title: Integrated approach to malaria prevention at household level in rural communities in Uganda: experiences from a pilot project.
abstract: BACKGROUND
  Malaria is a major public health challenge in sub-Saharan Africa. In Uganda, malaria is the leading cause of morbidity and mortality especially among children under five years of age. This pilot project promoted prevention of malaria at household level using an integrated approach in two rural communities in Wakiso District, Uganda. This involved advocating and implementing several strategies in a holistic manner geared towards reduction in the occurrence of malaria. The specific strategies involved can be classified as: 1) personal protection - use of insecticide-treated bed nets and insecticide sprays; 2) reducing mosquito breeding sites - draining pools of water, larviciding and clearing unnecessary vegetation around homes; and 3) reducing entry of mosquitoes into houses - installing mosquito proofing in windows, ventilators and open eaves, and closing windows and doors early in the evenings.
  
  
  METHODS
  The objectives of the project were to: carry out a baseline survey on malaria prevention; train community health workers and increase awareness among the community on the integrated approach to malaria prevention; and, establish demonstration sites using the integrated approach. A baseline survey among 376 households was conducted which generated information on the knowledge, attitudes and practices of the community in relation to malaria prevention. The project trained 25 community health workers and over 200 community members were sensitized on the integrated approach to malaria prevention. In addition, 40 demonstration households using the integrated approach were established.
  
  
  RESULTS
  The use of multiple methods in the prevention of malaria was appreciated by the community particularly the demonstration households using the integrated approach. Initial project evaluation showed that the community had become more knowledgeable about the various malaria prevention methods that were advocated in the integrated approach. In addition, some of the methods that were not being used before project implementation, such as early closing of windows, had been adopted. The presence of mosquitoes in the demonstration households had also reduced.
  
  
  CONCLUSIONS
  The integrated approach to malaria prevention at household level was well perceived by the project community, which could be scaled up to other areas. More rigorous studies such as randomized controlled trials are also recommended to further explore the public health impact of the integrated approach to malaria prevention.
authors.affiliation: Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda. dmusoke@musph.ac.ug.
authors.forename: David
authors.initials: D
authors.lastname: Musoke
authors.forename: George
authors.initials: G
authors.lastname: Karani
authors.forename: John C
authors.initials: JC
authors.lastname: Ssempebwa
authors.forename: Miph B
authors.initials: MB
authors.lastname: Musoke
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003625:Data Collection; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011247:Pregnancy; D012424:Rural Population; D014454:Uganda
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