IRS – does the community accept?

The Agencia de Informacao de Mocambique reported that, “spraying campaigns have often failed to attain the desired results because people refuse to allow the Ministry of Health teams to spray their homes. The last spraying campaign, intended to cover 47 of Mozambique’s 128 districts, only met 37 per cent of its target.” The Ministry of Health reported that, “much of the low coverage is due to people simply refusing the health workers access to their homes.” Similarly the President’s Malaria Initiative (PMI) identified that only 50% of targeted homes were covered in a 2006 IRS campaign in Mozambique.

The World Health Organization confirms that part of the decline in the use of IRS to control malaria has been low community acceptance. “Community acceptance of house spraying and cooperation, for exam­ple, by allowing access and removing some household contents prior to spray­ing, are critical for the program to be successful. Repeated spraying of houses commonly generates fatigue and refusal by householders. Reduced acceptability has been an impediment to effective IRS implementation in vari­ous parts of the world.”

remove-hh-items-before-irs.jpgWHO identifies other factors that reduce community acceptance including, “Some insecticide formulations are less acceptable because of their smell or because they leave unattractive deposits on walls.” IRS may also make community members feel uncomfortable and suspicious of spray teams, such as when household possessions are moved to enable spraying, as seen in the drawing from a WHO Eastern Mediterranean Office publication.

One was to overcome these problems is enhancing community participation and improving the capacity of the health system: “Acceptance and cooperation by house owners are higher with better health education and more involvement in planning. The cost for personnel is much reduced although the local health service or a community-based organization may have to give the spray workers some financial or other compensation. The health services, however, have to be strengthened in order to provide health education as well as the supervision and evaluation of activities.”  Similarly, PMI suggested that a “well-run … spraying program has been able to keep refusals below 5-10% over the course of 11 rounds of spraying” through involving community leaders and string health education efforts. Therefore, IRS, like any other public health intervention, needs a strong community involvement and health education component to succeed.

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