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An Assessment of the use of insecticide treated-nets in urban and rural areas of Tanga Region-Tanzania

Ngum Halmata, B. (2004) An Assessment of the use of insecticide treated-nets in urban and rural areas of Tanga Region-Tanzania. Masters thesis, RUPRECHT-KARLS UNIVERSITY HEIDELBERG.

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About 100 countries in the world are at risk of malaria, with 300 to 500 million people suffering from clinical episodes every year. 1.5 to 2.7 million people die from the disease yearly, of which 1 million are young children. There is an inverse relationship between malaria intensity and economic growth.
In Tanzania, malaria alone accounts for more than 30% of the national disease burden. The annual malaria mortality rate in all ages is 141-650 per 100.000 and the annual malaria mortality in children below five years is 300-1600 per 100.000. The most vulnerable groups are children below five years and pregnant women. The Government of Tanzania through the MoH (Ministry of Health) for many years now is supporting the strategy of preventing malaria through the use of ITN (Insecticide Treated Net). This is done in partnership with the private sector such as NGO’s (Non Governmental Organization), projects and others stake holders. In the Tanga Region of Tanzania, malaria is the first cause of mortality and morbidity. The health authorities in this region promote the use of ITNs, assisted by mainly Population Service International (PSI) in social marketing of ITN and insecticides in both urban and rural settings. A number of studies carried out in different parts of the world and Africa have proven the efficacy and effectiveness of ITN in controlling malaria.
The general objective of this study was to assess the use of ITN as well as to identify factors influencing their use in urban and rural areas of the Tanga Region in order to generate useful information for policy and planning towards improving malaria control. Specific study objectives were (1) to determine the proportion of households possessing ITN, (2) to determine the proportion of individuals and subgroups using ITN, (3) to determine the extend to which the households use nets properly, and to assess the characteristics of nets used, and (4) to identify factors that will contribute to improve the use of ITN in both urban and rural areas of Tanga Region.
This is a descriptive study using quantitative and qualitative research methods. For the collection of quantitative data, a modified EPI cluster sampling method was used to select participating households (HH). In the first step, Tanga urban area and Pangani rural area were purposefully selected as study sites. HH were selected from all the 12 wards in the urban and 10 villages selected at random in the rural study area. A structured questionnaire was applied, and the main outcome variable was ITN coverage. For the collection of qualitative data, key informant interviews were conducted: 2 with district malaria focal persons, 6 with persons responsible for mother and child health (MCH) clinics, and 18 with ITN sellers. Quantitative data were processed in Access and analyzed in EPI info software. Qualitative data were summarized and categorized according to themes related to the specific objectives of the study.
A total of 134 and 86 HH were interviewed in the urban and in rural area respectively. The urban HH were composed of 778 individuals, while the rural HH were composed of 392 individuals. There were more females as respondents than males. HH heads were in majority males. The education level of HH heads was higher in the urban as compared to the rural study area.
The overall proportion of HH possessing ITN in Tanga urban was 56% and in Pangani rural 22%, while the proportion of individuals using ITN was 54% are and 20% in the urban and rural area respectively. These figures were similar in young children and pregnant women. Of those who had an ITN, almost all individuals slept under ITN the previous night in both areas. Females used ITN more than males in both study areas.
Nets used in the area were mostly of white color, round shape, hanged on the ceiling, and long enough to be tucked under the mattress. The conditions of nets being used were better in the urban area than in the rural area. Most of the nets were procured from shops. In the urban study area, net sellers do not usually run out of ITN stocks, while the MCH clinics were often out of stock. In the rural study area, net sellers were often out of stock, while the only MCH clinic was better equipped with ITN.
Only few HH members knew how to treat nets properly with an insecticide. Half of the urban HH knew they had to retreat their ITN after the third wash or after six months compared to only one quarter of rural HH.
In assessing some factors influencing the use of nets, the majority of people considered the use of ITN not to be harmful. There was however still a small proportion of the population in both settings that had not heard about ITN or re treatment of ITN. The main source of information on ITN was the media.

Our findings on a higher coverage with ITN in the urban study area compared to the rural study area confirms similar findings from a national survey in Tanzania. It is encouraging, that the majority of individuals were actually using their ITN since they had slept under it the night preceding the survey. However, we also found that young children and pregnant women, the major risk groups for malaria, were not more protected with ITN than the rest of the population. This points to the importance of better education of the population on the rationale of using ITN. Our findings furthermore confirm the problems with re treatment of ITN in African communities. The media seem to be good channels for the diffusion of relevant information. ITN were always available in shops, while the availability in MCH services was not so regular. This points to the importance of private channels in a continuous provision of ITN in Tanga Region and African communities in general

Item Type: Thesis (Masters)
Keywords: insecticide treated-nets, Tanga, Tanzania, Malaria control
Subjects: Malaria > Surveillance, monitoring, evaluation
Divisions: Other
Depositing User: Mr Joseph Madata
Date Deposited: 25 Aug 2012 11:09
Last Modified: 25 Aug 2012 11:09

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