Long Lasting Insecticidal Nets to Prevent Malaria
A recent discussion on the HIFA2015 listserv on the barriers to use of Long Lasting Insecticidal Nets prompted us to look at the literature and we found several relevant articles on use/non-use and reasons why.
While many of the articles cite reasons of cost or concerns about safety and effects of chemicals, some mention that sleeping under bed nets was too hot, and that they were used more during the rainy season than the dry.
Some other lessons:
- Treated nets were more likely to be used than untreated ones;
- Nets two years old or less were more likely to be used than older nets;
- Nets that were paid for were more likely to be used than nets obtained for free;
- Larger nets were more likely to be used than smaller ones, except in Ethiopia;
- The more nets a family owned, the less likely that all of them would be used.
Other information from the articles include:
- In Uganda a project to test the accuracy of reporting about bed net use was carried out through a questionnaire sent to schools vs. a more traditional and more expensive community survey method.The study concludes that in areas with high school attendance rates, school children’s report of bed net use monitored by school teachers could give a good approximation of household ownership of bed nets at community levels with about ±5% difference between community and school surveys.
- In Timor-Leste, there was a widespread perception that nets could or should only be used by pregnant women and young children, and extensive re-purposing of nets (fishing, protecting crops) was both reported and observed, and may significantly decrease availability of nighttime sleeping space for all family members if distributed nets do not remain within the household.
- In some parts of Kenya, despite insecticide treated nets ownership reaching more than 71%, compliance was low at 56.3%.
- In Zambia, some bed net distribution strategies missed households occupied by the elderly and those without children, resulting in overall low use as well as a perception that the insecticide-treated mosquito nets wore out before they could be replaced.
- In Tanzania, while 65 percent of some 200 respondents were aware of the use of insecticide treated nets (ITNs), the coverage of any mosquito net and ITN was 12.5% and 5%, respectively. Affordability, unavailability and gender inequality were identified to be major factors associated with the low ITN coverage.