TY - JOUR
T1 - Human behaviour and residual malaria transmission in Zanzibar
T2 - Findings from in-depth interviews and direct observation of community events
AU - Monroe, April
AU - Mihayo, Kimberly
AU - Okumu, Fredros
AU - Finda, Marceline
AU - Moore, Sarah
AU - Koenker, Hannah
AU - Lynch, Matthew
AU - Haji, Khamis
AU - Abbas, Faiza
AU - Ali, Abdullah
AU - Greer, George
AU - Harvey, Steven
N1 - Funding Information:
This work was made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI) under the terms of USAID/JHU Cooperative Agreement No. AID-OAA-A-14-00057 (VectorWorks Project). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background: Zanzibar 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. Methods: A 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. Results: Participants 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. Conclusions: Targeting 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.
AB - Background: Zanzibar 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. Methods: A 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. Results: Participants 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. Conclusions: Targeting 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.
KW - Elimination
KW - Human behavior
KW - Imported case
KW - Malaria
KW - Migration
KW - Outdoor biting
KW - Qualitative research
KW - Residual transmission
KW - Sub-Saharan Africa
KW - Travel
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U2 - 10.1186/s12936-019-2855-2
DO - 10.1186/s12936-019-2855-2
M3 - Article
C2 - 31262306
AN - SCOPUS:85068525507
SN - 1475-2875
VL - 18
JO - Malaria journal
JF - Malaria journal
IS - 1
M1 - 220
ER -