Insecticide treated shukas: Examining the determinants of the adoption of an innovative malaria prevention strategy in northern Kenya
Description
This dissertation examines the postulated socio-demographic, economic and malaria-related factors that affect whether an innovative malaria prevention strategy could be successfully adopted as an effective and sustainable disease prevention program in Samburu District, northern Kenya. An efficacy trial, conducted in the same area, had demonstrated that insecticide-treated shukas (ITSs), locally worn wraps and bed-sheets, had the potential to reduce malaria transmission. While these are exciting results, they do not address how this strategy would operate outside of controlled, study-trial conditions A mixed-method research design using both qualitative and quantitative data collection methods explored four research questions related to this topic: (1) Was the population willing to impregnate their personal clothing with a chemical insecticide? (2) Would community household heads agree to participate in community-wide impregnation efforts? (3) Were household heads willing to pay for insecticide treatment of shukas? and, (4) What was the maximum amount that household heads would agree to pay for ITSs? Data collection took place during two phases. Rapid ethnographic techniques, including in-depth interviews and focus group discussions, were used to collect information related to the ethnomedical and socio-cultural context of febrile illnesses including malaria in the study area. Results from these activities informed the design of a structured questionnaire used to conduct a community-based household survey, including a contingent valuation component in Phase 2 of the research Ethnomedical results indicate that two local illness terms, nkirewa---'fever' and nkirewa enkajingani ---'fever of mosquitoes', approximate the biomedical definition of malaria infection. Moreover, triangulated qualitative and quantitative information demonstrate an inverse association between the perceived severity of the illness constructs and treatment seeking at the local dispensary. With regard to the specific study questions, approximately 9 out of 10 household heads were willing to impregnate their shukas (97.3%), participate in impregnation efforts (87.7%), and pay for ITSs (91.1%). However, the maximum amount that individuals were willing to pay per shuka treated (mean 24 Ksh; median 15 Ksh) will necessitate subsidization by the implementing organization if ITSs are to be offered as a malaria prevention option