title: Feasibility of repellent use in a context of increasing outdoor transmission: a qualitative study in rural Tanzania.
abstract: BACKGROUND
  Extensive employment of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) has substantially reduced malaria morbidity and mortality in sub-Saharan Africa. These tools target indoor resting and biting vectors, and may select for vectors that bite and rest outdoors. Thus, to significantly impact this residual malaria transmission outdoors, tools targeting outdoor transmission are required. Repellents, used for personal protection, offer one solution. However, the effectiveness of this method hinges upon its community acceptability. This study assessed the feasibility of using repellents as a malaria prevention tool in Mbingu village, Ulanga, Southern Tanzania.
  
  
  METHODS
  Change in knowledge, attitude and practice (KAP) in relation to repellent use was assessed before and after the implementation of a cluster randomized clinical trial on topical repellents in rural Tanzania where repellent and placebo lotion were provided free of charge to 940 households for a period of 14 months between July 2009 and August 2010. Compliance, defined as the number of evenings that participants applied the recommended dose of repellent every month during the study period, was assessed using questionnaires, administered monthly during follow up of participants in the clinical trial. Focus group discussions (FGDs) were conducted in the same community three years later to assess the community's KAP in relation to repellents and preference to different repellent formats.
  
  
  RESULTS
  At baseline, only 0.32% (n=2) households in the intervention arm and no households in the control arm had ever used topical repellents. During follow-up surveys, significantly more households, 100% (n=457) in intervention arm relative to the control, 84.03% (n=379), (p=<0.001) perceived the repellent to be effective.Post-study, 99.78% (n=462) and 99.78% (n=463), (p=0.999) in the intervention and control arms respectively, were willing to continue repellent use. Mosquito nuisance motivated repellent use. From the FGDs, it emerged that most respondents preferred bed nets to repellents because of their longevity and cost effectiveness.
  
  
  CONCLUSIONS
  High repellent acceptability indicates their feasibility for malaria control in this community. However, to improve the community's uptake of repellents for use complimentary to LLINs for early evening and outdoor protection from mosquito bites, longer lasting and cheap formats are required.
authors.affiliation: Ifakara Health Institute, Box 74, Bagamoyo, Tanzania. psangoro@ihi.or.tz.
authors.forename: Onyango
authors.initials: O
authors.lastname: Sangoro
authors.forename: Ann H
authors.initials: AH
authors.lastname: Kelly
authors.forename: Sarah
authors.initials: S
authors.lastname: Mtali
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Moore
mesh_terms: D005191:Family Characteristics; D005240:Feasibility Studies; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007302:Insect Repellents / Q000008:administration & dosage / Q000627:therapeutic use; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D026023:Permethrin / Q000008:administration & dosage / Q000627:therapeutic use; D036301:Qualitative Research; D063465:Skin Cream; D011795:Surveys and Questionnaires; D013636:Tanzania
chemical_list: D007302:Insect Repellents; D026023:Permethrin