Human behaviour and residual malaria transmission in Zanzibar: findings from in-depth interviews and direct observation of community events

Malaria Journal

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[1] 0000 0000 9144 642X, grid.414543.3, Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania;0000 0000 9144 642X, grid.414543.3, Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania;0000 0004 1937 1135, grid.11951.3d, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Republic of South Africa;0000 0001 2193 314X, grid.8756.c, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK;0000 0001 2171 9311, grid.21107.35, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;0000 0004 1937 0642, grid.6612.3, University of Basel, Basel, Switzerland;0000 0004 0587 0574, grid.416786.a, Swiss Tropical and Public Health Institute, Basel, Switzerland;0000 0000 9144 642X, grid.414543.3, Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania;U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar Es Salaam, Tanzania;Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania;grid.449467.c, PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA;grid.449467.c, PMI VectorWorks Project, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA;0000 0004 1937 0642, grid.6612.3, University of Basel, Basel, Switzerland;0000 0004 0587 0574, grid.416786.a, Swiss Tropical and Public Health Institute, Basel, Switzerland;

关键词: Malaria;    Elimination;    Residual transmission;    Outdoor biting;    Imported case;    Migration;    Travel;    Human behavior;    Qualitative research;    Sub-Saharan Africa;   

DOI  :  10.1186/s12936-019-2855-2

来源: publisher

【 摘 要 】

BackgroundZanzibar has maintained malaria prevalence below 1% for the past decade, yet elimination remains elusive despite high coverage of core vector control interventions. As part of a study investigating the magnitude and drivers of residual transmission in Zanzibar, qualitative methods were utilized to better understand night time activities and sleeping patterns, individual and community-level risk perceptions, and malaria prevention practices.MethodsA total of 62 in-depth interviews were conducted with community members and local leaders across six sites on Unguja Island, Zanzibar. Twenty semi-structured community observations of night-time activities and special events were conducted to complement interview findings. Data were transcribed verbatim, coded, and analysed using a thematic approach.ResultsParticipants reported high levels of ITN use, but noted gaps in protection, particularly when outdoors or away from home. Routine household and community activities were common in evenings before bed and early mornings, while livelihood activities and special events lasted all or most of the night. Gender variation was reported, with men routinely spending more time away from home than women and children. Outdoor sleeping was reported during special events, such as weddings, funerals, and religious ceremonies. Participants described having difficulty preventing mosquito bites while outdoors, travelling, or away from home, and perceived higher risk of malaria infection during these times. Travel and migration emerged as a crucial issue and participants viewed seasonal workers coming from mainland Tanzania as more likely to have a malaria infection and less likely to be connected to prevention and treatment services in Zanzibar. Some community leaders reported taking the initiative to register seasonal workers coming into their community and linking them to testing and treatment services.ConclusionsTargeting malaria interventions effectively is critical and should be informed by a clear understanding of relevant human behaviour. These findings highlight malaria prevention gaps in Zanzibar, and the importance of identifying new approaches to complement current interventions and accelerate the final phases of malaria elimination. Development and deployment of complementary interventions should consider human behaviour, including gender norms, that can influence exposure to malaria vectors and prevention practices. Expansion of community-level programmes targeting travellers and seasonal workers should also be explored.

【 授权许可】

CC BY