Effect of user preferences on ITN use: a review of literature and data

Abstract

BackgroundInsecticide-treated bed nets (ITNs) are the primary tool for vector control, and optimizing ITN use is a key concern of national programmes. Available evidence indicates that bed net users often have preferences for shape, colour, size, and other attributes, but it is unclear whether these preferences are strong enough to have any significant effect on bed net use, and whether countries and donors should invest in more expensive attributes in order to maximize ITN use. The link between bed net attributes, preferences, and use was investigated using a literature review and review of publicly available, nationally representative household surveys from sub-Saharan Africa.MethodsA literature search was conducted to identify publications with data on preferences for net attributes and on associations between net attributes and use. Publicly available DHS and MIS datasets were screened for variables on net preferences and net attributes. Wald tests were run to obtain odds ratios and confidence intervals for the use of nets of various attributes in univariate analysis. A multilevel logistic regression was constructed to assess the odds of a net’s use, controlling for background variables and adding random effects variables at the household and cluster level.ResultsPreferences for certain net attributes exist, but do not impede high rates of net use in countries where data were available. Stated preferences for shape and colour do not significantly influence net use to degrees that would require action by programme planners. By and large, people are using the nets they receive, and when they do not, it is for reasons unrelated to shape and size (primarily perceived mosquito density, heat or an excess of nets). Households in higher wealth quintiles tend to own greater numbers of conical nets, indicating that they have the ability to obtain or purchase these nets on their own, and individuals resident in higher wealth quintile households also use conical nets preferentially.ConclusionsThe increased manufacturing costs for conical nets are not outweighed by the very small, often non-existent, increases in use rates in sub-Saharan Africa. Programmes that wish to explore the relationship between net attributes, preferences and use rates should include these questions in nationally representative household surveys to be able to capture trends across geographic and socio-economic groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1879-8) contains supplementary material, which is available to authorized users.

Evidence of high bed net usage from a list randomization experiment in rural Gambia

“…The results of this list randomization experiment suggest very high LLIN usage among household heads in a rural area of a region of The Gambia with high coverage. High usage in a context of high coverage would be good news for public health practitioners worried about disuse and misuse, and is consistent with previous research showing high LLIN use following distribution campaigns [ 25 – 27 ]. Though list randomization has been shown to be a useful tool for eliciting sensitive behaviours in other contexts, for the specific case of LLIN usage further research is needed.…”

Evidence of high bednet usage from a list randomization experiment in rural Gambia

“…High usage in a context of high coverage is good news for public health practitioners worried about disuse and misuse, and is consistent with previous research showing high LLIN use even when not purchased (22)(23)(24). Net distribution campaigns should take into account these results when estimating effectiveness and planning time between interventions.…”

The Consequences of Declining Population Access to Insecticide Treated Nets (ITNs) on Net Use Patterns and Physical Degradation of Nets after 22 Months of Ownership

“…In fact, an analysis of PMI-country surveys found that the variation of overall durability of ITNs was larger between countries than among net types, although the durability of net types does vary within countries [50,51]. A literature and data review by Koenker and Yukich [52] found that product attributes do not affect use, agreeing with this study which shows NetProtect® was used equally to the other products but was only found to be more durable in Tanzania. The Tanzania NMCP should consider procuring the most appropriate longer-lasting ITN product to be distributed to ensure those nets distributed last for the intended interval between campaigns.…”