title: Promising perceptions, divergent practices and barriers to integrated malaria prevention in Wakiso district, Uganda: a mixed methods study.
abstract: BACKGROUND
  The World Health Organization recommends use of multiple approaches to control malaria. The integrated approach to malaria prevention advocates the use of several malaria prevention methods in a holistic manner. This study assessed perceptions and practices on integrated malaria prevention in Wakiso district, Uganda.
  
  
  METHODS
  A clustered cross-sectional survey was conducted among 727 households from 29 villages using both quantitative and qualitative methods. Assessment was done on awareness of various malaria prevention methods, potential for use of the methods in a holistic manner, and reasons for dislike of certain methods. Households were classified as using integrated malaria prevention if they used at least two methods. Logistic regression was used to test for factors associated with the use of integrated malaria prevention while adjusting for clustering within villages.
  
  
  RESULTS
  Participants knew of the various malaria prevention methods in the integrated approach including use of insecticide treated nets (97.5%), removing mosquito breeding sites (89.1%), clearing overgrown vegetation near houses (97.9%), and closing windows and doors early in the evenings (96.4%). If trained, most participants (68.6%) would use all the suggested malaria prevention methods of the integrated approach. Among those who would not use all methods, the main reasons given were there being too many (70.2%) and cost (32.0%). Only 33.0% households were using the integrated approach to prevent malaria. Use of integrated malaria prevention by households was associated with reading newspapers (AOR 0.34; 95% CI 0.22 -0.53) and ownership of a motorcycle/car (AOR 1.75; 95% CI 1.03 - 2.98).
  
  
  CONCLUSIONS
  Although knowledge of malaria prevention methods was high and perceptions on the integrated approach promising, practices on integrated malaria prevention was relatively low. The use of the integrated approach can be improved by promoting use of multiple malaria prevention methods through various communication channels such as mass media.
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Musoke
authors.affiliation: Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: George
authors.initials: G
authors.lastname: Miiro
authors.affiliation: Cardiff School of Health Sciences, Cardiff Metropolitan University, Wales, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Karani
authors.affiliation: Cardiff School of Health Sciences, Cardiff Metropolitan University, Wales, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Morris
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Simon
authors.initials: S
authors.lastname: Kasasa
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Rawlance
authors.initials: R
authors.lastname: Ndejjo
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Jessica
authors.initials: J
authors.lastname: Nakiyingi-Miiro
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: School of Sciences, Nkumba University, Entebbe, Uganda.
authors.forename: Miph Boses
authors.initials: MB
authors.lastname: Musoke
mesh_terms: D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D016015:Logistic Models; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D014454:Uganda
references.citation: BMC Public Health. 2014;14:315
references.pmid: 24708708
references.citation: Trop Med Int Health. 2001 Sep;6(9):677-87
references.pmid: 11555434
references.citation: PLoS One. 2010;5(7):e11692
references.pmid: 20657782
references.citation: Indian J Public Health. 2001 Jul-Sep;45(3):93-8
references.pmid: 11917328
references.citation: Bull World Health Organ. 2009 Sep;87(9):655-65
references.pmid: 19784445
references.citation: Cochrane Database Syst Rev. 2010;(4):CD006657
references.pmid: 20393950
references.citation: Am J Trop Med Hyg. 2009 Sep;81(3):519-24
references.pmid: 19706925
references.citation: Med Vet Entomol. 2013 Mar;27(1):1-9
references.pmid: 22624654
references.citation: Malar J. 2013;12:327
references.pmid: 24041445
references.citation: Med Vet Entomol. 2007 Mar;21(1):2-21
references.pmid: 17373942
references.citation: Am J Trop Med Hyg. 2011 Dec;85(6):1080-6
references.pmid: 22144448
references.citation: Int J Health Plann Manage. 2013 Jan-Mar;28(1):102-21
references.pmid: 22689390
references.citation: Malar J. 2014;13:123
references.pmid: 24679068
references.citation: Malar J. 2008;7:146
references.pmid: 18667091
references.citation: Trans R Soc Trop Med Hyg. 2008 Nov;102(11):1081-8
references.pmid: 18644611
references.citation: BMC Med Res Methodol. 2004 Dec 22;4(1):30
references.pmid: 15613248
references.citation: Acta Trop. 2012 Mar;121(3):184-95
references.pmid: 21420377
references.citation: Malar J. 2013;12:62
references.pmid: 23402342
references.citation: J Vector Borne Dis. 2014 Jun;51(2):119-27
references.pmid: 24947219
references.citation: Malar J. 2013;12:200
references.pmid: 23758967
references.citation: Ann Trop Med Parasitol. 2007 Oct;101(7):601-9
references.pmid: 17877879
references.citation: Bull World Health Organ. 1948;1(2):309-52
references.pmid: 20603927
references.citation: Parasit Vectors. 2013;6:118
references.pmid: 23618516
references.citation: Demography. 2001 Feb;38(1):115-32
references.pmid: 11227840
references.citation: Cochrane Database Syst Rev. 2004;(2):CD000363
references.pmid: 15106149
references.citation: Malar J. 2012;11:15
references.pmid: 22236358