TABLE OF CONTENTS
DECLARATION………………………………………………………………………………………………….. i
DEDICATION……………………………………………………………………………………………………. iii
ACKNOWLEDGEMENTS…………………………………………………………………………………. iv
LIST OF TABLES…………………………………………………………………………………………….. viii
LIST OF FIGURES…………………………………………………………………………………………….. ix
ABBREVIATIONS AND ACRONYMS……………………………………………………………….. x
DEFINITION OF OPERATIONAL TERMS………………………………………………………… xi
ABSTRACT………………………………………………………………………………………………………. xii
CHAPTER ONE: INTRODUCTION…………………………………………………………………….. 1
- Background to the study………………………………………………………………………………….. 1
1.10. Conceptual Framework………………………………………………………………………………….. 8
CHAPTER TWO: LITERATURE REVIEW…………………………………………………………… 9
CHAPTER THREE: MATERIALS AND METHODS…………………………………………… 20
- Introduction………………………………………………………………………………………………….. 20
CHAPTER FOUR: RESULTS…………………………………………………………………………….. 27
CHAPTERFIVE: DISCUSSION, CONLUSIONS AND RECOMMENDATIONS…. 51
workers…………………………………………………………………………………………………… 51
REFERENCES………………………………………………………………………………………………….. 63
APPENDICES…………………………………………………………………………………………………… 68
Appendix 1: Consent Form………………………………………………………………………………….. 68
Appendix 2: Questionnaires………………………………………………………………………………… 72
Appendix 3: Key Informant Interview Guide…………………………………………………………. 78
Appendix 4: Kenyatta University Graduate School Approval…………………………………… 80
Appendix 5: Kenyatta University Graduate Authorization……………………………………….. 81
Appendix 6: Kenyatta University Ethical Review Committees…………………………………. 82
Appendix 7: Research Authorization by National Commission for Science,
Technology and Innovation, Kenya……………………………………………………. 83
Appendix 8: Research Permit National Commission for Science, Technology and Innovation, Kenya………………………………………………………………………………………………………. 84
Appendix 9: Abstract of Papers published and submitted for publication…………………… 85
Appendix 10: Abstract of Jaggery and Tea Workers Perceptions on the Use of ITNs in Prevention of Malaria in South Mugirango Sub- County, Kisii County, Kenya………….. 86
Appendix 11: Abstract of Factors Influencing the Use of ITNs among the Jaggery and Tea Workers in the Prevention of Malaria in South Mugirango Sub – County, Kisii County, Kenya 87
Appendix 12: Maps of the study area…………………………………………………………………….. 88
LIST OF TABLES
Table 4.1: Characteristics of the Jaggery and tea worker…………………………………….. 29
Table 4:2: Knowledge on treated and non-treated nets against ITNs use……………… 31
Table 4.3: Knowledge about ITNs among the Jaggery and tea workers……………….. 32
Table 4.4: Number of mosquito nets in household……………………………………………… 33
Table 4.5: Type of net used by the Jaggery and tea workers in the house…………….. 34
Table 4.6: Perceived benefits related to use ofITNs…………………………………………… 39
Table 4.7: Perception of ITNs use, beliefs and mode of malaria transmission………… 40
Table 4.8: Type of house, number of people sleeping in the house………………………. 42
Table4. 9: Number of rooms and people sleeping in the house…………………………… 43
Table 4.10: Demographic factors associated with ITNs use……………………………….. 46
Table 4.11: Economic factors versus ITN use……………………………………………………. 47
Table 4.12: Weather conditions versus ITN use…………………………………………………. 49
LIST OF FIGURES
Figure 4.1: Household income level of the Jaggery and tea workers……………………. 30
Figure 4.2: The level of knowledge on treated and non- treated net……………………. 32
Figure 4.3: Whether nets had been re-treated……………………………………………………. 35
Figure 4.4: Where they could prefer to re-treat the nets…………………………………….. 36
Figure 4.5: Where the Jaggery and tea workers could obtain nets………………………. 37
Figure 4.6:Perceived effectiveness on ITNs use……………………………………………….. 38
Figure 4.7: Perceived dangers of malaria among the Jaggery and tea workers……… 41
Figure 4.8: How often the Jaggery and tea workers slept under net……………………. 44
Figure 4.9: Where the visitors slept………………………………………………………………….. 45
ABBREVIATIONS AND ACRONYMS
| AMREF | African Medical and Research Foundation |
| CDC | Centre for Disease Control and prevention. |
| FGD | Focused Group Discussion |
| GTZ | Germany Agency for Technical Cooperation |
| ITNs | Insecticide Treated Nets |
| MCP | Malaria Control Program |
| MOH | Ministry of Health |
| NGOs | Non-Governmental Organizations |
| RBM | Roll Back Malaria |
| UNICEF | United Nations Children’s Fund |
| WHO | World Health Organization |
| NMS | National Malaria Strategy |
| MDGs | Millennium Development Goals |
| KMIS | Kenya Malaria Indicator Survey |
| IGAs | Income Generating Activities |
DEFINITION OF OPERATIONAL TERMS
Household: One or more people who live in the same dwelling and also share meals together or share living accommodation
Jaggery worker: Employees hired to make sugarcane concentrates to produce sukari nguru.
Morbidity: Frequency of infection
Nguru: A brown product of sugarcane concentrates.
Poverty: State in which family’s income is too low to be able to buy food, shelter and clothing that are deemed necessary.
Prevalence: Is the proportion of a population found to have a condition typically a disease or a risk factor.
Tea workers: Employees hired to pick tea in small scale and taking it to tea buying centers for collection to the factory.
ABSTRACT
Insecticide- treated nets (ITNs) if used correctly are the most powerful malaria control intervention tools which have been recommended by most governments in the world. Yet up to date, use is still very low in some places with only three percent of African sleeping under an ITN and about 20 percent sleeping under any kind of net. Worse still, malaria continues to be the leading cause of mortality and morbidity among the Jaggery and tea workers in both sugar cane and tea industry. The main aim of this study was to assess the use of ITNs among the Jaggery and tea workers in the prevention of malaria in the South Mugirango Sub County, Kisii County. The specific objectives include; to establish the demographic and socioeconomic characteristics, to determine knowledge on the use of ITNs, to examine the perception of the ITNs use, to establish the level of ITNs use and to identify the factors that influence the ITNs use among the Jaggery and tea workers. The study adopted descriptive cross sectional design whereby both cluster, proportionate, purposive and snowball sampling approaches were used to get the sample size of 209 respondents from the Jaggery and tea workers to be interviewed. Data was collected using questionnaires, key informant interview and focused group discussions. Qualitative and quantitative data were transcribed; coded and categorized to come up with the emerging themes. Data was analyzed using SPSS version 20.0. Chi-Square was used to determine the relationship between variables. The results show low levels of ITNs use due to lack of knowledge and low level of income as (52.2%) of respondents did not know the difference between ITNs and non-treated nets. It was found that 56% of respondents were males with 44% being females. Most of the Jaggery and tea workers were aged between 29- 39 years and 40-50 years with 41%and 26% respondents respectively. Education was significantly related (p<0.001) with ITNs use whereby 82.4% of non- users were found to have no education at all. Gender and occupation were significantly related with (p<0.001) and (p<0.003) and the use of ITNs respectively. Economic factors were also associated with ITNs use. The cost, accessibility and house structure were related with (p<0.010) and (p<0.001) and the use of ITNs respectively. The study found that weather was significantly related (p<0.001) with the use of ITNs among the Jaggery and tea workers. The study concludes that demographic and socio- economic characteristics were statistically associated (p<0.001) with the use of ITNs. Furthermore, knowledge, perception, level of use and factors such as accessibility and affordability were statistically related and influence ITNs utilization among the Jaggery and tea workers. This study recommends implementation of programs and policy formulation to empower the Jaggery and tea workers in education and economically through income generating activities to strengthen their resource base. Study results are useful in addressing ITNs utilization among the Jaggery and tea workers in the prevention of malaria in Kisii County, Kenya. It will also help the Kisii County government to redirect more resources to malaria prevention. Therefore, this study recommends the future research in the informal sector as well as low income earners as they were found to be the most malaria vulnerable group.
CHAPTER ONE: INTRODUCTION
Background to the study
Globally, malaria is a leading cause of morbidity and mortality, particularly in Tropical Africa, where at least 90 percent of malaria deaths occur (UNICEF, 2009). More than three quarters worldwide malaria deaths occur in people living in malarias countries in Sub-Saharan Africa. It was estimated that there were about 207 million cases of malaria in 2012 with 627000 deaths (WHO, 2013). Malaria continues to be a significant cause of morbidity and mortality worldwide. Adults living in malaria endemic areas develop some level of partial immunity to malaria as a result of repeated exposures to parasite antigens. This naturally acquired partial immunity involves both humoral and cellular immune responses and appears protective against symptomatic disease, but not against malaria infection (WHO, 2008).
About half of African countries have waived taxes and tariffs on nets, netting material and insecticides. Since 2002, African countries have started scaling up free of charge or highly subsidized provision of mosquito nets. As a result, there has been a substantial increase in mosquito net coverage in African countries (UNICEF, 2009).
In Kenya, malaria accounts for 25-40 percent of all outpatient visits at health care facilities. Up to 20 percent of all hospital admissions and 15 percent of in-patient deaths are due to malaria. About 30-40 percent of all fevers seen in health centers in Africa are due to malaria with huge seasonal variability between rainy and dry seasons. At the end of the rainy season, it is less than 10 percent and more than 80 percent as the rainy season winds up. Therefore, on its part, Kenya Vision 2030 includes among its health sector objectives the intention to reduce the proportion of
inpatient malaria fatality to 3 percent (Republic of Kenya, 2010). One of the most effective tools or malaria prevention is the insecticide treated mosquito net (ITN). Consistent use of ITNs can reduce malaria transmission by up to 90 percent (Gimning, et al; 2008) and overt as much as 44 percent of all causes mortality (Lengeler, 2010).
