Research Prospectus

Title: Using Insecticide Treated Nets after washing and reusing for two years as an Effective Malaria Prevention Strategy in Rural Areas of Africa

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Problem Statement

In the 21st century, Malaria is still categorized as a global health challenge, listed as a primary public health concern in a majority of the countries (Nyarko & Cobblah, 2014). In fact, it is considered to be an endemic in approximately 100 countries, and almost 50% of the worldwide population is at risk of contracting malaria (Fana et al., 2015). It is estimated that approximately one million people die from malaria every year. It is a life-threatening disease that can be transmitted from one person to another via the bite of female mosquitoes (genus Anopheles) (Patz & Olson, 2006). In 2015, malaria transmission was recorded in over 95 countries, which constituted in approximately 214 million cases (World Health Organization (WHO), 2015). However, it is important to note that approximately 80% of all deaths caused by malaria in that country were concentrated to only 15 countries mainly from the African region (World Health Organization (WHO), 2015). According to the World Health Organization (WHO) it estimates that 9 out of 10 deaths in children is caused by malaria in Africa (World Health Organization (WHO), 2015). It is also important to note that, malaria transmission tends to be higher in the rural settings than the urban areas mainly because of higher vector density, lower housing quality, and poor drainage systems in the rural areas. Lack of education on malaria has been found to be among the factors that prevent the natives of Aba from taking precautionary measures. More so, the community lacks access to healthcare workers to treat the emerging infections (Manu et al., 2017). Therefore, this research will look at the effectiveness of using mosquito nets that have been reused and treated with insecticide repellants. Notably, insect treated mosquitos have been found to have several advantages such as killing the mosquitos once they land on the net (Manu et al., 2017). In the previous locations that insecticide-treated nets have been used, the number of people with malaria has significantly declined however, the effect of reusing old nets, rewashing them and treating them is yet to be established.

Purpose of the Study

The purpose of this study is to identify the effectiveness of using insecticide-treated mosquito nets that have been reused after two years. The findings of the study will provide the cost effective alternative of using old but treated nets. Majority of the communities are not aware of the effects of the treated mosquito, and the rates of mosquito infections increase because some people often sleep in an untreated net (Manu et al., 2017). Therefore, this research will take into account the exiting knowledge on re-using mosquito nets in various rural area settings in different parts of Africa. The independent variables for the analysis will consist of age, literacy, and the prevalence of information on the availability of treated mosquito nets. On the other hand, the dependent variable for the research will be the use of old treated nets. Notably, in the last decades, mosquito related cases have dropped owing to the use of ITNs. Nonetheless, the study will also look at the correlation between literacy levels and the prevalence of mosquitos.

Significance

The findings from this research will be important especially to the rural areas in the most affected African countries where malaria is considered to be highly prevalent, and a major cause of morbidity and mortality among the regions' populations. The results of the study will assist in coming up with an appropriate solution for dealing with malaria especially in the rural areas where a majority of the people are not aware of the recycling mechanisms (Azunie, 2017). Notably, most of the rural residences are not aware of the benefits of treating and washing their nets with repellant insecticide once the effect has worn out. As a result, the rate of malaria continues rising as the nets are ineffective. Additionally, some of the residents have a negative attitude towards treating nets with the insecticide repellant due to cultural beliefs. Therefore, the findings of the research will be vital as they will assist in reducing the effect of malaria in the rural areas of African countries while providing the necessary awareness.

Background

The research carried out in developing countries by Zollner et al. found out that most of the residence lacked awareness of malaria and the few of the residence used insecticide-treated nets (ITNs) (Zollner et al., 2014). Additionally, the attitude toward using ITNs has been found to be affected by the social and cultural beliefs of the natives. Some of the symptoms of malaria have similar symptoms like fever. Therefore, women who are pregnant are often advised against using mosquito treated nets (Zollner et al., 2014). As a result, the knowledge barriers and the misconceptions of using ITNs have contributed to the misunderstanding on the importance of the ITNs.

The awareness of ITNs varies according to the localities. Therefore, when creating personalized solutions for a community, it is essential to understand their cultural beliefs (Singh, Brown, & Rogerson, 2013). Notably, the awareness of malaria intersects with causes of malaria, symptoms, the conventional mosquito practices, and the costs of the nets. Therefore, the level of knowledge on the mosquito nets varies depending on the locality. Additionally while creating the awareness of malaria, it is essential to stress that mosquitos are the critical cause of malaria. In so doing, the ITNs will be viewed as the only defense shield against malaria. Regarding vector control, the ITNs are the most prone control agents, and they reduce the transmission of malaria by 90% (Singh et al., 2013). Furthermore, the long-lasting ITNs have been found to have a re-treatment period of 3 to five years, thus creating a long-term solution.

However, in most developing nations, the supply of the ITNs remains the major obstacle towards achieving efficiency (Nwagha et al., 214). The benefit of the usage of the ITNs can also not be ignored as a 2009 Cochrane report indicated that stillbirths and the reduction of malaria symptom had declined over the years (Admasie, Zemba, & Paulos, 2018). The annual deaths caused by malaria can also be reported to be among the barriers for economic and social development in the affected countries. Notably, the traditional preventatives malaria control methods focused mostly on the biology of the malaria-causing parasite and overlooked the human factors (Nwagha et al., 214). However, the current worldwide roll back program focuses on the ITNs and the use of drug therapy as a preventative measure. As per the schedule, it is crucial that people sleeping under the net create a consistent regime of treating the nets to prevent the people of low immunity from contracting malaria.

Therefore, while considering the preventative measures, it is essential to find out whether people are buying into the ideology of using treated nets (Admasie et al., 2018). In essence, while combating malaria and reducing the population of the mosquitos, the human behavior need to be monitored. The collaborative measures of using the ITNs and appropriate human behaviors can translate to positive outcomes. Nonetheless among some of the human behaviors indicated those communities that were at risk of malaria rarely used the ITNs which therefore infer that the prevalence of the ITNs does not mean that they are being used (Admasie et al., 2018). Pregnant mother and children under the age of fie are the most likely to succumb to malaria. Thus it is crucial that when providing the treated nets the households with the identified demographic be given priority.

Therefore, while determining the factors leading to malaria, it is also essential to decide on the factors affecting the utilization of the ITNs (Ugwu, Ezechukwu, Obi, Ugwu, & Okeke, 2013). Additionally, other emerging factors lead to the inconsistency of the treated nets such as lack of proper education on when to treat the nets and the seasonality of malaria. In most developing countries malaria is prevalent during the rainy season due to the stagnant water and uncultivated environment. Therefore while considering the effectiveness of the ITNs, proper knowledge of other factors should also be given the communities (Ugwu et al., 2013). Notably, the households that correctly use ITNs were found to be least affected by malaria.

The health bureaus should not only focus on the provision of the treated nets but also capitalize on the extensions vices such as education (Ugwu et al., 2013). More so, additional studies should also be conducted on the geographic location of the affected areas. Such factors will enable to determine other unforeseeable variable and provide tailor-made solutions that fit the localities. In all the affected areas, the attitude towards the chemicals used for treating the nets reduced the size, and the lack of access for nets was found to be among the factors that influenced the use of ITNs (Teklemariam, Awoke, Dessie, & Weldegebreal, 2015). Therefore with the focus of eradicating the malaria problem, the governments of the affected countries have to take up an active role in the replacement of treated nets and providing better access to ITNs. Additionally, health education should be among the primary emphasis of the affected regions Bazirutwabo, 2018). In so doing, it will be easier to reduce the disparities in the population that is not aware of the practices of re-using nets.

Framework

The research focuses on the effect of treating nets and the after two years when the insecticide has worn out. The analysis expounds on the themes of the unavailability of the nets and the lack of sufficient education on the treated nets in the rural regions. Additionally, the research looks at the attitude of the people the affected areas particularly the social, cultural beliefs. When all the themes are combined, they intersect to provide a conceptualized outlook of the research question.

Research Question(s) and Hypotheses

The research will use qualitative analysis to answer the following questions

What are the benefits of re-using old nets while treating them as required?

What is the attitude of the affected communities towards treating nets as a measure to reduce the prevalence of Malaria?

Can educating the rural communities on treating nets, and destroying the breeding areas of mosquitoes reduce the high prevalence of Malaria in the rural communities in the worst hit regions in Africa? What do you think of my proposal to your lecturer's concerns?

Nature of the Study

The researcher will employ a systematic review to collect data that will be used in this study. A Boolean search string will be created using keywords such as 'malaria,' 'rural African regions' 'morbidity,' 'mortality,' 'treated nets,' 'untreated nets,' 're-used treated nets,' 'education of malaria,' 'malaria infections,' and 'malaria transmission.' These keywords will be combined using brackets, 'OR,' and 'AND' to create a Boolean search string that will mainly be used in the PubMed database. The researcher will mainly focus on randomized controlled trials and clinical trials from the results that will be generated from the Boolean search. The researcher will then conduct a review of the existing studies and discuss their findings in relation to the problem statement and research questions of this study.

References

Admasie, A., Zemba, A., & Paulos, W. (2018). Insecticide-treated nets Utilization and associated Factors among under-5 Years Old children in Mirab-abaya District, gamo-gofa Zone, ethiopia. Frontiers in public hea...