Community perceptions and acceptability of insecticide-treated screens for mosquito-proofing of unimproved houses in Chalinze district, Tanzania: A mixed-methods study

Fadhila Kihwele ^1* Olukayode Odufuwa ^1,2,3,4 Joseph B. Muganga ¹ Emmanuel Mbuba ^1,2,3 Rose Philipo ¹ Jason Moore ^1,2,3 Ole Skovmand ⁵ Rune Bosselmann ⁶ John Bradley ⁴ Sarah Moore ^1,2,3,7 Zawadi Mageni Mboma ^7,8

• ¹ Vector Control Product Testing Unit, Department of Environmental Health and Ecological Sciences, Ifakara Health Institute, Bagamoyo, Tanzania
• ² Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
• ³ Faculty of Science, University of Basel, Basel, Switzerland
• ⁴ MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
• ⁵ MCC47,, Montpellier,, France
• ⁶ Vegro Aps,, Copenhagen,, Denmark
• ⁷ Nelson Mandela African Institution of Science and Technology, Arusha, Arusha, Tanzania
• ⁸ Ifakara Health Institute, Dar es Salaam, Tanzania

Unimproved housing is a risk factor for malaria. Therefore, netting incorporated with deltamethrin and piperonyl-butoxide, supplied as a roll for screening opened eaves, windows, and holes in walls of unimproved houses, may offer protection by killing or reducing mosquito entry in a house. This study assessed the community perceptions and acceptability of these insecticide-treated screens (ITS), previously described as insecticide-treated eave nets (ITENs) and window screens (ITWs).A mixed-method approach was implemented in three villages of Chalinze district in Tanzania. This approach included In-depth interviews of local carpenters who installed ITS, focus group discussions with community members in both ITS control arms, and administration of structured-questionnaire to members in the ITS arm. Data collection was conducted at six-and twelve-months post installation. A thematic framework approach was used to identify and extract relevant themes from the qualitative data, including but not limited to community perceptions, acceptability, and adverse events; which were quantified. Furthermore, a separate structured questionnaire was administered during ITS installation, to collect information on the time required for installation and the amount of netting used per house (214), to assess the cost implication of rolling out ITS in the community.The ITS was perceived to reduce mosquitoes, other insects, and crawling animals like snakes and lizards in houses.This intervention was accepted in the community, whereby the majority (95%) of participants expressed willingness to purchase the netting if sold at an affordable price of 1,000-6,000 TZS (≤USD 2.50) per square meter.The average time for installation of ITS was one-hour per house, using an average of 29.5 running meters of fabric netting from rolls with a width of 1.5m.The average material cost of ITS was 1.25USD per kg in transport. In this study, the average installation cost per house was 6.6USD using standard Tanzanian salary rates, half the annual cost of ITNs for a five-person household.ITS for unimproved houses is a promising adaptable, and acceptable tool to supplement existing vector control tools.The community perceived ITS as a feasible intervention.The study highlighted the importance of intensive community engagement during the development of novel interventions to promptly address concerns and improve its acceptability are essential.