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Published on: March 16, 2019
Evaluating the acceptability and feasibility of new mosquito bite prevention tools in a "forest pack" to support
David J McIver1, Dyna Doum2,3, Chean Men2
1Malaria Elimination Initiative, Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. davidjmciver@gmail.com.
Background:
Cambodia is nearing malaria elimination after years of sustained progress. The remaining challenges are at-risk populations living or working in forested areas exposed to outdoor and early evening biting and where treated nets or residual spraying is not practical. This study evaluates the acceptability and feasibility of additional mosquito bite protection products, delivered to these high-risk populations.
Methods:
This study was conducted in two high-malaria burden operational districts (OD) in Cambodia, targeting high-risk individuals: forest goers, forest dwellers, and forest rangers. A total of 28,000 forest packs containing a volatile pyrethroid spatial repellent (VPSR) and topical repellent (TR), were distributed over four rounds and clothing was treated with insecticide over two rounds. Social and Behavior Change Communication (SBCC) materials to support adoption were included. The evaluation included surveys, key informant interviews, and focus group discussions. Outcomes were assessed using implementation science frameworks and descriptive statistics.
Results:
A total of 2935 individuals from 18 villages were enrolled. Product distribution through village malaria workers reached 85% of the target population in Sen Monorom OD and between 72-102% in Phnom Srouch OD, though pack fidelity varied, with fewer complete packs delivered than planned, particularly in Phnom Srouch. Coverage of ITC was very low across both ODs (1-40% in Sen Monorom and 1-5% in Phnom Srouch). Reported acceptability and appropriateness of the products increased over time, with up to 96% of participants finding the SE acceptable, 93% for TR, and 100% for insecticide treated clothing (ITC). Reported product use was high, particularly among forest dwellers; forest rangers had lower reported use, especially for topical repellent. Users indicated the potential for early and consistent SBCC engagement to improve use. Having trusted members of the community deliver tools and SBCC is important. Each tool was reported to be most useful in different use scenarios and at different times of the day. Government and NGO implementers believed the products were appropriate for the targeted groups and that, while delivery to remote communities was challenging, especially for ITC, they support implementation of these products for malaria elimination.
Conclusion:
This study demonstrated the acceptability and feasibility of new bite prevention products distributed together with SBCC, from the perspective of forest-exposed, at-risk community members. It highlighted the need for better implementation to ensure more timely and consistent dissemination of product and SBCC materials. Further studies are needed to assess the epidemiological impact of combined bite prevention tools.
