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CHAPTER TWO
LITERATURE REVIEW
2.1 Conceptual review.
2.1.1 Overview of long lasting insecticidal nets
Long lasting insecticidal nets (LLIN) began in India and amazon with the free distribution in
priority locations, data regarding the actual distribution and the use of impregnated mosquito net
in this region is scarce. In India the mosquito net was called telegu. Cleopatra, the last active
pharaoh of ancient Egypt also slept under the mosquito net (NVBDCP 2016).LLIN is a type of
meshed curtain made up of every fine cloth impregnated with insecticide and the insecticide is
cleverly bound within the fibers that make up the netting and is “ slow released” over a 4 to 5 year
period (WHO 2013). LLIN is constructed of a fine see through mesh made of cotton, 100% density
polyethene polyester and polypycene and draped over a box shaped frame, it is designed to fit
under an area or item such as a sleeping bag to provide protection from mosquito bite and other
insects (WHO 2022). LLIN are supplied by UNICEF and they also provide the market update for
LLINs, it details the supply and demand (WHO 2020).
Over one billion ITNs distributed in Africa since 2000.In sub-Saharan Africa, the estimated
proportion with access to an ITN in their household was 56 percent in 2014 (WHO 2015). The
proportion of children under five sleeping under an ITN in sub-Saharan Africa increased to 68
percent in 2015, it is estimated that based upon the number of cases averted since 2000, and the
cost associated with care in the public sector, ITNs and LLINs saved US$900 million between
2001 and 2014 (WHO 2015). However, an estimated 269 million of 840 million people at risk of
malaria in sub-Saharan Africa lived in households without any ITNs or IRS in 2014, It is estimated
that 300 million new nets are needed each year to ensure universal coverage of ITNs in countries
where it is the primary method of vector control (WHO 2015).
2.2 Contextual review
2.2.1 Knowledge of LLINs
Definition of LLINS
Long lasting insecticidal nets was defined as a factory- treated mosquito net made with netting
material that has insecticidal incorporated within or bound around the fibers. The net must retain
its effective biological activity without retreatment for at least 20 WHO standard washes and 3
years of recommended use under field conditions (WHO 2010).
Types of LLINs
There are at present three LLINs recommended as eligible for public sector procurement by WHO
which are;
•
Pesticide evaluate scheme olyset nets which has 2% permethene incorporated into the
polyethylene fibres
•
Permanent which is treated with 55mg/m2 of deltamethrin to coat fibres.
•
Interceptors which has target dose of 200mg, alpha-cypermethurm per square metre
polyester netting olyset net has wider mesh size(4mmx4mm) than the permanent net(WHO
2022).
Importance of LLINs/ benefits of LLINs
•
By acting as a physical barrier between mosquitoes and the people sleeping under the net
(WHO 2015).
•
The chemical in LLINs repels mosquitoes, or kills them when they land on the net (WHO
2015).
•
Through the ‘community effect’, which occurs when the majority of people in a community
sleep under an LLIN, resulting in an overall reduction of the mosquito population and its
lifespan, thereby reducing the transmission of malaria (WHO 2015).
•
It also repels mosquitoes reducing the number that enter the house and attempt to feed on
people inside (WHO 2019).
•
It enhances a peaceful night rest (WHO 2019).
Distribution of LLINS
Lon lasting insecticidal nets are distributed in two ways;
•
Mass campaigns: Time-limited operations to distribute ITNs to a defined population. Mass
campaigns are a cost-effective way to rapidly scale-up and achieve equitable coverage, yet
gaps appear almost as soon as a campaign is concluded, so must generally be repeated
every three years (WHO 2015).
•
Continuous distribution systems: These involve delivering ITNs continuously, or creating
conditions to make ITNs available continuously. Continuous distribution systems often
operate through antenatal clinics, schools or private providers, and are important to
provide an uninterrupted supply of nets to replace those that are lost or damaged (WHO
2015).
2.2.2 Practices of LLINS
Recommendations for LLINs usage.
LLINs usage was discovered in 201. It came into existence because people developed
resistance to other methods of vector control. Below are WHO recommendations for use of
LLINs
•
Universal coverage remains the goal for all people at risk of malaria and those living
in malaria endemic zones.
•
In order to maintain universal coverage, countries should apply a combination of mass
free distribution and continuous distributions through multiple channels in particular
antenatal and immunizations services
•
Distribution of one LLINs for every two persons at every 3 years (WHO 2014).
Instructions for LLINs usage
•
Before using LLIN hang it in a shade to air out for 24 to 48hours.
•
With the help of a partner, hang the net over the bed on the ceiling using strings on the
corners of the net.
•
During the day, flip up the net to prevent damage.
•
During the night, put down the net, tug in three corners under mattress and tug the last 4th
corner when inside the net to prevent the entry of mosquitoes. This should be done every
night.
•
Wash the net only when it is dirty with clean water and soap.
•
Dry it away from direct sunlight under a shade.
•
In case of any hole on the net, sew it using thread and needle
•
Retreatment should be done after 3-4 year period (WHO 2011).
How to wash and maintain LLINs
•
Wash it with clean water and soap not often will enhance durability.
•
Keeping LLINs in good conditions will enhance durability.
•
Repairing by sewing and changing a LLIN every 3 years as recommended by WHO (WHO
2011).
2.2.3 Challenges of LLINs
Some of the challenges that people faced while using LLINs include; heat, phobia for chemicals,
lack of space and difficulty in hanging nets, preference for other preventive measures, ignorance
and cultural beliefs (Ajegena et al., 2018).
2.3 Empirical review
2.3.1 To assess knowledge of the use of long lasting insecticidal nets in the prevention of
malaria among inhabitants of quarter 11 Mutengene.
Malaria remains a major infectious disease in most developing countries. Uganda has the third
largest malaria burden in Africa and malaria accounts for high morbidity and mortality among
pregnant women and children under five (WHO 2007). Malaria during pregnancy is linked to
gestational anemia with low birth weight, abortion and miscarriage (Desai et al., 2007). To the
country’s health and economy, malaria negatively affects productivity, adds to costs of care
(Alonso et al., 2011) and impacts negatively on the household income. This has compelled the
government of Uganda and implementing partners like the Global Fund and the Roll back Malaria
initiative to try to maximize the use of insecticide treated mosquito nets, to mitigate the effects of
malaria among vulnerable populations. In addition, the WHO-Global malaria program encouraged
global efforts to fortify the use of LLINs for malaria prevention (WHO 2007). The use of effective
LLINS are considered key to the elimination of the mentioned sequalae among the vulnerable
populatons.
Sleeping under an insecticide-treated net (ITN) is the most widely adopted preventive measure
against malaria. ITNs are effective because in the majority of malaria-endemic regions of the
world, the female mosquito that transmits malaria only bites at night. ITNs – and in particular
long-lasting insecticidal nets (LLINs), represent a cost effective means of malaria prevention for
at risk populations (WHO 2015).
During a study among Antenatal Clinic Attendees in Abakaliki, Southeast Nigeria three hundred
and eighty-three respondents (95.8%) were aware of the LLITNs, while only 17 (4.2%) were not
aware. More than half of the clients got information about LLITNs from health facilities.
Interestingly, more than seventy percent of the respondents were not aware that the net could be
retreated. Among the study participants, 150 (37.5%) sleep under LLITNs in the index pregnancy,
while the remaining do not. Among those who sleep under the net, 49 (32.7%) do so regularly,
while 101 (67.3%) used it occasionally. Factors affecting their utilization among our respondents
include discomfort/heat 160 (40%), fear of the chemical 7 (1.8%), using other measures 36 (9%),
and not acceptable to husbands 8 (2%). 37.5% of the respondents use LLITNs in the index
pregnancy, while 62.5% did not use them for one reason or another (Chidebe et al ., 2020).
A case–control study in South West Cameroon had also shown a 70% protection of LLINs use
against malaria (Apinjoh et al., 2015) Similarly, a cohort study conducted in Malawi had indicated
that the use of LLINs had reduced significantly the incidence of malaria in children by 30%
(Lindblade et al., 2015). The individual-level protectiveness of LLINs in this study results is also
supported with a case–control study in Bungoma that shown regularly sleeping under LLINs had
conferred 77% protection against malaria (Obala et al., 2015).
During a survey among pregnant women in Lamingo, Nigeria. Almost all the respondents (98.4%)
had heard of LLITNs with the main sources of the information on LLITNs being mass media 105
(33.9%) and healthcare workers 171 (55.2%). The majority of the women knew the usefulness of
LLITNs as means of prevention of malaria by 127 (54.0%) and prevention of mosquito bite by
168 (71.5%). The level of knowledge of LLITNs among the respondents was high as 229 (73.9%)
had good knowledge of LLITNs with a mean knowledge score of 4.9 ± 1.8 out of 7 points (Tolupe
et al., 2014).
A study conducted in Rwanda on pregnant women revealed that Among 384 study participants,
381 (99.2%) of them knew that they can use LLINs just to avoid the burden of malaria and 378
(98.4%) agreed also that sleeping under LLIN can prevent malaria transmission to the pregnant
women. Additionally, 122 (31.8%) of study participants demonstrated that LLINs were factory
made with insecticides with the expiration period of four to five years and 110 (28.6%) believed
that LLINs are often being washed. The present study has reported that 219 (57%) of respondents
as highly knowledgeable on LLINs whereas 88 (23%) had fair knowledge (Habimana et al., 2020).
According to a study conducted in an endemic area in Iran the results showed that 77.8% of the
studied population mentioned mosquitoes as the vector of malaria and 60.8% reported LLINs as
the preventive measure against malaria transmission, LLINs were used by only 18.5% when
interviewers checked bed nets use visually in the morning hours (Soleimani et al., 2014).
Results of study conducted in Ziway-Dugda district, Ethiopia revealed that 31 (46.3%) cases and
more than half (54.3%) of the controls had a high-level knowledge of malaria prevention using
LLIN (Wubishet et al., 2021).
During a study carried out in Fako division, Cameroon. From the study findings, it was shown that
103 (76.26%) individuals perceived some advantages for utilizing ITNs. The most commonly
mentioned were: to “prevent malaria” (65),” kill mosquito” (27) and “avoid nuisance by mosquito
bites and a better sleep” (14). Among those who perceived ITNs as disadvantageous (33), their
reasons included the fact that these nets were not “cost effective” (19) in comparison to other
preventive methods. Other reasons were the perceived toxicological effects of the chemicals
impregnated in the nets (8) and the illnesses such as cough and irritations (6) associated to these
nets (Terence Bengyela 2011).
During a study in Ghana, Laos, Senegal and Tanzania Approximately half of all participating
healthcare providers knew that using untreated nets can divert extra biting to sleepers without nets
in the same houses (48%), that ITNs need regular re-treatment to remain effective while longlasting ITNs do not (57%), and that ITNs have been demonstrated to reduce the number of malaria
episodes in communities with stable malaria (57%) (Hoffman et al., 2011). In a study conducted
in Osun state Nigeria, all the caregivers have heard about LLIN and they all gave correct meaning
to LLIN, as a bed net treated with insecticide for the purpose of killing and repelling mosquitoes.
The main sources of information for the respondents about LLIN were radio and television 950
(94.2%). When asked for the advantages of LLIN, all 1008 (100%) respondents said it protects
against mosquito bite and malaria infection and 1006 (99.8%) of them also said it protects against
other insect bite. Eight Hundred and forty six (83.9%) of the respondents agreed that some people
can still come down with malaria despite sleeping under LLIN, 886 (87.9%) of them agreed that
the net can offer protection against malaria infection for some years if used consistently, After
scoring of the outcome variables for knowledge and categorizing the scores, 767 (76.1%) had good
knowledge while 241, (23.9%) had poor knowledge (Israel et al., 2018).
2.3.2 To assess practices of the use of long lasting insecticidal nets in the prevention of malaria
among inhabitants of quarter 11 Mutengene.
Malaria remains one of the greatest killer and devastating disease in Africa, a big threat to public
health economic burden despite all control strategies put in force by the National Malaria Control
Programme, Global Fund for Health, Roll Back Malaria (RBM) and the World Health
Organization (Fokam et al ., 2016). In 2019, about 215 million cases, up from 214 million cases
of malaria in 2014 (WHO 2017), were reported leading to 384000 deaths down from 438000 deaths
in 2015 (WHO 2020), about 94% of which occurred in the African region (WHO 2018).
The WHO’s prevention package for the fight against malaria consists of vector control measures
and preventive treatment strategies for the most vulnerable groups (WHO 2017), of which vector
control is the main approach to malaria control. Two forms of vector control (insecticidal treated
mosquito nets and indoor residual spraying of insecticides.) are effective in a wide range of
circumstamces (Raghavendra et al., 2017). Recently, the scale up of effective prevention tools has
a major impact in the fight against malaria. Thus, increased investment in proven prevention
measures and in the development and deployment of new tools will accelerate progresss towards
a world free from malaria (WHO 2017).
The WHO department for making pregnancy safer in Cameroon showed that among pregnant
women in Cameroon, about 12.4% are reported to have slept under a net, 1.6% are said to have
slept under an ever treated net while just 1.5% slept under an insecticide treated net the night before
the survey. Among those interviewed in the survey, approximately 56% of them delivered in rural
settings (about 647,000 births) in 2005 alone (UN Department of Economic and Social Affairs,
2007). During a survey among pregnant women in Lamingo, Nigeria. Two hundred
and thirty five (75.8%) of the respondent owned at least one LLITNs out of which 184 (78.3%)
consistently utilized it (Tolupe et al., 2014).
In a study conducted in Lagos state, only 110 (35.5%) of 310 respondents reported ever washing
their LLINs. Of these, 43.6% washed the LLINs every two months while 37.3% and 18.2%
claimed to do same every 3 to 5 months and monthly respectively while 0.9% could not remember.
The women claimed to wash their LLINs 1 to 6 times a year with a mean of 2 times per year. The
average annual washing rate per net pre-intervention in Bayeku, Oreta and Imota was
approximately 2 times respectively (Adeneye et al., 2021).
During a study carried out in Tiko, One thousand and twenty-five (49.1%) of the 2089 de facto
residents who slept home last night used LLINs. The indicators of bed net utilization showed no
association to any of the covariates. The universal utilization of LLINs was more likely in
households with female heads most likely in households headed by those with primary education
and most likely in houses that had parts built with blocks and plank/caraboat and those situated in
environments with stagnant pools of water/surrounding bushes were less likely when compared
with their counterparts (Paulette et al., 2021).
In a study conducted in Ghana, Laos, Senegal and Tanzania, very few participating healthcare
providers self-reported performing all five clinical practices according to established evidence
(2%), whether from Ghana (1%), Laos (1%), Senegal (4%) or Tanzania (5%). Approximately half
of providers often or very often reported that they enquired about young children’s home-use of
ITNs (52%), recommended to caregivers that young children use those (56%) and advised
caregivers on the need to regularly re-treat them (46%) (Hoffman et al., 2011). Also during a study
in an endemic area in Iran, most of the studied population (82.5%) reported that all of family
members sleep under bed nets and 17.5% of respondents mentioned that only parents or children
(8%) use bed nets. The results also showed that 43.5% of households use the bed nets all the time
at night and 56.5% of them over the sleeping time. Protection against mosquito bites and malaria
transmission was reported to be the main reason for using LLINs (84%). The other reasons were
having an undisturbed night sleep with protection from other insects’ nuisance (8.5%) and
protection from scorpion stings (5.5%). In this study, approximately 87% of households reported
they did not receive instructions on washing and drying the bed nets at the time of LLINs
distribution. The results also showed that 44.8% of studied population wash the LLINs once in six
months. Moreover, the majority of respondents (92%) mentioned that they dry the washed LLINs
in direct sunlight because it is a usual practice for drying wet cloths (Soleimani et al., 2014).
During a study among Rural Dwellers in Oyo State, Nigeria the study revealed a lack of proper
maintenance of ITNs, with 51.33% of the respondents rarely washing their nets, 38% doing so
sometimes, and 10.67% never washing their nets. Similar observations were made regarding
replacement practices, with 53.33% replacing their nets once in five years (Ekeleme et al., 2023).
Also in a study in South West Ethiopia the average number of bed nets per household was 0.9
while the average household family size was 5.63. Approximately 90% (745) of households owned
at least one LLIN. Almost all had complete knowledge about the proper use of LLINs. Out of the
745 households that owned LLINs, 68.3% (509) reported that someone had slept under the LLIN
the prior night. Children under 5 years of age had greater utilization of LLINs than pregnant
mothers (59.2% vs 52.5%). Only half of the study participants reported using LLINs throughout
the year (Hambisa et al., 2018).
During a study carried out in Fako division, Cameroon. Out of 103 respondents who owned one
or more ITN, it was found that 80 (77.67%) utilized them on a regular basis as opposed to 23
(22.33%) who utilized them irregularly. It was however noted that other than those who did not
utilize ITN, neither possess one. Those who possessed ITN utilized them at least at some point in
time. Thus, in the entire study, “don’t use” have been referred to respondents who did not possess
ITN (Terence Bengyela 2011).
During an assessment conducted in Ethiopia, out of the 1250 households that owned LLINs, 349
(27.1%) had slept under it the night prior to the survey. LLINs are mainly utilized by all family
members in more than ¾th (81.8%) of the households, while children under 5 years of age or
pregnant mothers are given priority in only 135 (10.8%) and 93 (7.4%) households respectively.
Regarding periods of LLINs use, 36.3% of respondents used it during rainy season while 23.8%
of the study participants used LLINs throughout the year. Respondents underscored the role of
weather as one of the reasons for inconsistent LLIN use. However, only 8.1% use LLIN during
hot weather because it is uncomfortable and they frequently use it during rainy seasons as malaria
transmission is higher during rainy session, and the temperature is relatively low according to their
reports. Some households were using LLINs for unintended purposes like rapping over mattresses
to protect from bugs, for carrying grain, for spreading grains on the sunshine, using as curtain and
other similar purposes were observed during the assessment (Hunde et al., 2023).
Furthermore, during a study conducted in Osun state Nigeria on caregivers, overall 836 (82.9%)
of the respondents had at least one LLIN and 591 (58.6%) of them reported that their under five
children slept under the net night t preceding the survey. Less than half (41.2%) slept every night
under an LLIN, while 63 (7.5%) caregivers mentioned their under five children had never slept
under the net. Six hundred and eighty six (82.1%) respondents claimed their net was hung and
ready for use, however, 416 (60.6%) LLINs were observed to be hung (Israel et al., 2018).
2.3.3 Challenges faced in the use of long lasting insecticidal nets in the prevention of malaria
among inhabitants of quarter 11 Mutengene.
Studies have shown that adequate malaria control could prevent 3-8% of infant deaths (Steketee
et al., 2001).the use of long lasting insecticidal nets has been shown to reduce the number of
malaria episodes by as much as 50%, to reduce childhood mortality by 20% (Lengler, C., 2004)
and to provide protection for pregnant women, who are the most susceptible to malaria (Binka et
al., 2006). Epidemiologist evidence, arising mainly from studies in the countries of sub Saharan
Africa, suggests that sleeping under LLINs is a cost effective and efficacious method of controlling
malaria. For this reason, promotion of LLIN use has become a key malaria control strategy (Ehiri
et al., 2004). Widespread coverage of vulnerable populations including pregnant women and
children under five years of age, with LLINs constitutes an important component of the strategy
to control malaria. The targets of the 2000 Abuja summit on Roll Back Malaria (RBM) call for
60% and 80% coverage of both pregnant women and children under five years of age by 2005 and
2010 respectively (TDR 2000).
In a study conducted in Lagos state, when the respondents were asked about what they perceived
as restraints to LLIN use by the people in their communities pre-intervention, they mentioned:
inconveniences relating to LLIN use (e.g. hanging problem) (210, 67.7%); it causes heat/hot to
sleep under (153, 49.3%); durability concerns as LLIN is perceived to get worn out and tear easily
(126, 40.6%); gets dirty/stained and must wash frequently (102, 32.9%); add some people don’t
like the shape of the net (94; 30.3%)(Adeneye et al., 2021).
During a study conducted in central Ivory Coast, One fifth of the households and significantly
poorer households stated that LLINs were expensive; less than 1% of households thought that
LLINs were not efficient. The most widely reported negative effect or inconvenience arising from
LLINs use was heat, followed by suffocation and unpleasant smell. The high costs of LLINs was
cited by most Yoho and N’Dakonankro households as reason for not using LLINs .The suffocation
was a negative effect mentioned by one fifth of N’akonankro households versus less than one tenth
of the households in Bozi and Yoho (Ouattara et al., 2011). During a study carried out in Tiko,
said it gives heat” (21.1%), forgetfulness (6.5%), use of fan (2.8%), difficulty to install LLINs
(2.4%), and use of mosquito repellent (2.2%) (Paulette et al., 2021).
During a study in Rwanda, Among 384 study participants, 59 (18.3%) were reported not using
LLIN. Observed frequent factors that affect LLIN use were included: high temperature/heat 56
(94.9%), no access to LLIN 52 (88.1%) and used mosquito coil/spray 8 (13.6 %). Other factors
were included: the absence of mosquitoes 15 (25.4%), feel uncomfortable sleeping under LLIN 20
(33.9%) and the rest use mosquito coil/spray 8 (13.6%) causes the skin rashes/ itch 42 (71.2%)
reduces ventilation /asphyxia 45 (76.3%) (Habimana et al., 2020). Also During a survey among
pregnant women in Lamingo, Nigeria. Reasons commonly adduced for non-consistent utilization
of LLITNs among pregnant women were the associated difficulty in getting up from bed at night
34 (11.0%), the perception of LLITNs making the room hot 83 (26.8%), reduction of ventilation
of the room 55 (17.7%) and perception of the harmfulness of the chemical used for treating the net
by 44 (14.2%) (Tolupe et al., 2014).
During a survey around Lake Tana, Northwest Ethiopia, almost all interviews reported that bedbug
infestation was observed as a major deterrent for persistent use of LLINs, the hanging corners of
LLINs and the top inside of the nets harbored bedbugs. Additionally bedbug urine and faeces were
associated with pigmentation of LLINs. Others cited insufficient supply of LLINs inequitable and
late delivery and irregular replacement of old nets as a barrier. Another barrier to persistent
utilizations of LLINs was the lack of adequate information about their proper use, in some houses
bed structure was a critical barrier to utilization and lastly some residents dislike the nets and said
it has odor, stuffy, made sleep spaces dark and that it causes allergic reactions (Asmamaw et al.,
2019).
CHAPTER THREE
MATERIALS AND METHODS
3.1 Research Design
A descriptive cross sectional study will be carried out that will be aim at exploring and describing
the knowledge and practices of inhabitants of quarter 11 Mutengene on the use of long acting
insecticidal nets in the prevention of malaria.
3.2 Study Area
This study was carried out at quarter 11 Mutengene. Mutengene is located within Tiko sub-division
in Fako division, South west of Cameroon. It has a population of approximately 48,626 inhabitants
( Tiko health district report). It main indigenous are the Kaka and the Bakweri tribes. A majority
of the population are workers of the Cameroon development corporation (CDC) and are farmers.
Mutengene has so many swampy areas, running water, gardens around houses, pig fences, fish
ponds which are all building grounds for mosquitoes which pre-exposes the people to malaria
infection. The town has recreational facilities such as game house, drinking spots, bakeries, night
clubs, hotels and shops.
3.3 Study Population
The study was restricted to men and women aged 18-55 years during the time of study.
3.4 Sample Size
The sample size included 41 men and women leaving in quarter 11 Mutengene. Yamane (1967)
provides a simplified formula to calculate sample size. This formula was used to calculate the
sample size where a 95% confidence level and P= 0.5 are assumed.
The formula is given as below
n = N÷[ 1 + N(e)^2] , where n is the sample size, N is the target population size and e is the
precision level.
When this formula is applied to the above sample we going to have;
n =? , N =70 inhabitants e = 0.1
This implies n = 48626÷ [ 1 +70(0.1)^2] = 41.17 approximately 41
Therefore the sample size is 41 inhabitants of quarter 11 Mutengene.
3.5 Sampling Technique
A simple random sampling will be used to create sample as per ease of access, readiness to be part
of the sample, availability at a given time slot.
3.5.1 Inclusion Criteria
➢ Men and women aged 18-55 years living in quarter 11 Mutengene
3.5.2 Exclusion Criteria
➢ Children and older adults living in quarter 11 Mutengene.
➢ Those living out of quarter 11 Mutengene
3.6 Data collection tools and Method
3.6.1 Data collection tools
Well-structured questionnaires will be the main instruments used to collect data. It will be designed
to meet the objectives of the study.
3.6.2 Data collection method
An informed consent will be presented to respondents that meet the inclusion criteria. When they
accept and sign, the researcher proceed by handing the questionnaire for them to fill or reading it
loud and explaining where necessary for them to provide responses. This will be done in an area
convenient for respondents, free from noise and distraction and at a time convenient for both
researcher and respondents.
3.7 Data Management and Analysis
The data collected will be organized and stored in my laptop in accessible files and the
questionnaires will be kept in a secure place to avoid data loss.
Data from the filled questionnaire will be entered into Microsoft excel, analyzed and presented in
tables, charts and scored in percentages.
3.8 Ethical Considerations
An authorization letter will be obtained from the BUIB administration to carry out my research
and collect my data. The letter was then handed to the District medical officer of Tiko alongside
with the research proposal for approval of the study to commence in the area. The authorization
letter was taken to the quarter head of quarter 11 Mutengene to carry out the study in his area for
his own approval.
Names of respondents will not be included in the questionnaires which guarantee confidentiality,
voluntary participation, privacy and human rights issues was considered.
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