Factors associated with acceptance of indoor residual spraying in Amac Sub County, Lira District

Abstract

Introduction Malaria is a major public health problem associated with slow socio-economic development and poverty and the most frequently reported disease at both public and private health facilities in Uganda. Indoor residual spraying (IRS) is recommended by World Health Organisation (WHO) as a cost effective vector control measure against malaria. The impact of IRS depends on high coverage which in turn depends on high acceptance by the community to have their homes sprayed. IRS has been implemented in northern Uganda for malaria control however the acceptance of IRS by the community has been sub optimal in most cases. Study objectives The study aimed to examine the factors associated with community acceptance to IRS in Amac Sub County, Lira District to help the district implement suitable interventions to increase IRS coverage. Methodology This was a cross sectional study with mixed methods of data collection. A household survey was conducted in 431households in Amac Sub County, Lira district. Households were sampled using systematic random sampling from the list of households. Eight (8) key informants were interviews were conducted with opinion leaders for an in-depth understanding of the subject matter. IRS acceptance was estimated by the proportion of household heads that accepted for their households to be sprayed during the last IRS intervention. A multivariate analysis was done to determine the factors associated with IRS acceptability. Qualitative data was analyzed manually by master sheet analysis. Results About 88.4% (381/431) of the respondents accepted spraying of their households. The coverage for the last round of IRS in 2019 was however high at 97.2% (419/431) because some households were forcefully sprayed despite the refusal of the heads of households. The main reasons for acceptance was that IRS protects against malaria (350/381), and IRS kills bed bugs 71.9% (274/381). Some of the respondents did not accept IRS for a number of reasons including having a sick person in the house during the time of spray 48% (24/50), the bad smell of the chemical (actelic 300cs insecticide) 42 %( 21/50), associating IRS with bedbugs 42 %( 21/50), perception that IRS does not kill mosquitoes 24% (12/50), lack of prior information given 20% (10/50), and fear of side effects of IRS 20% (10/50). IRS was more likely to be accepted by peasant farmers (OR = 5.68, CI: 1.68 - 7.85), households who own mosquito nets (OR = 2.16, CI: 1.01 - 4.15) and less likely to be accepted among; households with less than six members in the home (OR = 0.76, CI: 0.35 - 1.65). Conclusions Acceptance of IRS in Amac Sub County was associated with diverse operational and contextual factors. Future implementations should strengthen leadership commitment, integrate community sensitizations to eliminate preconceived ideas within the community, reconsider appropriate timing of IRS and prioritize choice of insecticide that does not offend the community.