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Prior to implementation of a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in western Kenya, ethnographic studies were conducted to understand local perceptions of disease, sleeping patterns, and other factors that might affect use of ITNs. Educational activities took place prior to distribution, but immediately after distribution in Asembo only approximately half of the ITNs were in use. A qualitative study was then conducted to identify the community’s perceptions about ITNs and the ITN project. While participants ranked malaria as important and recognized that malaria prevention could be beneficial, they believed ITNs would be only partly effective due to the perception that malaria has multiple causes. Concerns expressed included fear of the insecticide, thought by some to be a toxic family planning aid, the taking of blood during clinical studies, and the mixing up of family ITNs during net re-treatment, which would violate cultural taboos. Attempts were made to allay fears by improved communication on these subjects and modification of the study design.
Acknowledgments: The leading roles of Jane Oiro, Timothy Orwa, Carren Anyango, Norman Okello, and Maurice Kong’ong’o in this study are acknowledged. The vital event monitors, the participatory educational theater team, George A. Otiende and Nelson Opiyo, provided helpful assistance. The support and cooperation of village participants is greatly appreciated. Dr. Larry Slutsker is thanked for reviewing the manuscript. This paper is published with the approval of the Director of the Kenya Medical Research Institute.
Financial support: The project was funded by the United States Agency for International Development. Jane A. Alaii was supported by the Netherlands Foundation for the Advancement of Tropical Research (WOTRO), and the Kenya Medical Research Institute.
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Jane A. Alaii and John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. H. W. van den Borne Department of Health Promotion, Faculty of Health Sciences; Maastricht University, Maastricht, The Netherlands. S. Patrick Kachur, William A. Hawley, and Penelope A. Phillips-Howard, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Karen Shelley, Department of International Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322. Halima Mwenesi, Academy for Educational Development, Johannesburg, South Africa. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, 1211 Geneva 27, Switzerland.
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