1. Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5–15 years
- Author
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Andry Andrianasolo, Ammy Fiadanana Njatosoa, Chiarella Mattern, Bakoly Rahaivondrafahitra, Christophe Rogier, Mauricette Andriamananjara, Aina Harimanana, Thomas Kesteman, Dolorès Pourette, Elliot Rakotomanana, Jocelyn Razafindrakoto, Emma Raboanary, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), Unité de Recherche sur le Paludisme [Antananarivo, Madagascar], Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Oxford University Clinical Research Unit [Hanoi] (OUCRU), Population Services International Madagascar [Antananarivo], Population Services International [Washington], Ministère de la Santé Publique [Antananarivo, Madagascar], U.S. President’s Malaria Initiative [Antananarivo] (PMI), U.S. President's Malaria Initiative [Atlanta, GA,], Institut international des sciences sociales [Antananarivo] (IISS), Primum Vitare, The publication process of this paper has been funded by USAID through the Research, Innovation, Surveillance and Evaluation (RISE) programme., Institut de Recherche pour le Développement (IRD), and Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)
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Male ,medicine.medical_specialty ,Mosquito Control ,lcsh:Arctic medicine. Tropical medicine ,Adolescent ,lcsh:RC955-962 ,LLIN use ,030231 tropical medicine ,[SHS.ANTHRO-BIO]Humanities and Social Sciences/Biological anthropology ,Ethnic group ,Qualitative property ,[SHS]Humanities and Social Sciences ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,parasitic diseases ,medicine ,Madagascar ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,Children over five ,Insecticide-Treated Bednets ,Child ,Disease burden ,Research ,Public health ,[SHS.ANTHRO-SE]Humanities and Social Sciences/Social Anthropology and ethnology ,medicine.disease ,3. Good health ,Malaria ,Infectious Diseases ,Geography ,Child, Preschool ,Mosquito net ,Female ,Parasitology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Thematic analysis ,Sociocultural factors ,Qualitative research - Abstract
BackgroundAlthough it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years.MethodsQualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.ResultsA total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.ConclusionsPerceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.
- Published
- 2021
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