Online Program

Is 1+1<2? Exploring Disinhibition Theory and Malaria Prevention Interventions in Angola

Tuesday, November 3, 2015

Karishma Furtado, MPH, Brown School of Social Work, Washington University, St. Louis, MO
In the areas of greatest malaria endemicity and instability, standard protocol consists in large part of simultaneously deploying two interventions: (1) periodic indoor residual spraying (IRS); and (2) insecticide-treated bednets (ITNs), under which people must sleep every night for maximal benefit. This study investigated whether IRS, a relatively convenient procedure, is negatively associated with compliance with the more onerous recommendation of ITN usage, which could indicate that IRS is disinhibiting adherence to ITNs. Participants (N= 9,347) were those who reported living in a household with at least one ITN in the 2011 Angola Malaria Indicator Survey. Logistic regression was used to determine whether having sprayed walls was negatively associated with ITN use after adjusting for individual, household, and environmental characteristics and whether this association was modified by malaria knowledge. Overall, 88% (742) of those with sprayed walls slept under an ITN compared to 76% (6,482) of those without sprayed walls (p<0.0001). Malaria knowledge modified the association between sprayed walls and ITN use (p<0.0001). At the low and moderate knowledge levels, those with sprayed walls had greater odds of using an ITN (aOR=2.36, 95% CI [1.38 4.03] and aOR=1.70, 95% CI [1.14, 2.54]). However, at the high-knowledge level, individuals with sprayed walls had 30% lower odds of sleeping under an ITN than those without sprayed walls (aOR=0.69, 95% CI [0.45, 0.98]). There seems to be a negative, dose-response relationship between knowledge of malaria and use of ITNs when walls are sprayed: vulnerability to disinhibition may grow with increasing knowledge of malaria.

Learning Areas:

Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related education

Learning Objectives:
Describe the frequency with which insecticide-treated bednets (ITNs) and indoor residual spraying (IRS) are used in conjunction in individual households in Angola, where, as with many sub-Saharan African countries, malaria is a leading cause of morbidity and mortality among children under 5, and explore whether ITNs are less likely to be used (i.e., slept under) in households with IRS compared to in households without IRS (i.e., whether IRS might disinhibit adherence to ITNs). Discuss the possibility that deploying prevention interventions simultaneously (within the context of the prevention of malaria specifically and with respect to other disease cases) may be less effective than expected due to disinhibition effects--or the possibility that the easier, more convenient intervention is cannibalizing (or disinihbiting) adherence to the other intervention. Demonstrate how knowledge of malaria may modify susceptibility to disinhibition exhibited in the relationship between having sprayed walls and using a bednet--and whether a similar relationship may exist between various other risk factors and disease related outcomes. Discuss the role of concepts from fields like psychology, behavioral economics, and decision science may improve epidemiological modeling.

Keyword(s): Epidemiology, Behavioral Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a graduate student in public health, I have conducted several studies of various health outcomes using secondary data. My focus has narrowed to the application of concepts from behavioral economics and psychology in the formulation of epidemiological models of disease for the improvement of disease prevention and communication strategies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.