Misuse of insecticide treated bed nets in malaria epidemic areas of Gende Rege Kebelle, Dire Dawa Administration, Eastern Ethiopia

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1 2015; 2(4): The Journal of Zoology Studies ISSN JOZS 2015; 2(4): JOZS 2015 Received: Accepted: Getachew Mulualem Department of Biology, College of Natural Sciences, Dire Dawa University, P.O. Box 1362, Dire Dawa, Ethiopia Molla Fentie Department of Biology, College of Natural Sciences, Dire Dawa University, P.O. Box 1362, Dire Dawa, Ethiopia Misuse of insecticide treated bed nets in malaria epidemic areas of Gende Rege Kebelle, Dire Dawa Administration, Eastern Ethiopia Author: Getachew Mulualem & Molla Fentie Abstract Over the past decades, significant gains have been made in the implementation of malaria prevention measures in sub-saharan Africa, including the distribution of insecticide-treated nets (ITNs). Currently most nations in Africa have policies for distributing ITNs to the society through various mechanisms; however the bed nets are being misused for purposes other than vector control strategies. The study was carried out from January to June The objective of the study was to assess misuse of insecticide treated bed nets in Gende Rege Kebelle, Dire Dawa city administration, Eastern Ethiopia. Before the beginning of the study a preliminary survey were carried out to assess the status of misuse among the households of the kebele. Subsequently, a cross-sectional study was employed. Considering the outcome of the preliminary investigation only households misusing the bed nets 10% (50 households) for purposes other than malaria control were taken. Study participants were interviewed through a standardized household questionnaire form using the local Oromiffa language. The data were entered in to Microsoft Exel data sheets, cross checked and transferred, and analyzed using table and percentage representation. Around 68% of the local community pointed, they use insecticide treated bed nets for purposes other than malaria control. In contrary, 32% of the respondents reported that, they didn t utilize the bed nets for mosquito control measures after they have it. About 64% of the local community responded that, they didn t knew the effect of using insecticide treated bed nets for purposes other than malaria control strategies. On other hand, 36% of the respondents are familiar with the possible effects of using insecticide treated bed nets for purposes other than malaria control programs. About 94% of the respondents reported that, there was breeding area of mosquitoes in their locality while 6% of the respondents reported there was no breeding area of mosquitoes nearby their homes. The study shown that, there is significant misuse of insecticide treated bed nets by the local communities. Owing this, Promoting positive attitude towards use of insecticide treated bed nets and its health benefits should be a focus of future vector control campaign at regional and national level. Keywords: Misuse, bed net, Insecticide, vector control, long lasting bed nets Corresponding Author: Getachew Mulualem Department of Biology, College of Natural Sciences, Dire Dawa University, P.O. Box 1362, Dire Dawa, Ethiopia 1. Introduction Malaria is the most widespread and persistent disease which affects human populations throughout the world and especially in tropical countries. It is one of the biggest health problems in sub-saharan Africa [21] and its contribution to morbidity and mortality among people in Africa has been a subject of academic interest, political advocacy and thought [20]. In sub-saharan Africa alone, 400 million persons are at risk, and nearly all the 1 million deaths per annum from malaria in the world occur in this region [20]. Page 39

2 Malaria kills a child in every 30 sec [3]. In addition, pregnant women are at immense risk of malaria due to natural immune depression in pregnancy [8]. Malaria is a serious public health problem in most parts of the globe being a leading cause of death and disease in many developing countries. Malaria occurs mostly in poor, tropical and subtropical areas of the world [7]. In Africa, malaria transmission is maintained by the presence of a very efficient vector, Anopheles gambiae, predominance of Plasmodium falciparum, optimum local conditions, scarce resources, poor environmental conditions, social, political and economic instabilities [7]. Among the public health problems in developing countries malaria, causes by far the largest worldwide disease burden particularly in Sub-Sahran Africa including Ethiopia [25]. Insecticide-treated mosquito nets (ITNs) are being used for protection against mosquito bites and have proven to be a practical, highly effective, and cost-effective intervention against malaria [13]. Scaling up ITNs coverage and use by young children and pregnant women s has been made a consensus target of the Millennium Development Goals (MDGs), the Roll Back Malaria Partnership (RBM), and the US President s Malaria Initiative (PMI) (US President s Malaria Initiative, 2006). Studies done by the world health organization in 2002 reveled that, sleeping in the bed nets treated with insecticide can greatly reduce deaths by malaria, especially children s [24]. However, there is a number of potentially damaging in misconceptions about insecticide treated nets in Africa [1] Across Africa insecticide treated bed nets are perceived as discomfort that provides only partial protection against a trivial illness [18, 19]. Other typical examples of wide spread misuses of insecticide treated bed nets have been reported in the past 10 years and include claims about the use of nets as wedding Vials in Uganda and Tanzania [17] Inline to this, it was used for fishing in Kenya and Zambia [26], as protection of plants /crops in sierraleon [11] The effectiveness of insecticide treated bed nets is not only measured by the coverage but also includes proper adherence to yet fully convinced of the effectiveness of insecticide treated net, for malaria prevention [1] Good health is a fundamental foundation for social and economic advancement in a given country. Knowledge, however, is a crucial element in health improvement and the education of a diseaseburdened group on the ways of disease prevention to the attainment of self-reliance in disease endemic countries. Furthermore, proper understanding of local communities on the prime use of insecticide treated bed nets is crucial especially in sub-saharan Africa where there are inadequate medical facilities. The knowledge, attitude and practice of the societies, on the proper use of insecticide treated bed net are in its infancy. Owing this, the societies are misusing the bed nets for purposes other than malaria control such as covering of hairs, house hold materials and shatter. Therefore, this study was aimed at assessing the extent of miss use of insecticide treated bed nets among households of Gende rege Kebelle, Dire Dawa city administration, Eastern Ethiopia 1.1 Study Area Dire Dawa is located 9 28' 1" N and 9 49' 1 latitude and between and between In the north, east, and west the administration is boarded by the Somalia national regional state and in the south and south east by the Oromia national regional state [4]. Dire Dawa administration is character city administration that consists of 9 urban and 38 rural Kebelle. In all, the administration has a total land size of 1288 square, of which 97.73% accounts for the size of the rural area, while the remaining 2.27% covers the land size of urban areas found in the administration. The administration is found in southeast Ethiopia, and is located 515 km to east of Addis Ababa, 55 km to the north of historic city of harari and 311km to the west part Djibouti.the administration has a worm and dry climate with a low level of precipitation the annual maximum and minimum temperature is C and 18.20C respectively [4]. The administration has an average annual rain fall of 60 mm. The range of altitude of the land in the administration is between above sea level. Dire dawa has a population of of whom are men and women: or 68.23% of the population are urban inhabitants. For all of dire dawa households were conducted living in housing units, which result in an average of 4.5 persons to households with urban households having an average 4.2 and rural households 4.9 people [4]. Page 40

3 2. Methods Before the beginning of the study a preliminary survey were carried out to assess the status and causes of misusing of insecticide treated bed nets among the households of the kebele. Accordingly, the current study site was selected for the survey. A crosssectional study was carried out to assess misuse of insecticide treated bed nets in Gende Rege Kebelle, Dire Dawa city administration, Eastern Ethiopia. The survey was carried out from January to June The total population in the kebelle was 500 households. Considering the outcome of our preliminary investigation only households misusing the bed nets 10% (50 households) for purposes other than malaria control were taken. A study clerk explained the aim of the survey to the household s heads to have their consent. Those who consented were listed and asked to provide details of the extent of misuse of insecticide treated bed nets for purposes other than malaria control. Study participants were interviewed through a Fig 1: Map of the study site Table 1: Socio demographic characteristics of respondents standardized household questionnaire form using the local Oromiffa language. Questionnaire recorded data on distribution status of insecticide treated bed nets, Status of misuse of insecticide treated bed nets, Causes of misuse of insecticide treated bed nets, Knowledge on the effect of misuse of insecticide treated bed nets. The data were entered in Microsoft Exel data sheets, cross checked and transferred, and analyzed using table, and percentage distribution. 3. Results 3.1. Socio demographic characteristics of respondents About 60% of the study participants were females while 40% were males. Majority (40%) of the informants were daily laborers. The educational status was 28% and 20% elementary and high school completed respectively. The detail socio-demographic characteristics of the interviewed inhabitants of the study area are given in (Table 1). Evaluated factor Assessed variable Frequency Percentage (% ) Sex Occupational status Educational status Male 20 40% Female 30 60% Farmers 17 34% Teachers 3 6% Merchants 10 20% Daily laborer 20 40% Elementary completed 14 28% High school completed 10 20% Diploma 3 6% Others 23 46% Page 41

4 3.2. Distribution status of insecticide treated bed nets in the locality Almost all (92 %) of the local villagers reported that, there was intensive distribution of bed net in the locality while 8% of the inhabitant responded, they did not receive bed net a few years back. On the other hand, All (100%) of the informants used insecticide treated bed nets than other types of bed nets Status of misuse of insecticide treated bed nets Most 68% of the local community pointed, they use insecticide treated bed nets for purposes other than malaria control. Likewise, 32% of the respondents reported that, they didn t utilize the bed nets for mosquito control measures after they have it (Table 2). Table 2: Status of misuse of insecticide treated bed nets among the local households Status of misuse of insecticide treated bed nets Frequency Percentage (%) Protecting bed bugs and other harm full insects 25 50% Covering household materials 9 18% Not used for mosquito control 16 32% Total Figure 2: Misuse of insecticide treated bed net in the study site (Photo by Getachew Mulualem, 2014) Page 42

5 3.4. Causes of misuse of insecticide treated bed nets by the households of the locality There are a number of reasons which causes the local community to practice misuse of insecticide treated bed nets in their live hood. The causes are summarized in (Table 3). Table 3: Reasons for misuse of insecticide treated bed nets among the local community Reasons for misuse of bed nets Frequency Percentage (%) The need to cover household problems 31 62% Misunderstanding of its importance 6 12% Technical limitation on its use 10 20% Others 3 6% Fig 3: Causes for misuse of insecticide treated bed nets in the study site (Photo by Getachew Mulualem, 2014) Majority (66%) of the local villagers reported that, post distribution advice was given by health workers on the proper utilization of insecticide treated bed nets. On other hand, 34% of the respondents didn t obtain guidance on the technical utilization of insecticide treated bed nets from the health extension workers. The specific time in which the advice was delivered is presented in (Table 4). Table 4: Time of advice on bed nets utilization by health workers Time of advice on bed nets utilization Frequency Percentage (%) During susceptible outbreak of malaria 16 32% During preparedness program for malaria 9 18% During reported cases from family member 7 14% Others (public meeting and social affairs) 18 36% Page 43

6 3.5. Perception on the effect of miss use of insecticide treated bed nets About 64% of the local community responded that, they didn t knew the effect of using insecticide treated bed nets for purposes other than malaria control strategies. On other hand, 36% of the respondents are familiar with the possible effects of using insecticide treated bed nets for purposes other than malaria control programs. The perception of the households regarding the effect of miss use of insecticide treated bed nets along its percentage contribution are summarized (Table 5). Table 5: Perception on the effects of miss use of insecticide treated bed nets by the community Perception on the effects of misuse of bed nets Frequency Percentage (%) Spread of malaria disease % Economy decline 8 16 % Others 2 4 % Have no adverse effect % Total % Majority (74%) of the local community responded that, there was some kinds of technical helps given on the use of insecticide treated bed nets during the period of distribution. These include how to hang the nets on the bed and handle it accordingly. In contrary, 26% of respondents reported that, there was no any kind of practical guidance given on the use of bed nets in time of distribution. Table 6: Number of bed nets ownership per family units Ownership of bed net per family Frequency Percentages (%) One 7 14% Two 16 32% Three 15 30% Above three 12 24% 3.6. Frequency on the use of insecticide treated bed nets Majority (64%) of the local community responded that, the frequency of utilizing insecticide treated bed nets were limited to sometimes than utilizing on regular basis ( 36%) to avoid mosquito bite and other vector borne diseases (Table 7). Table 7: Frequency on the use of bed nets by households of the community Frequency on the use of bed net in your house hold Frequency Percentage (%) Regular 18 36% Sometimes 32 64% About 94% of the respondents reported that, there was breeding area of mosquitoes in their locality while 6% of the respondents reported there was no breeding area of mosquitoes nearby their homes. The important breeding sites of mosquito along their preferences are summarized in (Table 8). Page 44

7 Table 8: Knowledge of breeding habitats of mosquito in the locality Breeding sites of mosquito in the locale Frequency Percentage (%) Nearby home garden 25 30% House hold dust bin 13 26% Open house hold equipments in the garden 4 8% Others 8 16% 4. Discussion This study showed that the potential off-putting implication of miss use of insecticide treated bed nets towards the efforts of mitigating the episodes of malaria in Ethiopia. The present study site is one of the top malaria reported cites in Ethiopia with some recorded cases of the diseases in greater extent but the practice of proper utilization of the freely distributed bed nets is in its infancy. Several epidemiological surveys showed that there have been a wide coverage of distribution of ITNs in Ethiopia, but very poor utilization of the nets has not been severally reported to undermine the efforts in the malaria control fight. The present study indicated a poor utilization of the ITNs. Furthermore, About 92 % of the households own ITNs. This may be attributed to the government effort to scale up the coverage of insecticide treated bed nets as an effort of mitigating malaria across the country. However, the distribution status is not aligned with the intended use. Our data shown 68 % of the households were misusing insecticide treated bed nets for purposes other than malaria control measures. This finding is in agreement with similar studies done in Oromia regional state, Arsi zone, Ethiopia. Furthermore, this study confirmed that bed nets were being used as bed sheets, mattress covers, room partitions, and covers or sidewalls for outdoor toilets. Other alternative uses were specific to farming households including the use of bed nets to cover grain, make rope for ploughs, and create livestock stables (C-Change, 2012). Besides, a study conducted in Western Kenya has shown that, attempts to use bed nets are often hampered by environmental, social, and cultural considerations. Potential factors that affect bed net use are education level of family head, wealth, colour and shape of bed nets, house structure, sleeping arrangement, distance to retail stores and cultural taboos [1] Studies have shown that owning LLINs does not always increase the prevalence of use [11]. For instance, nets are occasionally misused for other purposes such as fishing in villages near Lake Victoria [1]. We attempted to understand the reason behind miss use of insecticide treated bed nets by the households of the current study site. The need to cover household problems and technical short coming on its use are the prime factors for misuse. This study is in agreement with a study done in Uganda which shown the associated factors of misuse was difficulty in hanging the net, dislike for the net among some household members, sleeping under the net can cause suffocation to children, inconvenience to proper and free sexual intercourse between spouses [18, 19]. In contrary a study done in Democratic Republic of the Congo has shown, the most common reason given for not using bed nets was discomfort due to heat within the net [10]. The other reasons given were based on cultural myths, and failure to use bed nets is often associated with misconceptions and cultural taboos [1]. The majority of respondents reported that, there is post distribution advice by the health workers on the proper utilization of insecticide treated bed nets. Different types of education campaigns have been utilized, including mass communication, communication target to specific communities, schools and health facilities follow up visit to house hold. Despite the fact that, there is significant misuse use of the bed nets in the surveyed site. In our study the number of bed nets ownership was two (32%) and three (30%) per households respectively. This may be associated with the good health policy and continuous effort to reduce the adverse effect of malaria on socioeconomic and attainment of millennium development goals in the country. The number of bed nets in family unit depends on the number of individuals in the family. In the other study as mandated by the national malaria control strategy, reported bed net owner ship in intervention communities was nearly two nets per house hold (C- Change, 2012). As regards to the knowledge of the households on the use of bed nets 84% perceived that, it s befit in controlling malaria were significant. This finding may be a good indication of misusing the bed nets even if they had the Knowledge on its use. This was also reported in a study conducted in Uganda by Okello, Similarly, a study done in Imo River Basin of Imo State Nigeria showed that, all participants and key informants knew that mosquito nets were a Page 45

8 useful preventive measure against malaria [6]. Our finding revealed that, nearby home garden 30% followed by House hold dust bin 26% was the most important breeding habitats of mosquito in the locale. This finding is consistent with a study done in Butajira District, southern Ethiopia [23]. In summary, educational campaigns informing local household about the dangers of misuse of the bed nets and the potential benefits of proper use has an influential impact on malaria control actions. Therefore, post distribution awareness creation program on the extent of miss use of insecticide treated bed nets are significant health management strategies in malaria control strategies. 5. Conclusion In the current study there is large scale distribution of bed net but the intended aim is misused. Hence, post distribution advice by health extension workers may be part of the solution. The prime factor for misuse of insecticide treated bed nets in the community was household problem and technical limitation on its use. Consequently, the local authorities should take part to mitigate such problems in advance. Almost all of the households knew the effect of misusing the bed nets for purposes other than malaria control but they continually practice it. Therefore, community based malaria control programs should be designed to address the existing situations. 6. Acknowledgements The authors sincerely acknowledge the Department of Biology, College of Natural and Computational Science, Dire Dawa University for providing the help to pursue this research work. We would like to thank Mr. Abdul feta Zeynu and Mr. Bekele Tilahun for their support during the field work. We are also grateful to the study area inhabitants for responding to the questionnaires honestly. 7. References 1. Alaii J, Hawley W, Kolczak M, ter Kuile F, Gimnig J, Vulule J, Odhacha A, Oloo A, Nahlen B, Phillips H. Factors affecting use of permethrin-treated bed nets during a randomized controlled trial in western Kenya. Am J Tropical Medicne Hygene. 2003; 68(4 Suppl): Alaii J, Hawley W, kolczok S, Terkuile F, Gimnig J. Factors affecting use of permitinin treated bed net during a randomized controlled trail in western Kenya. American Journal of tropical medicine and hygiene. 2003; 68 (4): Alnwick D Roll B. Malaria what are the prospects? Bull World Health Organ. 2000; 78(12): BoFED. Bureau of finance and economic development of Dire Dawa. Eastern Ethiopia. 2011; 9-12pp. 5. Change C. Scope and Extent of Alternative Use of Bed Nets within the Arsi Zone in Ethiopia: Preliminary Findings from Household Interviews and Observations. Washington, DC: C-Change Project. 2012; FHI Chukwuocha U, Dozie I, Onwuliri C, Ukaga C, Nwoke B et. al. Perceptions on the Use of Insecticide Treated Nets in Parts of the Imo River Basin, Nigeria: Implications for Preventing Malaria in Pregnancy. African Journal of Reproductive Health. 2010; 14(1): Elom, M, Alo M, Ugah U, Okeh N, Ibiam, G. Survey of Utilization and Effectiveness of Insecticide Treated Bednets As Intervention Strategy in Malaria Transmission among Pregnant Women in a Rural Community in Ebonyi State, South Eastern Nigeria. Journal of Dental and Medical Sciences Volume 2013; 9(2): Fievet N, Cot M, Ringwald P, Bickii J, Dubois B, Le Hesran J (1997). Immune response to Plasmodium falciparum antigens in Cameroonian primigravidae: evolution after delivery and during second pregnancy. Clin Exp Immunol. 107(3): Fotenalin M (2010). Sierraloen. (Miss used) key to malaria nets presentations. Inter press service new Agency, Rome, inter press service new Agency. Pp?? 10. Julie K Noboru M (2010).The importance of education to increase the use of bed nets in villages outside of Kinshasa, Democratic Republic of the Congo. Ndjinga and Minakawa. Malaria Journal. 9: Korenromp E, Miller J, Cibulskis R, Kabir M, Alnwick D, Dye C (2003). Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years. Trop Med Int Health. 8: Legeser C (2004). Insecticide treated bed nets and certain for preventing malaria. Cochrane database system Revise CDOOO363.??? 13. Lengeler C (2004). Insecticide-treated nets for malaria control: real gains. Bull World Health Organ. 82(2): Millennium, Project: Final report to United Nations Secretary General. London/Sterling VA: United Nations; 2005, 356. Page 46

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