Community perceptions and experiences of a non-pyrethroid insecticide-treated wall lining (ITWL) for malaria control in Tanzania: A qualitative study

Introduction Although long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) have made significant contributions to malaria reduction, they are hampered by sustainability issues, increasing insecticide resistance, operational challenges, low uptake, retention, and compliance. Newer and more effective complementary interventions are needed to address these issues. A non-pyrethroid insecticide-treated wall lining (ITWL) was piloted to address these challenges. Objective: We explored community perceptions and experiences that impacted the acceptability and uptake of an ITWL when used together with LLINs in a low-income rural community in Muheza district, Tanzania. Methods: The study combined observations, repeated interviews, and focus group discussions (FGDs). In-depth interviews (IDIs) were conducted with village leaders, community health workers, and ITWL installers. Observations were made during the installation and follow-up stages. FGDs were held with male heads of households, mothers of children under 5, and aged 5-11 years. The data were analysed using a content analysis approach. Results: Due to its long-term experience with past malaria research, the study communities had substantial knowledge and awareness of malaria and control tools. ITWL was seen as an important complementary tool to LLINs against malaria vectors, if effective. Nevertheless, initial implementation challenges combined with historical beliefs around insecticides somewhat threatened its reception. ITWLs were generally appreciated, with participants emphasizing their aesthetic value and their ability to beautify their houses. Some cement structures and environmental circumstances found in the communities proved to be challenging for installation, maintenance and cleaning of the material, suggesting the need for modification of any future design and installation improvements. Improper installation and fitting of the ITWL provided hiding places for pests, such as rats and snakes. In addition, concerns about insecticides' and installation materials' impact on human health slowed household uptake of ITWLs and, in some cases, led to some community members discarding their ITWLs. Poor ITWL fitting in some houses demanded constant maintenance, which was reported as being technically demanding by trained artisans. Finally, despite participants being encouraged to keep using LLINs after receiving ITWLs, some households discontinued using LLINs, threatening sustained malaria protection. Conclusions A future improved prototype ITWLs may have potential as a malaria prevention tool, but its practical behaviour would require effective community engagement and education strategies to increase uptake and sustain long-term use, in conjunction with conventional malaria vector control tools like LLINs.