Factors influencing the use of topical repellents: implications for the effectiveness of malaria elimination strategies

摘要

In Cambodia, despite an impressive decline in prevalence over the last 10 years, malaria is still apublic health problem in some parts of the country. This is partly due to vectors that bite earlyand outdoors reducing the effectiveness of measures such as Long-Lasting Insecticidal Nets.Repellents have been suggested as an additional control measure in such settings. As part of acluster-randomized trial on the effectiveness of topical repellents in controlling malaria infections atcommunity level, a mixed-methods study assessed user rates and determinants of use. Repellentswere made widely available and Picaridin repellent reduced 97% of mosquito bites. However,despite high acceptability, daily use was observed to be low (8%) and did not correspond to thereported use in surveys (around 70%). The levels of use aimed for by the trial were never reachedas the population used it variably across place (forest, farms and villages) and time (seasons), or inalternative applications (spraying on insects, on bed nets, etc.). These findings show the key role ofhuman behavior in the effectiveness of malaria preventive measures, questioning whether malaria inlow endemic settings can be reduced substantially by introducing measures without researching andoptimizing community involvement strategies.