Barriers to Mosquito Net Use in an Underserved, Vulnerable Population in Uganda, Africa

Purpose: The Purpose is to describe the findings of a pilot study that examined mosquito net use among an underserved population in Uganda, Africa. The participants were living in a community of persons who had Hanson’s Disease or other stigmatizing health issues and were atat risk for contracting the disease.

Background & Significance: The World Health Organization (WHO) ranked the east African country of Uganda highest in the world for malaria transmission (World Health Organization, 2013).  Sleeping under mosquito nets effectively prevents malaria and the use of mosquito nets are a common component of Malaria prevention programs around the world.  However, the World Health Organization determined that only 33% of surveyed Ugandan households reported sleeping under nets (2013). While several studies have reported mosquito nets, when provided are misused or redirected for other purposes (Gitonga et al., 2012, Minakawa, Dida, Sonye, Futami, & Kaneko, 2008), there is limited research describing the experience of sleeping under mosquito nets or barriers to sleeping under mosquito nets from the perspective of persons living in Uganda.

 Methods:

This qualitative, descriptive study explored the experience of sleeping under a mosquito net and perceived barriers to sleeping under a net for participants living in a remote area of Uganda. The study was approved by the Florida Atlantic University Institutional Review Board.  In April 2015, qualitative interviews were conducted in two remote Ugandan communities identified as leper colonies located near Lake Victoria.  Community residents demonstrated consequential, physical sequelae of Hanson’s Disease such as missing digits and blindness. A few of the residents had other stigmatizing health issues such as being deaf-mute or visible signs of polio or elephantiasis.   

  Communities were selected based on researcher knowledge and input from a community chairman who granted approval for the study and presided over the communities.  Two local community member guides, identified by the community chairman, accompanied the researcher during community visits. Participants were recruited by visiting hut to hut.   One community health partner served as the English to Soga and Soga to English interpreter while the second partner verified the accuracy of the interpretations.  The researcher, via the Soga interpreter, explained the purpose of the study and read the verbal informed consent to participants.  Verbal consent was received and recorded for each participant. Face to face interviews were conducted using open-ended questions with the assistance of the Soga interpreters, recorded digitally and transcribed.  Handwritten field notes were maintained.  

Results:

Data were analyzed using Colaizzi’s phenomenological method of data analysis as interpreted by Sanders (2003).  To assure methodological rigor, each analysis step was reviewed with an experienced qualitative research team.  Three themes emerged: (1). protection, (2.) honoring older persons, and (3). living connected to the community.  Protection emerged in the context of participants expressed understanding that family members could and should be protected against malaria. They believed sleeping under mosquito nets offered some protection against malaria but also believed malaria was caused by wind, coldness or water. Therefore, they did not believe sleeping under mosquito nets provided complete protection against malaria.  Honoring older persons and the understanding parents must be well to provide for the family and care for children explained the local practice of reserving sleeping under mosquito nets for the oldest person in the home when an insufficient number of nets were available.  While not directly related to the use of mosquito nets, the theme living connected to the community emerged as participants reported shared stigmatized health conditions drew the community together.

Conclusion:

The data suggests that barriers to sleeping under mosquito nets were lack of access to a sufficient number of mosquito nets and misconceptions regarding malaria transmission.  The findings also revealed that in order for children to be protected by nets, there must be enough nets for the older family members.  This finding is significant in light of a study conducted in the Tororo district of Uganda in which researchers reported though 67.9% of households owned at least one net, only 9.9% reported having at least one net per two occupants (Pullan et al., 2010). The results of this study can inform nurses and international health care providers as they develop culturally sensitive, effective malaria education and intervention programs and policy change regarding the wide availability of mosquito netting for all persons in developing countries.  Understanding culturally sensitive barriers to mosquito net use may improve individual community integration of prevention strategies.