Abstract:
BACKGROUND: Indoor residual spraying (IRS), the coating of interior walls of houses with insecticides, is common in
malaria-endemic areas. While important in malaria control, IRS potentially exposes residents to harmful insecticides.
The World Health Organization recommends steps to minimize exposure; however, no programme has focused on
educating populations.
METHODS: A dramatic presentation and song were developed by study personnel and performed by lay performers in order to spread awareness of the importance of IRS and to minimize insecticide exposure. Performances were
staged at 16 sprayed villages in the Vhembe District of Limpopo, South Africa, at which 592 attendees completed
short questionnaires before and after the performance about behaviors that might limit insecticide exposure. Overall
indices of the attendees’ change in knowledge of precautions to take prior to and after spraying to prevent insecticide exposure were analyzed using hierarchical mixed models to assess the efect of the performance on change in
participants’ knowledge.
RESULTS: Approximately half of attendees lived in homes that had been sprayed for malaria and 62% were female.
Over 90% thought it better to allow IRS prior to the presentation, but knowledge of proper precautions to prevent
exposure was low. The proportion answering correctly about proper distance from home during spraying increased
from 49.4% pre-performance to 62.0% post-performance (RR=1.26, 95% CI=1.13, 1.41), and the proportion reporting correctly about home re-entry interval after spraying increased from 58.5 to 91.1% (RR=1.54, 95% CI 1.35, 1.77).
Attendees improved in their knowledge about precautions to take prior to and after spraying from mean of 57.9%
correct to a mean of 69.7% (β=12.1%, 95% CI 10.9, 13.4). Specifcally, increased knowledge in closing cupboards,
removing food and bedding from the home, covering immoveable items with plastic, and leading animals away from
the home prior to spraying were observed, as was increased knowledge in sweeping the foors, proper disposal of
dead insects, and discarding dirty washrags after spraying.
CONCLUSIONS: A dramatic presentation and song were able to increase the attendees’ knowledge of precautions to
take prior to and after spraying in order to limit their insecticide exposure resulting from IRS. This approach to community education is promising and deserves additional study.
