“In starvation, a bone can also be meat”: a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania

Abstract

Background Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribution. This study investigated the factors associated with the decision of users to discard LLINs. Methods A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years), younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organization (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analysed in this study. Results In FGDs, integrity of LLIN influenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR = 1.05 (95%CI (1.04–1.07)), p < 0.001]. Younger age group [OR = 4.97 (95%CI (3.25–7.32)), p < 0.001], male-headed households [OR = 6.85 (95%CI (4.44 –10.59)), p < 0.001], and wealthy households [OR = 3.88 (95%CI (2.33–6.46)), p < 0.001] were more likely to discard LLINs. Conclusion Integrity of LLIN was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with socioeconomic status of the household, and the age and gender of respondents. WHO “too torn” nets are encouraged to be used instead of none until replacement, and disposal of nets should be based on recommendation.

Challenges of Proper Disposal of Old Long-Lasting Insecticidal Nets and its Alternative Uses in Rural South-Eastern Tanzania

“…Mostly in rural areas, it was observed small strips made out of polyester netting were used during as ropes tied with branches and woods on mud houses (huts). Similarly LLINs alternative uses had been documented across other areas in sub-Saharan Africa [9,[44][45][46][47][48][49]. Numerous motives for the bed net alternative uses were revealed from the study; poverty and need for alternative materials being the most common, as LLIN is considered to be a steady fabric material and durable.…”

Challenges of proper disposal of old long-lasting insecticidal nets and its alternative uses in rural south-eastern Tanzania

“…Mostly in rural areas, it was observed that small strips made out of polyester netting were used during house building as ropes tied with branches and wood on mud houses (huts). Similarly, LLINs alternative uses had been documented across other areas in sub-Saharan Africa [ 11 , 34 , 41 – 44 ]. Numerous motives for bed net alternative uses were revealed from this study, including poverty and the need for alternative materials being the most common, as LLIN is considered to be a sturdy fabric material and durable.…”

Community perception of the autodissemination of pyriproxyfen for controlling malaria vectors in south-eastern Tanzania

“…This is attributed to changes in the behavior of the mosquitoes [3,4,48], and the development of resistance to insecticides [5][6][7]. In addition, the nondurable LLINs can easily get torn and enable mosquitoes to penetrate and gain access to the sleeping individuals [49], allowing transmission to continue even in areas with high LLIN coverage. These views are well echoed by most recent suggestions of having mosquito nets that last longer, as that will ensure extended protection against mosquito bites and interrupt malaria transmission [50,51].…”