Assessing bed net use and non-use after long-lasting insecticidal net distribution: a simple framework to guide programmatic strategies

Abstract

BackgroundInsecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use.MethodsA simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger.ResultsThe percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations.ConclusionsThe framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.

Success of Senegal's first nationwide distribution of long-lasting insecticide-treated nets to children under five - contribution toward universal coverage

“…Utilization rates for ITNs were relatively low given the high level of ownership in comparison with other reports [11,12,14,18-21]. While the proportion of houses with at least one ITN is high, given the large median household size, only a minority of households have enough ITNs to allow every member to sleep under one.…”

The impact of behaviour change communication on the use of insecticide treated nets: a secondary analysis of ten post-campaign surveys from Nigeria

“…Understanding why available ITNs are not used is needed to develop targeted IEC/BCC activities that can ultimately contribute to reducing malaria morbidity and mortality [18] and ensure more targeted and cost-effective strategies are developed [10]. The widespread use of BCC approaches for promoting ITNs is hampered by continued scepticism regarding their effectiveness [20], despite a previous study in Zambia suggesting that BCC “are necessary to improve use” and could “contribute towards closing the gap between ownership and use” [14].…”

The Use of Insecticide Treated Bed Net in Children Under Five Years of Age in Alakahia Community, Rivers State

“…Insecticide treated bed nets form a personal protection that have been shown to reduce the incidence of malaria, severe disease and death due to malaria in endemic regions like Nigeria. [20] However, many people still do not own or use it. In this study, the respondents' knowledge on the use of ITN for the prevention of malaria was unsatisfactory (25.6%) considering that majority (72.4%) knew that malaria was acquired through the bite of mosquito.…”

“…[9] Pyrethroids Alakahia Community, Rivers State do not rapidly break down unless washed or exposed to sunlight. [10] The great importance of pyrethroid deposit on the net arises because the body odour of sleepers attracts human seeking (anthropoliphic) mosquitoes to make contact with the net so that many are killed. Thus, with widespread use of treated nets, their mortality will be so high that one would expect a reduction in mean mosquito age and hence a major reduction in the population of mosquitoes.…”