Mosques against malaria

In a community-based malaria control project covering a predominantly Muslim population in the United Republic of Tanzania, difficulty was encountered in motivating people to have their mosquito nets reimpregnated with insecticide at six-monthly intervals. Education on this subject was therefore provided in mosques during Friday noon prayers. People who attended these services considered them an appropriate forum for discussing health concerns and viewed them as a credible source of information.Insecticide-impregnated bednets help to control the spread of the malaria parasite Plasmodium falciparum. The Bagamoyo Bednet Project is a community-based scheme to develop a sustainable system for the distribution and promotion of such bednets among 21,000 people in a rural coastal area 60 km north of Dar es Salaam. While the 13 village committees have sold and distributed the bednets, they have been unable to motivate people to have their nets impregnated with insecticide every 6 months, key to thwarting the spread of malaria. Posters and meetings also had only a limited impact upon user motivation. The target population is mainly Muslim. The sheikh in each of 4 villages was therefore recruited to teach during Friday noon religious services, when attendance levels are relatively high, the merits of regular bednet impregnation. This approach was chosen because people expect to receive some form of teaching or instruction during the service, and the religious leaders who run it are respected and seen as reliable sources of information. There are also many health teachings in the Koran and Sunna. Although only a minority of villagers attended, a considerable proportion disseminated the information to family and friends. This approach seemed most effective in reaching men aged 30-50 years, and ineffective in reaching youth; fewer women attended prayers than men. The project achieved 52-98% regular bednet reimpregnation except in one village where the level reached only 25%

Social and cultural factors affecting rates of regular retreatment of mosquito nets with insecticide in Bagamoyo District, Tanzania

Insecticide-treated mosquito nets have an impact on mortality and morbidity in young children under controlled conditions. When integrated into larger control programs, there is the danger that rates of regular retreatment of the nets with insecticide will drop, greatly limiting their effectiveness as a public health intervention. In Bagamoyo District, Tanzania, rates of retreatment dropped significantly when payment for the insecticide was introduced. A series of neighbourhood (hamlet) meetings were held in all study villages to discuss people\u27s concerns about the insecticide and ways to increase rates of retreatment. Although changes were made in the procedure for retreatment, rates of retreatment remained lower than expected and showed marked variation within as well as between villages. We then conducted unstructured key informant interviews as well as informal discussions in a village with strong variation between different sectors of the village in rates of retreatment. While logistical problems were most frequently cited as reasons not to bring nets for retreatment, political and social divisions within the community provided a better explanation. This is borne out by the low response to rearrangements in logistics which made retreating the nets significantly easier for households, and the higher response when changes were made in the channels of communication as well as the logistic features. It is clearly more difficult for villagers to appreciate the benefits of the insecticide than those of the nets. Great emphasis needs to be placed on the insecticide and its beneficial effects from the outset for any large-scale programme to be sustainable