Abstract of Dissertation

Agency : Refusal rate, IRS, KLW, Kala Azar, IEC

Objective : The objective of the study was to determine the reason of refusal for IRS among the community users and thus suggest to design IEC tools to reduce the same. The study also aimed to assess the involvement of KLWs in converting the refusals, thus increasing coverage

Background : Visceral Leishmaniasis is a protozoan disease caused by sand-fly and is the second largest parasitic killer after malaria. It continues to be a poor and neglected disease. Bihar is one of the most endemic states of Kala Azar accounting for more than 85% of case loads of India. Though there has been various efforts from the government to achieve the elimination of the disease by 2015, the case incidence is still very high. The major way of preventing the disease through IRS , which has been provided by the government for free is also of low quality and proper coverage is also not achieved which would have otherwise helped in the reduction of the vector and subsequently the diseases, owing to the high rates of refusals for IRS by the community members.

Methodology : The study was a descriptive cross-sectional study undertaken in one Patna district of Bihar. 16 blocks of Patna where IRS was going on were chosen and 200 households were purposefully taken for the purpose of this study from these blocks. The 16 blocks chosen had more than one case incidence at the block level in 2013. 2 villages were chosen purposively from each block which had reported high refusal rate and 6 households from each village who had refused for IRS were taken as study subjects

Findings : The findings of the study show that although 59% respondents had heard about Kala Azar, only 30% of them knew about the symptoms, cause and treatment of the disease. About two thirds of the respondents had heard about IRS and 86% seemed to be aware about its importance. However only 7% of them were aware of the real reason, i.e Kala Azar. The spray squads had visited only 77% of households and mostly after 12 noon. 85% of these households were not aware beforehand about the date of spray and those who were aware were mostly informed by KLWs. Of these households however, 77 percent refused to spray citing reasons like no prior information about spray, bad odor of DDT, increase in bed bugs, no effect on mosquitoes and some weird reasons like discoloration of walls, no trust on government services etc. These households were then counselled to spray, most of the counselling being done by KLWs after which 91% respondents agreed to spray the next time. Most of the refusals were influenced by female members.

Recommendations : From the study it can be concluded that level of awareness about the disease among the community members was very low and thus also the knowledge about importance of IRS for which the rates of refusals were very high. However through appropriate counselling these can be reduced and thus there is an urgent need to develop appropriate IEC tools to increase the awareness level among the community about the disease, which would in turn reduce the rates of refusal, thus increasing the coverage and the quality of IRS .