Understanding community and health system acceptability, readiness and perspectives on the introduction of new vector control approaches for malaria control in Papua New Guinea

BACKGROUND: Malaria remains a major public health challenge in Papua New Guinea (PNG) and accounted for most malaria cases and deaths in the Western Pacific Region in 2023. Despite current national efforts centred on insecticide treated nets (ITNs), there is a pressing need to explore supplementary vector control tools, given the resurgence of malaria in PNG since 2015, partly driven by declining insecticidal efficacy of ITNs. The Newly Adapted Tools and Network Against Mosquito Borne Disease Transmission (NATNAT) project is assessing the feasibility and acceptability of complementary vector control approaches in PNG communities and the health system. These tools include residual spraying, spatial emanators, and larval source management. METHODS: We conducted an exploratory qualitative study to examine community acceptability, readiness and perceptions of current vector control tools such as ITNs and the potential reintroduction of supplementary vector control approaches, like residual spraying. Using in-depth interviews and focus group discussions, data were collected from four villages along the north coast of Madang Province: Megiar, Bulal, Mirap, and Wasab. Transcripts were analyzed thematically using inductive techniques, with collaborative review to refine key themes by study team. RESULTS: The current malaria control practices and contextual factors shaped community perceptions and the prospective acceptability of residual spraying. Community members demonstrated a strong understanding of malaria risk, including seasonal transmission patterns and breeding sites, and reported both traditional and program-implemented vector control approaches used in their village. Engagement for vector control activities was motivated by strong leadership, personal values, and a comprehensive understanding of malaria risk factors. Community support for supplementary vector control measures, alongside a strong desire to address existing gaps in mosquito protection, were key drivers of acceptability. Addressing insecticide safety concerns informed in part by historical DDT spraying campaigns experiences through tailored, context-specific communication strategies will be critical for the successful adoption of residual spraying. Affordability and uptake of new vector control tools into existing programs are essential for sustainable uptake into policy and practice. CONCLUSIONS: Findings demonstrate the prospective acceptability of new vector control tools in PNG and underscores the importance of sustained, in-depth community engagement. To ensure effective implementation, policy development must consider community norms and practices, societal attitudes, and resource availability.