Perceptions regarding the use of long-lasting insecticide-treated bed nets for preventing malaria among rural females of Pakistan

Background: Globally, there are 300-500 million clinical cases of Malaria annually. It is endemic in Pakistan and has shown epidemic potential in the past. In World Health Organization's Eastern Mediterranean Region (EMR), about 10.5 million malaria episodes and 49000 malaria-related deaths occur every year. In Pakistan, Annual Parasite Incidence (API) is 0.8/1000 populations. Provincially, the Annual Parasite Incidence is highest in Baluchistan (5.8/1000 population) followed by Federally Administrative Tribal Areas (4.0/1000 population) and Sindh (1.08/1000 population). Long Lasting Insecticide-Treated-Nets(LLINs) when used properly, can reduce malaria transmission by at least 60% and child deaths by 20%. LLINs are advanced form of Insecticide Treated Nets. They are factory impregnated, stronger and longer-lasting with better efficacy than the ones without insecticides. Objective: To assess the knowledge, attitude and practices of the community regarding use of long lasting insecticide treated bed nets (LLINs) for preventing malaria. Methods: Primary data collection was done by the principal researcher on an estimated sample of 200 households based on 6% distribution of LLINs by multistage survey. Data was collected through the trained healthcare workers, cleaned and entered, whereby analyzed thereafter and results interpreted for the three domains of knowledge, attitude and practice on Likert scale. Results: Using the Likert scale, about half (56.8%) of the respondents did agree that the LLINs were useful in preventing against malaria, coated with insecticide (53.3%) and protect from nuisance effect (44.7%). Overall most (94.5%) of the respondents had a good knowledge regarding use of the LLINs, majority (63.8%) has fair attitude and all (100%) had good practice. Majority of people (63.8%) were in favor of using LLINs and almost all (100%) of them knew how to use them properly. Increasing age was found to be associated with good knowledge (p=0.007,) but not the better education (p=0.803) as majority (74%) of the participant remained illiterate. Limitation and strength: The study was done in the intervention area and was accessible through the local healthcare workers with a support from the local institutions. The interviewees were not representative of the population as a whole, with hundred percents females and mostly house-wives. The data collectors were the LHWs and there was a possibility of observer's bias which was minimized by administering structured questionnaire and training augmented by surprise visits by the principal researcher and data cleaning. Conclusion: The study shows good Knowledge, attitude and practices among the study population. However, an effort to impart education to females may have an augmenting effect on better implementation of the healthcare interventions.