Abstract
Background
Community acceptance is an important criterion to assess in community trials, particularly for new tools that require coverage and use by a target population. Installed on exterior walls of household structures, the attractive targeted sugar bait (ATSB) is a new vector control tool designed to attract and kill mosquitos. ATSBs were evaluated in Western Zambia during a two-year cluster randomized controlled trial to assess the efficacy of ATSBs in reducing malaria transmission. Community acceptance of ATSBs was critical for successful trial implementation.
Methods
A community engagement strategy outlined activities and key messages to promote acceptance. Annual cross-sectional surveys, conducted during the peak transmission period, assessed households for presence of ATSBs and participating households’ perceived benefits, concerns, and willingness to use ATSBs. Focus group discussions and in-depth interviews conducted at the end of each ATSB station deployment period, obtained a range of perceptions, attitudes, and household experiences with ATSB stations, as well as potential shifts in ITN use as a function of ATSB deployment.
Results
Community acceptance of ATSBs was high with ATSB coverage > 90%; >70% of households reported perceived benefits; and < 10% reported safety concerns. Common facilitators of acceptance included the desire for protection against malaria and reduction of mosquitos, trust in health initiatives, and understanding of the product. Common barriers to acceptance included misconceptions of the products impact on mosquitos, continued cases of malaria, association with satanism, and damage to household structures. Although ITN use was generally high, qualitative data suggest additional research is needed to further explore ways in which ATSB deployment might be associated with shifts in ITN use.
Discussion
Future use of the ATSB intervention will likely require supporting activities that foster community acceptance before, during and after the intervention is introduced. Additional research may be needed to understand the impact of less community engagement on ATSB station coverage, ATSB station perception, and ITN use.
Conclusion
There was high acceptance of ATSB stations during the trial in Western Zambia. Continuous and intense community engagement efforts contributed towards sustained ATSB coverage and trust in the product. Acceptance of ATSBs during programmatic delivery requires further research.