Household demographics
Of the 360 HH enrolled for the study, kits were effectively distributed to 350 HH (97%). The number of HH successfully used for data collection totalled 324, comprising 60 HH (19%) for direct observation to document behaviors as the kits were opened and contents were being used, and 264 HH (81%) for interviews after using the kit contents. Most of the responders were uneducated adult females who communicated mainly in the local Somali language. The interviews were conducted in either that dialect or in Swahili as possible. The participants indicated they understood the purpose of the kits they were given and the purpose of most of the components.
The remaining HH were not observed or interviewed for the following reasons: either HH was locked or the household head was absent (n = 11); the HH refused the product (n = 10); the kit was received but not used (n = 4), or the household head declined to be interviewed (n = 1).
The majority of the HH respondents were female (71%, n = 188), while 29% (n = 76) were male. Most of the participants/responders were between ages 20–49 years 62% (n = 163) while 37% (n = 97) were above 40 years of age. Regarding education, 61% of the respondents reported that they had never attended school, 17% had attended primary school, and 9% had attended post-secondary school or college. Overall, 97% of the response could speak Somali language, while 44% could speak Swahili and only 33% could speak the English language. Of the 264 HH interviewed, 83% (220) had another adult present in the HH. Of the 220 adults, 38% had never attended school, 18% had attended primary school, 28% had attended secondary school, and 15% had attended post-secondary school.
Participant understandings
When asked if the purpose of the kits had been adequately explained and understood 97% of respondents confirmed they definitely or at least somewhat understood. When asked if they understood the purpose of each mosquito control product included in the kit there were also positive responses (Fig. 3).
Each kit contained a booklet of pictogram Directions for Use (DFU) that described how the product was to be put to practical use, safety precautions, and specific directions where the products should be applied for best performance against Aedes mosquitoes. Most interview respondents indicated positively they understood the pictograms for each product (Fig. 4). This was an important outcome given the educational level of the responders.
The interview responses were confirmed by direct observation of a subset of HH as they handled products in the kits (Table 1). Over 80% of those observed were able to follow the pictogram instructions for adult control products. The larvicidal film presented a challenge for some users (21%).
Table 1
Observed user ability to follow the pictogram Directions for Use (DFU) for each product in their kits.
| Followed DFU (%) | Did not follow DFU (%) | Did not use product (%) |
Coil | 95 | 5 | 0 |
Aerosol | 95 | 5 | 0 |
Spatial repellent | 85 | 10 | 5 |
Trigger sprayer | 92 | 6 | 2 |
Curtains | 90 | 10 | 0 |
Personal repellent | 88 | 12 | 0 |
Larvicidal film | 71 | 21 | 9 |
Fly swatter | 89 | 11 | 0 |
When asked why some of the products in the kits were not used the most common reason was they did not know how to use the product (36%) or for what is was to be used (28%). Other rationale for not using a product included they did not think it would be effective (14%), did not know when it should be used (11%), or thought it was unsafe (7%).
Participants were asked to rank each product by difficulty to follow the DFU (Fig. 5). Coil pictograms were the easiest to follow and the larvicidal film was the most difficult. Further, when asked if the DFU pictograms explained how to use each product in a way that was easy to understand, most of the respondents stated that the DFUs were easy to understand.
When participants were asked about their knowledge of the time of the day each product was supposed to be used, as indicated in some of the pictograms, the average response was during morning hours and all were thought to be used before evening hours (Fig. 6). The majority of the respondents used the products in the bedroom. The exceptions were the larvicidal film, for which 83% of the respondents used the product outside the house, and the personal repellent that was applied to individuals rather than surfaces (Fig. 7).
When participants were asked to list the products from the most useful (1) to the least useful (6), the findings were analyzed in terms of the proportion of participants that listed the product within the first three rankings (1–3) as most useful, and within the last three rankings (4–6) as least useful. The trigger sprayer had the highest usefulness rating (90% of responders) followed by aerosol insecticide (84%), larvicidal film (84%), coils (75%), and personal repellent (70%). Responders rated less useful the interventions with which they were less familiar: insecticidal curtains (49%), spatial repellent (34%), and fly swatters (30%).
When asked about types already in the HH, 7% (n = 18) of respondents stated that they had products similar to the trigger sprayer (Dudu Spray) in their HH. Another 25% (n = 22) of respondents stated that they had products similar to the aerosol spray (SUPAkill) in their HH. Mosquito coils and personal repellents were also identified as product types that could be found in HH (9% of respondents each). However, participants indicated they did not think those product types came with clear DFU (Fig. 8).
The participants were given the opportunity to suggest other control products that should be included in the kits. The list included insecticidal mosquito nets (74% response), more aerosol insecticide (12%), coils, candles, and emitters (6%), treated mattresses and bedsheets (4%), water treatment tablets or chlorine (3%), and lemongrass oil (1%). When asked to rate the overall value of the kit the response was favourable with 85% rating the Family Vector Control Response Kit as good to excellent (Fig. 9).
Household (HH) knowledge and perception of vector control
When respondents were asked if anyone in the household had ever been infected with an Aedes-transmitted disease there was on average an 8% positive response. When pressed if it was dengue fever, chikungunya fever, yellow fever or Rift Valley fever; 12% ( n = 31) of the respondents confirmed that at least one person in their HH had been infected with either Rift Valley fever (3%), yellow fever (9%), dengue fever (6%), or chikungunya fever (5%).
On average, 89% of respondents did not know how diseases were spread by Aedes mosquitoes. Regarding respondents’ knowledge of how dengue fever, chikungunya fever and yellow fever are transmitted, only 12% (31/264) of those respondents had correct knowledge of how dengue fever is transmitted, followed by correct knowledge about the transmission of chikungunya fever (9%); yellow fever (9%); and Rift Valley fever (15%).
Regarding respondent’s knowledge of mosquito breeding sites around the household, more than half (56%) were not able to identify breeding sites. The other 44% (115/264) of respondents had correct knowledge of mosquito breeding sites around the house; stating that stagnant water, latrines, wells, water containers and bathrooms can act as breeding sites for mosquitoes.
HH survey of mosquito control practices
The respondents stated that mosquito control is regularly applied in the following areas of the house: adult bedroom 95% (252/264), kitchen 84% (223/264), living room 40% (105/264), bathroom 23% (60/264), children’s bedroom 9% (25/264), and other areas 3% (2/264).
When asked how often mosquito control products were used, 51% of the respondents (134/263) indicated daily or at least more than once per week. Others indicated they use only when mosquitoes are present (35%) or only during the rainy season (14%).
Most respondents (87%) listed mosquito nets as the most common method of mosquito control (229/264). Other control methods included spraying (5% of respondents), coils (3%), or smoke, candle, and brush clearing (5%). When asked about specific types of control over half the respondents had used smoke or candles (51%) and a few (4%) had experience with plug-in emitters.
More than half of the respondents indicated they purchase mosquito control products from either a kiosk (52%) or a supermarket (34%). Other places where such products were purchased included pharmacies, small stores, or from the street vendors. There is a clear indication from this brief survey of current practice that respondents were familiar with available mosquito control products.