Qualitative Study to Assess Consumer Preferences and Barriers to Use of Long-Lasting Insecticidal nets (LLINs) in Myanmar

Qualitative Study to Assess Consumer Preferences and Barriers to Use of Long-Lasting Insecticidal nets (LLINs) in Myanmar

Introduction In early 2012, Malaria Consortium carried out a vector control assessment of malaria prevention activities, including LLINs and alternative personal protection options supported by NetWorks in the Greater Mekong Sub-region (GMS) in three countries, Thailand (borders areas), Cambodia and Myanmar. One of the major information gaps identified during this assessment was the lack of evidence and understanding of consumer preferences for malaria prevention tools in Myanmar.

Rationale An assessment was conducted to: identify key consumer preferences for malaria prevention and willingness to pay for these tools in the target communities in Myanmar. identify any barriers to LLIN ownership and use, modification of specifications for LLINs, and preferred communication channels.

Study Objectives 1. To acquire in-depth qualitative information on knowledge, beliefs, and behaviours of the communities and migrants about malaria. 2. To identify perceived barriers to accessing LLINs and ordinary nets faced by consumers in Myanmar. 3. To determine preferred types of malaria prevention tools (LLINs, insecticide treated clothing, bedding) and characteristics (material, size, colour). 4. To assess the cost that consumers across target groups are willing to pay for LLINs/ different malaria prevention tools. 5. To identify preferred communication channels for accessing health information

Design & Methods (1/2) Participants included 339 male and female adults aged 18 years and above living and/or working in Myanmar and its border areas. FGDs and KIIs were used. Participants comprised of migrant workers, rubber tappers, forest goers, community members, community leaders, INGO staff, CBO staff, health centre staff, volunteers involved in LLIN distribution and shopkeepers/vendors of nets and personal protection products. For the purpose of this study, forest goer is defined as a person who sleeps in forested areas at night.

Design & Methods (2/2) The areas selected were Tanintharyi Division, Kayah state and Sagaing Division. Chosen because no previous LLIN studies have been conducted in these areas In each tier, two sites were selected, one close to (<5km) and one far from (>10km) a township/health facility.

Number of Interviews and FGDs per tier er Ti Site location Number of KIIs Number of FGDs Number of participants Tier 1 Tanintharyi 16 12 110 Tier 2 Kayah 17 12 118 Tier 3 Sagaing 15 12 111 Total: 48 36 339

Results Knowledge and Perception of Risk Malaria a common health problem in the target communities, for both community members and migrant workers Migrant workers, farm workers, and forest goers considered the most vulnerable to malaria. Knowledge of transmission by mosquitoes is high, but respondents believed that drinking dirty water or eating bananas contributed to or exacerbated malaria

Results Prevention Preferences Majority of participants reported using LLIN, and some conventional nets. Migrant workers and forest goers use bonfire smoke when working or sleeping away from home. Repellent viewed as expensive Mosquito coils commonly used, but contribute to poor respiratory health, especially for children. Community members reported highest access to LLINs, but still not enough for entire family. Migrants and forest goers were not eligible or nor present at time of LLIN distribution. Cost of conventional nets considered a significant barrier for migrants and forest goers.

LLIN preferences Soft texture Small holes to prevent mosquito entry and sand flies Migrant workers and forest goers prefer single-size net Community members and those with large families preferred large nets All requested nets tall enough to sit under White vs dark nets white because it looks clean; dark because it doesn t show dirt as much. No consensus. Insecticide appreciated for ability to prevent malaria and kill insects. Willingness to pay: 3000 to 30,000 Myanmar Kyats (3-30 USD); higher for community members.

Results Communication Participants heard about malaria through Health talks at health facilities, health staff NGOs Community and religious leaders Posters and pamphlets Tv and radio Sources for migrants Co-workers On-site health clinics Sources for community members Parents, village elders IPC from health staff felt to be most effective and trustworthy Discussion groups, peer educators, community health education sessions, and workplace targeting also suggested.

Recommendations 1. Preferences for nets should be validated with more robust data, but have potential to improve net use rates. 2. Establishing interest free payment plans for poorer consumers that do not have access to LLINs or prefer to purchase could expand accessibility and thus, coverage. 3. Reducing the cost of repellent and developing a topical solution that has a subtle odour could also increase use of prevention materials. 4. Allocating funds to provide engaging health activities and dialogues with community members, migrant workers and forest goers would improve knowledge of malaria transmission and prevention. 5. Communicating messages in local terms and languages, developing culturally appropriate Information, Education and Communication (IEC) materials for low literacy groups would expand access to essential health messages.