Community perceptions on effectiveness and safety of indoor residual spraying for malaria control in Uganda

Abstract Background Indoor residual spraying (IRS) remains one of the integral tools for malaria control and elimination globally. However, communities have mixed perceptions on the usefulness IRS and other malaria control measures. This study explored community perceptions on the effectiveness and safety of insecticides used in indoor residual spraying for malaria control in Uganda. Methods A qualitative study employing a phenomenological approach was used to collect data among adult (≥ 18 years) individuals in communities where indoor residual spraying was implemented. Household heads, IRS team leaders, spray operators, community leaders, and IRS field spray supervisors were purposively included in the study. In-depth interviews using an interview guide were used to collect data. Thematic data analysis was done using Nvivo ver 14 . 0 software. Results A total of 30 in-depth interviews were conducted. Study participants perceived IRS as effective from the observation of reduction in mosquito population and malaria cases following the spray. Most participants perceived IRS as safe causing only mild effects. The IRS killed other household insects including bed bugs, cockroaches, house flies and ants which helped enhance acceptance. Some of the insecticides used in the spray had strong smell and left stains on the walls. Individuals smeared sprayed walls remove the strong smell and the stains left behind. Participants reported discontinuation of use of bed nets among individuals in sprayed households. Conclusions The insecticides used in indoor residual spraying were perceived by participants as effective and safe. However, practices common in communities following IRS deployment such as discontinuation of use of bed nets and smearing of sprayed walls could potentially impact the effectiveness of IRS in malaria control. The Ministry of Health and implementing partners should strengthen community education and establish systems to help monitor implementation and effectiveness of indoor residual spraying for malaria control.