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Home Visits to Assess the Reliability of Caregiver-Reported Use of Insecticide-Treated Bednets by Children in Machinga District, Malawi
A malaria cohort study was conducted among young children in Machinga District, Malawi, following distribution of insecticide-treated bednets (ITNs) in May 2012. To assess ITN use, two independently sampled subsets of children (211 during survey 1 [December 2012–January 2013] and 325 during survey 2 [September–October 2013]) were randomly selected to compare the proportions of positive and negative agreement between caregiver verbal reports at monthly interviews with visual observation of the ITN at home visits. Caregiver-reported ITN use was consistently high during both surveys (98.1% and 96.0%, respectively; P = 0.17). Home visit-based ITN use fell significantly (P < 0.001) from survey 1 (98.6%) to survey 2 (88.6%). The proportions of positive agreement between caregiver report and home visit in the first and second surveys were 98.8% (95% confidence interval [CI] 97.6–99.8%) and 93.3% (95% CI 91.2–95.3%), respectively. The proportions of negative agreement in the first and second surveys were 28.6% (95% CI 0–75.0%) and 20.0% (95% CI 0.1–35.0%), respectively. ITN use by children was high in Machinga District, and caregiver reports and home visits with visual confirmation of the net demonstrated a high level of agreement for use of ITNs, but a low level of agreement when ITNs were not used.
Author Notes
Financial support: This work was made possible through support provided by the U.S. President's Malaria Initiative, U.S. Agency for International Development, under the terms of an Interagency Agreement with the Centers for Disease Control and Prevention (CDC) and through a Cooperative Agreement (No. U01CK000135) between the CDC and the Malaria Alert Centre, College of Medicine.
Authors' addresses: Jacklyn Wong, Monica P. Shah, and John E. Gimnig, Entomology Branch and Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: vsm0@cdc.gov, mshah2@cdc.gov, and hzg1@cdc.gov. Dyson Mwandama and Don P. Mathanga, Malaria Alert Centre, College of Medicine, Blantyre, Malawi, E-mails: dmwandama@mac.medcol.mw and dmathang@mac.medcol.mw. Kim A. Lindblade, Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Bangkok, Thailand, E-mail: kil2@cdc.gov.