct ITNs use. Respondents were worried that they might become
seriously ill with malaria if they did not use ITNs regularly and correctly.
Majority 72(40%) of the respondents got ITNs from shops and 70(25%) had been with them for just
months which meant that they had just started using ITNs by the time of the study. This implied that
respondents could have had poor quality ITNs because the best ITNs could be acquired from health
facilities where there were health workers who knew about their storage and instructions of use.
Researchers personal findings also proved that most mosquito nets sold in local shops are of low
quality because the shop keepers are profit oriented. On the contrary, Duta (2012) revealed that,
46
majority of the respondents had good practices towards ITNs use. Findings showed that, 97.7% of
the respondents owned bed nets and 94% used them and regularly washed them.
Findings showed that 168(94%) of the respondents had never retreated them and majority washed
them after a long period of time. This was a poor practice because ITNs are supposed to be retreated
after at least 6 months of use. This could have reduced the effectiveness of ITNs thus could no
longer repel mosquitoes and lowered the quality of ITNs since untidy ITNs could not favour good
sleep. In line with these findings, Hlongwana et al. (2009) in a study in Swaziland established that,
some respondents did not regularly retreat their ITNs after washing them the recommended number
of times. However, Atieli et al. (2010) in a study in the highlands of western Kenya, found out that
some respondents over washed their ITNs which made them to easily tear. Different findings still
showed in a study done in Myanmar where respondents consistently used ITNs because these areas
had a lot of mosquitoes and consistently retreated them so that they could repel mosquitoes (Myat et
al., 2014).
Policy implication: the Ministry of Health has not done enough to ensure that retreating drugs are
available to the general at the health facilities so that people easily access them. The public should
even be informed about the way they should use those drugs to that they dnot cause them any harm.
A good number 152(85%) of the respondents did not always check for holes in their ITNs which
was poor practice. Given the poor sleeping arrangements they had, it was easy for ITNs to develop
holes thus they needed to regularly check for holes. This could not have provided enough chance to
users to take the initiative to check for holes in the ITNs because ITNs were completely removed
and hide somewhere during the day. They only had to bring them when time for sleeping had
reached. However in a study in Muhorro Sub County, Kibaale District, located in South Western
Uganda, good practice on ITNs use was portrayed. It was found that majority 90% of the household
members were using nets and always took time to check and mend holes in ITNs. They were always
very careful when hanging them to avoid the nets being torn (Bashinyora, 2010)
Displaying ITNs was in most cases done at any time of convenience or when mosquitoes were too
many as reported by 120(67%) of the respondents. This was poor practice because displaying an
ITN at any time gives mosquitoes chance to enter and bite the user during sleep. However, in a
study carried out in south-western Tanzania, there was good ITN use because respondents displayed
ITNs when entering the bed and immediately folded them after sleep to avoid mosquitoes entering
the nets during the day (Emmanuela et al., 2011).
47
In 179(65%) households, there was at least one ITN and ITNs were not on children‟s beds only.
This implied that respondents at least knew that ITNs were beneficial and needed by every family
member. This was good practice because every member of the family is vulnerable to malaria
infection. it could be that, some beds that never had ITNs was due to the fact that household heads
did not have enough money to buy for all of them. Similarly Stevens et al. (2013) in a study done in
Togo, revealed that, majority of the respondents had good practices towards ITNs use. Findings
showed that, 97.7% of the respondents owned bed nets and 94% used them and regularly washed
them. They used them all seasons through even if mosquitoes were not plenty.
Majority 107(58%) of the observed ITNs had holes which gave mosquitoes to enter into the nets
thus increasing the chances of mosquito bites. However, some 102(55%) ITNs had holes and were
mended but not all of them. It is a good practice to always check for holes in ITNs and get mended
if found but according to observations, not all holes were mended which still predisposed the ser to
mosquito bites. Majority of the respondents had good practice which could have reduced malaria
incidence. In a closely similar study done in Western Kenya, Atieli et al. (2010) found out that,
respondents always mended holes in their ITNs to avoid mosquito bites. Mending holes was good
because it controlled mosquitoes from accessing inside the ITNs which could lead to mosquito
bites.
There were 133(72%) households without ITN hangs which made ITNs use difficult. Given the
inadequate space and the poor sleeping arrangements in most households, it was not easy to have
proper ITN hangs. Lack of hangs could lead to poor display which could let the mosquitoes into the
net. In line with these findings, a study done in Zambia, showed that most respondents poorly
hanged mosquito nets. Majority did not properly display the nets to provide enough space for them
to sleep which brought them in contact with the users during sleep thus eased and increased
mosquitoes bites. In contrast, a study carried out in Enugu, Nigeria, Edelu et al. (2010) showed that
respondents were always very careful during hanging and spreading the ITNs over their beds before
they slept. Also Bashinyora (2010) in a study carried out in Uganda noted that, respondents were
always very careful when hanging nets to prevent them from being torn. They in most cases used
threads and needles to mend all the holes that developed to ensure that no mosquito enters at night
during sleep (Ochomo et al., 2013).
There were unfavourable sleeping arrangements to enable good display of ITNs in 137(74%)
households which made regular ITN use difficult. The study area was a slum with a high population
48
with congested ram shackled houses that were small yet had large families. This led to inadequate
space especially during sleeping which led to poor sleeping arrangements. Most houses had
congested rooms that a bed was shared by more than two people especially the children which made
ITN display difficult. In contrast, in a study in Zambia, Pulford et al. (2011) revealed that majority
of the respondents displayed ITNs well which prevented mosquito bites and malaria because their
houses were spacious enough to enable them display their ITNs well.
ITNs were generally dirty as observed from 122(66%) households, not folded 107(60%) and
respondents could not make a good illustration of ITN display 113(63%). Dirty ITNs could not
attract respondents to regularly use them which could have increased malaria incidence in the area.
Unfolded ITNs and failure to make a good illustration of ITN display could have haboured
mosquitoes during the day or allow mosquitoes inside the nets even if they were in good conditions
hence biting respondents during sleep. On the contrary, a study in Zambia, Eisele et al. (2011)
showed that respondents used ITNs very well because they folded them after use which portrayed
good practice.
49
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
6.0 Introduction
This chapter presents the conclusions and recommendations of the study. They are based on study
findings in relation to the study specific objectives.
6.1 Conclusion
The study assessed the level of knowledge, attitude and practices of community members in
Namuwongo zones A and B in the utilization of ITNs in the prevention of malaria.
The study found relatively good knowledge about ITNs use because respondents had ever heard of
ITNs and knew they were used to prevent malaria. However, lack of awareness on; the right places
from where to buy ITNs and retreating them created doubt about their awareness on the efficacy
and effectiveness of ITNs.
Generally respondents had negative attitude towards the utilization of ITNs in the prevention of
malaria. Majority believed that; mosquitoes could still bite through ITNs, could make getting up at
night difficult, took much time to tuck the net each night, could lead to suffocation, ITNs had a bad
odour, drugs used to retreat ITNs were unsafe, did not believe that ITNs prevented annoyance from
mosquitoes and believed that it was not important to sleep under an ITN every day.
Majority never retreated their ITNs, did not get them from right places as majority got them from
shops within a few past months, did not always check for holes, display was in most cases done
when it immediately got dark and washed them after 3 months which was a very long period. This
indicated poor practice.
However, majority of the respondents reported that they had ever used ITNs and were currently
sleeping under them.
From the observation, ITNs utilization was also poor where; majority never had hangs, never had
favorable sleeping arrangements to enable good display, some had holes while others had been
mended, were untidy, not folded and majority could not make a good display of an ITN. However,
majority of households had at least one ITN and were not only on children‟s beds.
6.2 Recommendations
The study suggests the following reforms to be done
50
6.2.1 The government/Ministry of Health
Should emphasize education talks on the benefits of sleeping under an ITN over fears such as
suffocation and perceptions that mosquitoes can still bite through ITNs. This should be done
over the different media channels such as radios, televisions and newspapers.
Drugs used to retreat ITNs should even be made more available to the public more especially
through health care facilities so that people can access them free of charge.
The Health care teams in different communities should be empowered to give door to door
education on utilization of ITNs in the prevention of malaria. They should physically visit the
households and check the state of ITNs and advise them accordingly.
Both print and visual media such as newspapers, posters, flyers, brochures, radios and
televisions would be instrumental in educating the public on use of ITNs. This would enable
majority of the community members to get the information easily since the processes followed
in ITNs use would be illustrated.
They should provide the governments with periodical reports on malaria prevalence, so that
proper arrangements are done to provide more free of charge ITNs to the public through mass
distribution campaigns.
They should educate community members on the safety of drugs used to retreat ITNs. All myths
that associate ITNs with suffocation, cancer and skin irritation should be nullified and users
should be informed that if they face any of them, they should first seek medical advice before
putting the blame on ITNs.
They should mobilize more ITNs from the Ministry of Health so that they distribute them to the
community members. This will significantly increase the proportion of people having them
which may in the end attract many to use ITNs.
51
6.2.3 Community members in Namuwongo
Before using an ITN, they should read all the instructions so that they do not make any mistakes
during use.
They should ensure that they get the right information on use and efficacy of ITNs to rule out
rumours such as; mosquitoes can still pass through the ITNs and that drugs used to retreat ITNs
are not safe.
They should always wash ITNs before use to minimize the odour caused by the retreating drug
which may discourage them to use ITNs.
They should wash and retreat ITNs regularly so that they remain effective (bar and repel
mosquitoes).
They should always sleep under ITNs even if mosquitoes are few.
They should ensure that every bed in the home has an ITN so that everyone sleeps under it and
should be on a regular basis.
Should ensure that ITNs are displayed when one is entering the bed and that every one displays it
well by firmly tucking it at every end of the bed.
52
REFERENCES
Adekanmi, A., and Foluso, F. (2015) Assessment of Caregivers/Mothers Knowledge, Attitude and
Practices in Prevention and Treatment of Childhood Malaria in Yewa South Local Government
Area of Nigeria. Research Journal of Parasitology, 10: 15-24.
Adongo, PB. Kirkwood, B. and Kendall, C. (2008) How local community knowledge about malaria
affects insecticide treated net use in northern Ghana. Tropical Medical journal of International
Health; 10:366–78.
Ahmed, SM. and Zerihun, A. (2010) Possession and usage of insecticidal bed nets among the
people of Uganda: is BRAC Uganda Health Programme pursuing a pro-poor path? PLoS One 5.
Ahmed, SM., Hossain, S., Kabir, M.M. and Roy, S. (2011) Free distribution of insecticidal bed nets
improves possession and preferential use by households and is equitable: findings from two cross-
sectional surveys in thirteen malaria endemic districts of Bangladesh. Malar J.; 10:357. doi:
10.1186/1475-2875-10-357.
Allan, R., O‟Reilly, L., Gilbos, V. and Kilian, A. (2012) An Observational Study of Material
Durability of Three World Health Organization-Recommended Long-Lasting Insecticidal Nets in
Eastern Chad. Am J Trop Med Hyg, 87: 407-411. 10.4269/ajtmh.2012.11-0331.
Antonio-Nkondjio, C., Demanou, M., Etang, J. and Bouchite, B. (2013) Impact of cyfluthrin (Solfac
EW050) impregnated bed nets on malaria transmission in the city of Mbandjock: lessons for the
nationwide distribution of long-lasting insecticidal nets (LLINs) in Cameroon. Parasites & Vectors;
6:10. doi: 10.1186/1756-3305-6-10.
Atieli, FK., Munga, SO., Ofulla, AV. and Vulule, JM. (2010) The effect of repeated washing of
long-lasting insecticide-treated nets (LLINs) on the feeding success and survival rates of Anopheles
gambiae. Malar J. ; 9:304. doi: 10.1186/1475-2875-9-304.
Atieli, HE., Zhou, G., Afrane, Y., Lee, MC. and Mwanzo, I. (2011) Insecticide-treated net (ITN)
ownership, usage, and malaria transmission in the highlands of western Kenya. Parasit Vectors 4:
113.
Audrey, P., Eboni, T., Nku, D., Duvall, S., Tabala, M., Meshnick, S. and Behets, F. (2008) Bed net
ownership, use and perceptions among women seeking antenatal care in Kinshasa, Democratic
53
Republic of the Congo (DRC): Opportunities for improved maternal and child health. BMC Public
Health; 8:331.
Audrey, P., Eboni, T., Nku, D., Duvall, S., Tabala, M., Mwandagalirwa, K., Meshnick, S. and
Behets, F. (2009) Free distribution of insecticide treated bed nets to pregnant women in Kinshasa:
aneffective way to achieve 80% use by women and their newborns. Tropical Medicine and
International Health; 14(1):20-28.
Bashinyora, JB. (2010) Utilisation of Insecticide Treated Nets in Households with Children Under 5
Years in Muhorro Sub County, Kibaale District, Uganda, Research Dissertation submitted to the
postgraduate school in partial fulfilments of the requirement for the award of the degree of Masters
of Arts Sociology of Makerere University, Kampala
Baume, CA., Reithinger, R. and Woldehanna, S. (2009) Factors associated with use and non-use of
mosquito nets owned in Oromia and Amhara regional states, Ethiopia. Malar J; 8:264.
Bennett, A., Smith, SJ., Yambasu, S., Jambai, A., Alemu, W. and Kabano, A. (2012) Household
possession and use of insecticide-treated mosquito nets in Sierra Leone 6 months after a national
mass-distribution campaign. PLoS One; 7:e37927. doi:10.1371/journal.pone.0037927.
Deressa, W., Fentie, G., Girma, S. and Reithinger, R. (2011) Ownership and use of insecticide-
treated nets in Oromia and Amhara regional States of Ethiopia two years after a nationwide
campaign. Trop Med Int Health; 16(12):1552–1561.
Deribew, A., Alemseged, F., Birhanu, Z., Sena, L., Tegegn, A., Zeynudin, A., Dejene, T., Sudhakar,
M., Abdo, N. and Tessema, F. (2010) Effect of training on the use of long-lasting insecticide-treated
bed nets on the burden of malaria among vulnerable groups, south-west Ethiopia: baseline results
of a cluster randomized trial. Malar J; 9:121. doi: 10.1186/1475-2875-9-121.
Dutta, HS. (2012) KAP study on Malaria in project areas of malaria centres of OVHA (Orissa
Voluntary Health Association). Journal of Pharmaceutical and Biomedical Sciences (JPBMS),
23(23); 1-3.
Eisele, TP., Keating, J., Littrell, M., Larsen, D. and Macintyre, K. (2009) Assessment of insecticide-
treated bednet use among children and pregnant women across 15 countries using standardized
national surveys. Am J Trop Med Hyg; 80:209–214. [PubMed]
54
Eisele, TP., Thwing, J. and Keating, J. (2011) Claims about the misuse of insecticide-treated
mosquito nets: are these evidence-based? PLoS Med, 8: e1001019.
Emmanuela, EA., Humphrey, DM., Jorg, H., Gabone, O. and Damas, LM. (2011) Knowledge,
attitudes and practices regarding malaria and mosquito net use among women seeking antenatal
care in Iringa, South-western Tanzania. Tanzania Journal of Health Research;13(3).
Fuge, TG., Ayanta, SY. and Gurnamo, FL. (2015) Assessment of knowledge, attitude and practice
about malaria and ITNs utilization among pregnant women in Shashogo District, Southern
Ethiopia, Malar J; 14: 235,Published online 2015 Jun 4. doi: 10.1186/s12936-015-0755-7, PMCID:
PMC4475320
Gerstl, S., Dunkley, S., Mukhtar, A., Maes, P. and De Smet, M. (2010) Long-lasting insecticide-
treated net usage in eastern Sierra Leone – the success of free distribution. Trop Med Int Health 15:
480–488.
Graves, PM., Ngondi, JM., Hwang, J., Getachew, A., Gebre, T., Mosher, AW., Patterson, AE.,
Shargie, EB., Tadesse, Z., Wolkon, A., Reithinger, R., Emerson, PM. and Richards, FO. Jr. (2011)
Factors associated with mosquito net use by individuals in households owning nets in Ethiopia.
Malar J; 10:354. doi: 10.1186/1475-2875-10-354.
Hanafi-Bojd, AA. Vatandoost, H. Oshaghi, MA. Eshraghian, MR. Haghdoost, AA. and Abedi, F.
(2011) Knowledge, attitudes and practices regarding malaria control in an endemic area of
southern Iran. Southeast Asian J Trop Med Public Health; 42:491–501.
Hanson, K., Marchant, T., Nathan, R., Mponda, H. and Jones, C. (2009) Household ownership and
use of insecticide treated nets among target groups after implementation of a national voucher
programme in the United Republic of Tanzania: Plausibility study using three annual cross sectional
household surveys. BMJ; 339:b2434.
55
Hlongwana, KW., Mabaso, ML., Kunene, S., Govender, D. and Maharaj, R. (2009) Knowledge,
attitudes and practices (KAP) on malaria in Swaziland: a country earmarked for malaria
elimination. Malar J; 8:29.
Humphrey, D. and Mazigo, EO. (2010) Knowledge, Attitudes, and Practices about Malaria and Its
Control in Rural Northwest Tanzania. (K. Koram, Ed.) Malaria Research and Treatment, 1-9.
Isah, AY. and Nwobodo, EI. (2009) Awareness and utilization of insecticide treated mosquito nets
among pregnant mothers at a tertiary health institution in North Western Nigeria. Niger J Med;
18(2):175-178
Iwashita, H., Dida, G., Futami, K., Sonye, G. and Kaneko, S. (2010) Sleeping arrangement and
house structure affect bed net use in villages along Lake Victoria. Malar. J., 9(10).1186/1475-2875-
9-176.
Kamukama, P. (2012) "KCB Bank Lights up Namuwongo Slum". The Observer (Uganda). Retrieved
22 June 2014.
Karema, C., Aregawi, MW., Rukundo, A., Kabayiza, A., Mulindahabi, M. and Fall, IS. (2012)
Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial
interventions, 2000–2010, Rwanda. Malar J.; 11:236. doi: 10.1186/1475-2875-11-236.
Kateera, F., Ingabire, CM., Hakizimana, E. Rulisa, A., Karinda, P., Grobusch, MP., Mutesa, L., Van
Vuggt, M. and Mens, PF. (2015) Long-lasting insecticidal net source, ownership and use in the
context of universal coverage: a household survey in eastern Rwanda. Malar J.; 14: 390, PMCID:
PMC4596392, Published online 2015 Oct 6.
KCCA Report, (2015) Prevalence of Malaria. Kampala; Kampala Capital City Authority report on
Malaria, Uganda, Kampala Capital City Authority.
Khumbulani, W., Musawenkosi, H., Mabaso, LH., Unene, S., Govender, D. and Maharaj, R. (2009)
Community knowledge, attitudes and practices (KAP) on malaria in Swaziland: A country
earmarked for malaria elimination. Malaria Journal, 8:29 doi: 10.1186/1475-2875-8-29
Kilian A., Koenker, H., Baba, E., Onyefunafoa, E.O., Selby, RO., Lokko, K. and Lynch, M. (2013)
Universal coverage with insecticide-treated nets - applying the revised indicators for ownership
and use to the Nigeria 2010 Malaria indicator survey data. Malaria Journal.;12:314.
56
Kiwuwa, MS. and Mufubenga, P. (2008) Use of antenatal care, maternity services, intermittent
presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district,
Uganda. Malaria Journal; 7.
Kulkarni, MA., Vanden Eng, J., Desrochers, RE., Cotte, AH., Goodson, JL., Johnston, A., Wolkon,
A., Erskine, M., Berti, P., Rakotoarisoa, A., Ranaivo, L. and Peat, J. (2010) Contribution of
integrated campaign distribution of long-lasting insecticidal nets to coverage of target groups and
total populations in malaria-endemic areas in Madagascar. Am J Trop Med Hyg; 82:420–425. doi:
10.4269/ajtmh.2010.09-0597.
Loha, E. Tefera, K. and Lindtjørn, B. (2013) Freely distributed bed-net use among Chano Mille
residents, south Ethiopia: a longitudinal study. Malar J, 12: 23-10.1186/1475-2875-12-23.
Luyiga, FM. (2013) Knowledge, Attitudes and Practices on Malaria Prevention and Control in
Uganda, a Case Study of Nsaabwa Village, Mukono District, B.Mass Comm; MBA, MAKSPH-
CDC FELLOW
Masangwi, S.J., Grimason, A.M., Morse, T.D., Ferguson, N.S. and Kazembe, L.N. (2012)
Community knowledge variation, bed-net coverage and the role of a district healthcare system, and
their implications for malaria control in southern Malawi, South Afr J Epidemiol Infect, 27(3):116-
125
Matovu, F., Goodman, C., Wiseman, V. and Mwengee, W. (2009) How equitable is bed net
ownership and utilization in Tanzania? A practical application of the principles of horizontal and
vertical equity. Malaria Journal 8:109.
Mazigo, H.D., Obasy, E, Mauka, W., Manyiri, P., Zinga, M., Kweka, E.J., Mnyone, L.L. and
Heukelbach, J. (2010) Knowledge, attitudes and practices about malaria and its control in rural
northwest Tanzania. Malaria Research and Treatment; doi-10.4061/2010/794261.
Mebrahtom, B. and Wakgari, D. (2008) Use of insecticide treated nets by pregnant women and
associated factors in a pre-dominantly rural population in northern Ethiopia. Tropical Medicine
and International Health;13(10):1303–1313.
Megha, S. Graham, B. and Stephen, JR. (2013) Ownership and use of insecticide-treated nets
during pregnancy in sub-Saharan Africa: a review, Malar Journal; 12: 268.
57
Minakawa, N., Dida, GO., Sonye, GO., Futami, K. and Kaneko, S. (2008) Unforeseen misuses of
bed nets in fishing villages along Lake Victoria. Malar J; 7:165
Ministry of Health (MOH) [Uganda]. (2010) Heath Sector Strategic Plan, 2010/11 – 2014/15.
Kampala,
Ministry of Health, (2012) Republic of Uganda, author. Annual Health Sector Performance Report.
2012. Oct,
Ministry of Health, (2014) Republic of Uganda, author. Annual Health Sector Performance Report.
2014. Oct,
Myat, H., Nyunt, A., KM., Kyaw, MP., Kyaw, TT., Hlaing, T. Kyaw, O. Zaw, NN., Aye, TT. and
San, NA. (2014) Challenges in universal coverage and utilization of insecticide-treated bed nets in
migrant plantation workers in Myanmar. Malaria Journal, 13:211, DOI: 10.1186/1475-2875-13-
211.
Nam, J. (2009) "Israeli Ambassador Visits Uganda Children". New Vision. Retrieved 22 June
2014.
Nasasira, R. (2014) The Wetland That Sprouted Into A Slum". "Namuwongo: Daily Monitor.
Retrieved 22 June 2014.
Njau, JD., Stephenson, R., Menon, M., Kachur, S.P. and McFarland, DA. (2013) Exploring the
impact of targeted distribution of free bed nets on households bed net ownership, socio-economic
disparities and childhood malaria infection rates: Analysis of national malaria survey data from
three sub-Saharan Africa countries. Malar J.; 12:245. doi: 10.1186/1475-2875-12-245
Obol, J. Kitara, D. Lagoro, and Orach, C. Garimoi, D. (2011) Knowledge and Misconceptions about
Malaria among Pregnant Women in a Post-Conflict Internally Displaced Persons' Camps in Gulu
District, Northern Uganda Malaria Research and Treatment, Article ID 107987, 7,
http://dx.doi.org/10.4061/2011/107987
58
Obol, JH., Atim, P. and Moi, KL. (2013a) Possession, Attitudes and Perceptions of Insecticide-
treated Bed Nets among Pregnant Women in a Post Conflict District in Northern Uganda,
International Journal of Tropical Disease & Health, Sciencedomain international, available on
http//www.sciencedomain.org
Obol, JH., Ononge, S. and Orach, CG. (2013b). Utilization of insecticide treated nets among
pregnant women in Gulu: a post conflict district in northern Uganda, Afr Health Sci. Dec; 13(4):
962–969. doi: 10.4314/ahs.v13i4.15.
Oche, MO., Ameh, IG., Umah, AS., Gana, G. and Njoku, CH. (2011). Awareness and use of
insecticide treated nets among pregnant women attending antenatal at Usman Dan Folio University
Teaching Hospital Sokoto. Niger J Parasitol; ISSN: 1117-4145
Ochomo, EO. Bayoh, NM. Walker, ED. Abongo, BO. Ombok, MO. Ouma, C. Githeko, AK.
Vulule, J. Yan, G. and Gimnig, JE. (2013) The efficacy of long-lasting nets with declining physical
integrity may be compromised in areas with high levels of pyrethroid resistance. Malar J; 12:368.
doi: 10.1186/1475-2875-12-368.
O'Meara, WP., Smith, N., Ekal, E., Cole, D.and Ndege, S. (2011) Spatial distribution of bednet
coverage under routine distribution through the public health sector in a rural district in Kenya.
PLoS One; 6:e25949. doi: 10.1371/journal.pone.0025949.
Pulford, J., Hetzel, MW., Bryant, M., Siba, P.M. and Mueller, I. (2011) Reported reasons for not
using a mosquito net when one is available: a review of the published literature. Malaria Journal
10:83.
Rhee, M., Sissoko, M., Perry, S., MCFerland, Parsonnet, J. and Doumbo, O. (2005) Use of
Insecticide treated nets following a malaria education intervention in Piron, Mali: a control trial
with systematic allocation of households. Bamako: Mali.
Runsewe-Abiodun, Iyabo, T. and Runsewe Olugbenga, O. (2013) Attitude and practice of pregnant
women to use of Insecticide treated nets in South-West Nigeria, Accepted 25 June, 2013, Afr. J.
Pregnancy Childbirth, 1(1), 001-009.
59
Runsewe-Abiodun, T., Iyaniwura, A., Sotimehin, C. and Adetoun, S. (2012) Awareness and
Knowledge about Insecticide Treated Nets (ITNs) amongst pregnant mothers in Ogun State,
Western- Nigeria: A descriptive Cross sectional study. Education Research Journal. 2(2):1-8
San Oo, Soe, Z. and Shwe, WH. (2013) Knowledge, Attitude and Practice on Insecticide Treated
Nets in Myanmar, International Journal of Collaborative Research on Internal Medicine & Public
Health; 5(6).
Sande, S., Jagals, P., Mupeta, B. and Chadambuka, A. (2012) An investigation of the use of
rectangular insecticide-treated nets for malaria control in Chipinge District, Zimbabwe: a
descriptive study. Pan African Medical Journal, 13 5:
Sangare, LR., Weiss, NS., Brentlinger, PE., Richardson, BA., Staedke, SG., Kiwuwa, MS. and
Stergachis, A. (2012) Determinants of use of insecticide treated nets for the prevention of malaria
in pregnancy: Jinja, Uganda. PLoS One; 7:e39712. doi: 10.1371/journal.pone.0039712..
Shahrokh, EM. and Dougherty, E. (2014) Effects of separate sampling on classification accuracy.
Bioinformatics 30 (2): 242–250.
Skarbinski, J., Mwandama, D., Luka, M., Jafali, J., Wolkon, A., Townes, D., Campbell, C., Zoya, J.,
Ali, D. and Mathanga, DP. (2011) Impact of health facility-based insecticide treated bednet
distribution in Malawi: progress and challenges towards achieving universal coverage. PLoS One;
6:e21995. doi: 10.1371/journal.pone.0021995.
Soleimani-Ahmad, M., Vatandoost, H., Zare, M., Alizadeh, A. and Salehi, M. (2014) Community
knowledge and practices regarding malaria and long-lasting insecticidal nets during malaria
elimination programme in an endemic area in Iran, Malaria Journal, 13:511, DOI: 10.1186/1475-
2875-13-511
Stevens, ER. Aldridge, A. Degbey, Y. Pignandi, A. Dorkenoo, MA. and Hugelen-Padin, J. (2013)
Evaluation of the 2011 long-lasting, insecticide-treated net distribution for universal coverage in
Togo. Malar J; 12:162.
Tatem, AJ. and Smith, DL. (2010) International population movements and regional Plasmodium
falciparum Malaria elimination strategies, Proc Natl Acad Sci, 107(27).
60
Tenywa, G. (2013) “Namuwongo Residents Drink Their Way to Death”. New Vision. Retrieved 22
June 2014.
Terefe, GF. Ayanto, SY. and Gurmano, FL. (2015) Assessment of knowledge, attitude and practice
about malaria and ITNs utilization among pregnant women in Shashogo District, Southern
Ethiopia, Malaria Journal; 14: 235.
Uganda Bureau of Statistics (UBOS). (2010) The Uganda National Household Survey 2009/10:
Report on the Socio-Economic Module. Abridged Report, Kampala, Uganda: UBOS.
http://www.ubos.org/UNHS0910/unhs200910.pdf
Uganda Bureau of Statistics, (2010) Uganda Malaria Surveillance Project Molecular Laboratory,
National Malaria Control Programme, ICF Macro. Uganda Malaria Indicator Survey 2009.
Kampala; 2010.
Uganda Demographic and Health Survey, (2011) Malaria, Uganda Bureau of Statistics
Uganda Government. (2011a) Uganda Malaria Programme Review Report MPR 2001-2010.
Kampala: Ministry of Health.
Ministry of Health, (2014) Malaria report, Kampala, Uganda: Ministry of Health, available on
http://www.health.go.ug/docs/HSSP_III_2010,
Ukibe, SN. Ikeako, LC. Mbanugo, JI. Obi-Okaro, AC. and Ukibe, NR. (2014) Knowledge, Attitude
and Practices of Pregnant Women concerning the use of Insecticide Treated Bed Nets (ITNs) in
Anambra State, South-east Nigeria, Journal of Applied Medical Sciences, 3(1), 15-22 ISSN: 2241-
2328 (print version), 2241-2336 (online) Scienpress Ltd, 2014
Van Eijk, AM. Hill, J. Alegana, VA. Kirui, V. and Gething, PW. (2011) Coverage of malaria
protection in pregnant women in sub-Saharan Africa: a synthesis and analysis of national survey
data. Lancet Infect Dis 11: 190–207.
Vijayakumar, KN. Gunasekaran, K. Sahu, SS. and Jambulingam, P. (2009) Knowledge, attitude and
practice on malaria: A study in a tribal belt of Orissa state, India with reference to use of long
lasting treated mosquito nets. Actual Tropical; 112:137–42.
61
Wanzira, H. Yeka, A. Kigozi, R. Rubahika, D. Nasr, S. Sserwanga, A. Kamya, M. Filler, S. Dorsey,
G. and Steinhardt, L. (2014) Long-lasting insecticide-treated bed net ownership and use among
children under five years of age following a targeted distribution in central Uganda, Malar J; 13:
185. Published online 2014 May 19. doi: 10.1186/1475-2875-13-185 PMCID: PMC4035807.
Wanzira, H., Yeka, A., Kigozi, R., Rubahika, D., Nasr, S. and Sserwanga, A. (2013) Long-lasting
insecticide-treated bed net ownership and use among children under 5 years of age following a
targeted distribution in central Uganda. Malar J; 13:185.
WHO. (2011c) World malaria report. Geneva, Switzerland: World Health Organization.
WHO. (2012) World malaria report. Geneva, Switzerland: World Health Organization.
WHO. (2013a) The African Malaria Report 2013 from WHO and UNICEF. 2013. Downloaded on
31/3/2008 at http://www.rbm.who.int/amd2013/amr2013/amr_doc.htm.
WHO. (2013b) World malaria report. Geneva, Switzerland: World Health Organization.
WHO. (2014) World malaria report. Geneva, Switzerland: World Health Organization.
Wiseman, V., Scott, A., McElroy, B., Couteh, L., Stevens, W. (2007) Determinants of bed net use
in Gambia: Implications for malaria control. AM J Trop Med Hyg, 76(5): 830-6
Yukich, JO., Zerom, M., Ghebremeskel, T., Tediosi, F. and Lengeler, C. (2009) Costs and cost-
effectiveness of vector control in Eritrea using insecticide-treated bed nets. Malar J 8: 51.
Zangypo, K., Zangypo, N. and Poulsen, K. (2011) A study on knowledge, attitude and practice
about malaria awareness and bed net use. J Bhutan Studies; 135-146.
Zewdneh, T., Jadess, D. and David, K. (2011). Knowledge attitude and practice about ITNs. MEJS.
3 (2): 64-77.
62
APPENDIX I: CONSENT FORM
Respondent: I agree to participate in this research project. I will be orally interviewed in privacy by
the researcher and she will record my responses. The study is to identify the utilization and
hindrances to ITNs use in order to enhance use of ITNs to promote health. My name will not
be used; the exercise will take a short time and I may decline to answer any question or quit.
It is entirely voluntary and does not entail any foreseeable risks. I will be given a copy of the dated
and signed consent form to keep.
63
APPENDIX II: QUESTIONNAIRES
Title: Knowledge, Attitude and Practices of Namuwongo Zones (A and B) residents towards
use of insecticide treated mosquito nets in prevention of malaria.
a) Male b) Female
a) Single b) Married
c) Separated d) Divorced
c) Self-employed d) Student
f) Others, (specify)………………………
64
SECTION B
Instruction: Tick the most appropriate answer or give your own view where applicable
a) Yes b) No
a Prevention of malaria
a Shop, market
4. i) Do you get routine education about the use of ITNs in your community?
a) Yes b) No
a) Yes b) No
65
8. How many times should ITNs be washed before retreating?
SECTION C
No Item SD D NT A SA
13
66
SECTION D
Instruction: Tick the most appropriate answer or give your own view where applicable
a) Yes b) No
a) Yes b) No
a) A shop b) A pharmacy
e) A market
4. For how long have you had bed nets in this house?
a) Days b) Weeks
c) Months d) Years .
a) Yes b) No
6. How many times have you retreated your net in the last one year?
a Once or twice
a) Yes b) No
67
8. How often do you wash your bed nets?
a After a week
b After a month
c After 3 months
d After 6 months
e Others ( specify)
a) Yes b) No
The researcher will also use the observation checklist below on issues regarding respondents‟ practices
towards use of mosquito nets in prevention of malaria. Only those respondents who will accept the researcher
to observe their nets will be tested using this method.
No Question Response
Item Yes No
68
17 ITNs had holes and were mended.
69
APPENDIX III: MAP SHOWING STUDY AREA
70
APPENDIX IV: INTRODUCTORY LETTER AND CORRESPONDENCE
71