“My children and I will no longer suffer from malaria”: a qualitative study of the acceptance and rejection of indoor residual spraying to prevent malaria in Tanzania

BACKGROUND: The objective of this study was to identify attitudes and misconceptions related to acceptance or refusal of indoor residual spraying (IRS) in Tanzania for both the general population and among certain groups (e.g., farmers, fishermen, community leaders, and women). METHODS: This study was a series of qualitative, semi-structured, in-depth interviews and focus group discussions conducted from October 2010 to March 2011 on Mainland Tanzania and Zanzibar. Three groups of participants were targeted: acceptors of IRS (those who have already had their homes sprayed), refusers (those whose communities have been sprayed, but refused to have their individual home sprayed), and those whose houses were about to be sprayed as part of IRS scale-up. Interviews were also conducted with farmers, fishermen, women, community leaders and members of non-government organizations responsible for community mobilization around IRS. RESULTS: Results showed refusers are a very small percentage of the population. They tend to be more knowledgeable people such as teachers, drivers, extension workers, and other civil servants who do not simply follow the orders of the local government or the sprayers, but are skeptical about the process until they see true results. Refusal took three forms: 1) refusing partially until thorough explanation is provided; 2) accepting spray to be done in a few rooms only; and 3) refusing outright. In most of the refusal interviews, refusers justified why their houses were not sprayed, often without admitting that they had refused. Reasons for refusal included initial ignorance about the reasons for IRS, uncertainty about its effectiveness, increased prevalence of other insects, potential physical side effects, odour, rumours about the chemical affecting fertility, embarrassment about moving poor quality possessions out of the house, and belief that the spray was politically motivated. CONCLUSIONS: To increase IRS acceptance, participants recommended more emphasis on providing thorough public education, ensuring the sprayers themselves are more knowledgeable about IRS, and asking that community leaders encourage participation by their constituents rather than threatening punishment for noncompliance. While there are several rumours and misconceptions concerning IRS in Tanzania, acceptance is very high and continues to increase as positive results become apparent. SWAHILI ABSTRACT: USULI: Malengo mahususi ya utafiti huu ni kutambua tabia na imani potofu zinazopelekea kukubali au kutakaa upuliaziaji wa dawa ya kuua mbu majumbani (IRS) katika Tanzania kwa watu wote kwa ujumla na kwa makundi maalumu ya watu (kama wakulima, wavuvi, viongozi wa jamii na wanawake). NJIA: Utafiti huu ni mfululizo wa tafiti stahilifu zenye sehemu ya muundo, tafiti za kina na majadilianao ya vikundi vya walengwa yaliyofanyika Tanzania bara na Zanzibar kuanzia mwezi Oktoba, 2010 hadi mwezi Machi, 2011. Yalikuwepo makundi matatu ya walengwa: wanaokubali IRS (wale ambao nyumba zao zilikwisha kupulizwa dawa ya kuua mbu) wasiokubali (hii ni jamii iliyokwisha kupulizwa dawa na wale watu waliokataa dawa isipulizwe kwenye nyumba zao) na wale ambao nyumba zao zilikuwa zinakaribia kupulizwa dawa ikiwa ni kama sehemu ya kusambaza IRS. Usaili ulifanyika pia kwa wakulima, wavuvi, wanawake na viongozi wa jamii vile vile na kwa wanachama wa asasi zisizo za kiserikali waliokuwa wakiwajibika kwa IRS. MATOKEO: Matokeo yalionyesha kuwa waliokataa walikuwa ni asilimia ndogo sana ya watu wote. Walikuwa ni watu waelewa kama vile walimu, madereva, wafanyakazi katika miradi na watumishi wengine wa serikali ambao wanafuata amri kutoka kwa serikali yao au kwa wapuliza dawa lakini walikuwa na wasiwasi kuhusu mchakato huo mpaka waone matokeo yake. Waliokataa walikuwa katika maainisho matatu: 1) waliokataa kidogo mpaka wapewe maelezo; 2) waliokubali dawa ipulizwe kwenye vyumba vichache tu; 3) waliokataa katu katu. Mara kwa mara wengi wa wasailiwa waliokataa, walitoa sababu zao za kukataa nyumba zao zisipuliziwe, bila kukubali kuwa wamekataa kupuliziwa. Sababu za kukataa mwanzoni zilikuwa ni pamoja na; kutokuwa na uhakika kuhusu dawa inavyofanya kazi, kutoelewa matokeo yake, kuongezeka kwa kuenea kwa wadudu wengine. Athari nyingine mbaya zilizoonekana ni: harufu, tetesi kuhusu kemikali zinazoathiri urutubishwaji, aibu ya kutolewa vitu vyao vyenye thamani duni kutoka kwenye nyumba zao na imani kuwa dawa hiyo ilihamasishwa kisiasa zaidi. HITIMISHO: Ili kuongeza kukubalika kwa IRS, washiriki wanasisitiza zaidi kuzitoa dawa hizo kwa kuwaelimisha watu kwanza, kuhakikisha kuwa wanaonyunyuza dawa hiyo wana ujuzi wa kutosha kuhusu dawa yenyewe, kuwaomba viongozi wa jamii wawatie moyo wanajamii katika kaya zao badala ya kuwatishia na kuwalazimisha. Pamoja na kwamba kuna tetesi na watu kuelewa visivyo kuhusu IRS, kukubalika ni kukubwa na kunaendelea kuonyehsa kuwa na mafanikio chanya.