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Malaria N 7 - Subject N 5

R. Diseko, D.W. Rumisha & T.R. Pilatwe

Setting :
The Botswana Malaria Control Program in a rural district

Rationale :
The changing epidemiology of malaria in Botswana and indeed the whole world dictates the need to supplement control strategies with none traditional interventions. In most places, the vector and parasite have developed resistance to insecticide and drugs respectively. The use of impregnated material as means of recruiting community participation into malaria control has been tried elsewhere but very little is currently operational in Botswana. Active community participation for malaria control in Botswana has not been assessed but implicitly the acceptance of DDT indoor spraying and passive case finding has taken as proxy of the community involvement. A study thus conducted in an attempt to assess ways and means by which the community in Northern Botswana deals with malaria and the effect of introduction impregnated bednets as complementary method of malaria control.

Design :
A household survey on KAP on malaria control in Chobe district was conducted to identify the current information and practices on malaria control among the Chobe community.

Results :
448 household heads (71%) of the Chobe household heads were interviewed. Most (93.5%) consider malaria as a major public health problem with 82% report a death from malaria during the last transmission season. The community was already paying for preventive intervention including repellent (64%), bednets (17%). One in every five of the community members however believed that malaria was not preventable. Knowledge on the contribution of enabling environment towards malaria transmission including stagnant water was low but ranged from 21.7 - 51.2%. Consequently only 21% of the community was taking steps towards reduction of mosquito breeding sites.
More to it, 36.6% of the population do not consider indoor DDT spraying as cost effective method of malaria control. During the optimal biting time of mosquito 80% of the Chobe population was reported to be outside in the open air. It follows therefore that the risk of a successful bite between communities staying in spread houses and those staying in unspread houses might not be significantly different.
Only 8% of the Chobe community considers themselves responsible for malaria control as 58% hold the government responsible to check malaria transmission. A good number though, (58.5%) had at one time used bednets for protection against malaria.
44% of the study population sleeps on the floor half of them sharing. Such sleeping arrangements do not provide optimal situation for use of bed net.

Conclusion :
The community at Chobe recognise Malaria as a priority problem and practices vector control through the use of DDT indoor spraying (83%) use a repellent (64%) environmental manipulation (21-52%) bednets (17%) and case management with limited chemoprophylaxis. Institutional accountability of control activities however has been deemed to rest on the government. There is general reservation on DDT indoor spraying and there are reports of DDT behaviour resistance.
The introduction of an additional vector control intervention like bednet involvement of the lay community from the planning stages, monitoring and evaluation could serve as an entry point towards transferring vector control responsibility to the community.
In Chobe, the most viable NGO is the VHC under its umbrella organisation VDC. Using this village development agency for malaria control will in some ways link development of malaria control. The project has seen started and the impact will be reported in the next publication.

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