Traditional Nets Interfere with the Uptake of Long-Lasting Insecticidal Nets in the Peruvian Amazon: The Relevance of Net Preference for Achieving High Coverage and Use

Abstract

BackgroundWhile coverage of long-lasting insecticide-treated nets (LLIN) has steadily increased, a growing number of studies report gaps between net ownership and use. We conducted a mixed-methods social science study assessing the importance of net preference and use after Olyset® LLINs were distributed through a mass campaign in rural communities surrounding Iquitos, the capital city of the Amazonian region of Peru.MethodsThe study was conducted in the catchment area of the Paujil and Cahuide Health Centres (San Juan district) between July 2007 and November 2008. During a first qualitative phase, participant observation and in-depth interviews collected information on key determinants for net preference and use. In a second quantitative phase, a survey among recently confirmed malaria patients evaluated the acceptability and use of both LLINs and traditional nets, and a case control study assessed the association between net preference/use and housing structure (open vs. closed houses).ResultsA total of 10 communities were selected for the anthropological fieldwork and 228 households participated in the quantitative studies. In the study area, bed nets are considered part of the housing structure and are therefore required to fulfil specific architectural and social functions, such as providing privacy and shelter, which the newly distributed Olyset® LLINs ultimately did not. The LLINs' failure to meet these criteria could mainly be attributed to their large mesh size, transparency and perceived ineffectiveness to protect against mosquitoes and other insects, resulting in 63.3% of households not using any of the distributed LLINs. Notably, LLIN usage was significantly lower in houses with no interior or exterior walls (35.2%) than in those with walls (73.8%) (OR = 5.2, 95CI [2.2; 12.3], p<0.001).ConclusionNet preference can interfere with optimal LLIN use. In order to improve the number of effective days of LLIN protection per dollar spent, appropriate quantitative and qualitative methods for collecting information on net preference should be developed before any LLIN procurement decision is made.

Epidemiology of Plasmodium vivax Malaria in Peru

“…Among the potential explanations for the spatial heterogeneity of malaria are ecological factors that facilitate mosquito breeding and resting sites are associated with deforestation, natural and man-made water bodies (e.g., fish ponds), and surrounding secondary vegetation are among the potential explanations for the spatial heterogeneity of malaria. In addition to vector-related ecological factors, human socioeconomic differences such as poorer housing conditions (open or semiclosed houses)50 and outdoor economic activities (such as farming, logging, or fishing) and travel along riverine routes among endemic sites of transmission likely play an important role in the maintenance of malaria transmission, often with unexpected, stochastic patterns 7…”

High Mobility and Low Use of Malaria Preventive Measures Among the Jarai Male Youth Along the Cambodia–Vietnam Border

“…The factors contributing to the micro-epidemiology of malaria, including the substantial variation in malaria risk between neighboring villages 7 , 8 or even households 9 are still not fully understood but include variation in distance from the nearest mosquito breeding site, wind direction, and human genetic factors. 10 , 11 In addition, the potential underlying human behavioral factors have seldom been investigated and include local preferences for housing construction, 12 – 15 uptake of preventive measures, 2 – 4 human mobility, 16 , 17 and the presence of specific socially vulnerable or marginalized groups. 18 For countries with decreased transmission moving toward elimination, these pockets of transmission (or “hotspots”) and their multifactorial determinants have become increasingly important to understand and tackle.…”

Spatio-temporal analysis of malaria incidence in the Peruvian Amazon Region between 2002 and 2013

“…In addition, conditions that increase exposure to infectious mosquitos’ bites ( e.g., forest-based economical activities)10, and human behavioural factors that limit the coverage and effectiveness of malaria control interventions ( i.e. , low use of preventive measures, inappropriate treatment seeking behaviours, and low treatment adherence) may also influence the malaria transmission31112. Besides the above mentioned factors, the timing and the intensity of malaria control interventions may also play an important role in determining the geographical and chronological heterogeneity of malaria transmission.…”