An Exploratory Study of Community Factors Relevant for Participatory Malaria Control on Rusinga Island, Western Kenya

According to the authors, the involvement and active participation of communities has been identified as a key factor for success of malaria control in rural environments. Through an exploratory study, this research evaluates community factors relevant for participatory malaria control on Rusinga Island, western Kenya.


"The study presented here was implemented on Rusinga Island in Lake Victoria, Suba District, western Kenya as part of the Rusinga Malaria Project (RMP) of the Rusinga Island Child & Family Programme (RICFP), a local community based organization (CBO) affiliated to the international non-governmental (NGO) organization Christian Children's Funds – Kenya (CCF-K). Community members and staff of CCF-K approached locally-based researchers for assistance in their fight against malaria on Rusinga, acknowledging that the CBO's (and NGO's) knowledge on how to tackle the problem was insufficient.... As a first step, therefore, it needed to be established how much local people understood about the existing malaria problem on Rusinga, assess their socio-economic background and create awareness for the ongoing project while sensitizing community members for active participation. In order to do this, focus group discussions (FGD) and semi-structured individual interviews (knowledge, attitude and practice (KAP) surveys) were carried out to determine socio-economic and behavioural baselines to identify indicators for monitoring programme effectiveness, and to reveal the perceptions, misconceptions and practices of malaria control, thus yielding important information needed to plan and revise training activities, develop locally appropriate education material and design effective methods with the ultimate goal to encourage new malaria prevention behaviours."


From the focus groups and interviews, semi-structured sections of questionnaires were coded as data and analysed using social sciences software; and a socio economic scale was created using "Principal Component Analysis" (PCA), based on 13 asset variables (sofa set, bicycle, radio, television set, solar panel, generator, car battery, mobile phone, boat, fishing net, number of cows, goats, and chicken) that were identified by community members. As a result, each household was placed in a socio-economic quintile (most poor; very poor; poor; less poor; least poor).


Results showed that, though malaria is considered one of the major threats to life, there is little effective knowledge of malaria prevention, including causal knowledge of the transmission cycle. Misconceptions about malaria and distrust of messages from 'outside' were consistent with those found elsewhere in Africa. "[D]espite the fact that there is a lot of knowledge in the community, this knowledge was distorted and causal connections were not understood, raising questions about the quality of past health education messages and whether they might be more confusing than helpful if not implemented in a cultural sensitive way."


Socio-economic factors impacted the use of known preventative measures. "Although many (88%) knew bednets prevent malaria, only 48% of households actually owned a net, with... 37% sleeping under one the previous night." The authors found little knowledge of insecticide treatment of nets and no knowledge of a causal understanding of insecticide treatment as killing mosquitoes. Based on the information that bednet use was linked to socio-economic status and education, the authors recommend increased training and increased availability of bednets.


Ineffective measures (brush cutting and removal of small containers) were prevalent due to misleading health education messages in older print materials still in use, indicating, as stated here, a need for more interdisciplinary collaboration between socio-behavioural scientists, education specialists, and entomologists on materials using evidence-based and culturally sensitive interventions. Though diagnostic information is lacking in the villages (all symptoms of illness are considered symptoms of malaria), "[t]reatment is mainly done with modern and rarely with traditional medicine which provides opportunities for improvement of drug use through shop keepers training and training on home-based treatment."


The authors conclude that "[t]here is an urgent need to design culturally sensitive but evidence-based education interventions which take local beliefs into account and which help the community to understand the causal connections between mosquito habitats, malaria transmission, malaria symptoms, treatment and prevention. The authors hypothesize that this will be best achieved through participatory, 'hands-on experience', including the community in mapping of larval habitats, studying the mosquito life cycle by rearing them, collecting adult mosquitoes in houses, implementing various vector control strategies and monitoring their impact."