What happens to lost nets: a multi-country analysis of reasons for LLIN attrition using 14 household surveys in four countries

Abstract

BackgroundWhile significant focus has been given to net distribution, little is known about what is done with nets that leave a household, either to be used by others or when they are discarded. To better understand the magnitude of sharing LLIN between households and patterns of discarding LLIN, the present study pools data from 14 post-campaign surveys to draw larger conclusions about the fate of nets that leave households.MethodsData from 14 sub-national post-campaign surveys conducted in Ghana, Senegal, Nigeria (10 states), and Uganda between 2009 and 2012 were pooled. Survey design and data collection methods were similar across surveys. The timing of surveys ranged from 2–16 months following their respective mass LLIN distributions.ResultsAmong the 14 surveys a total of 14,196 households reported owning 25,447 nets of any kind, of which 23,955 (94%) were LLINs. In addition, a total of 4,102 nets were reported to have left the households in the sample: 63% were discarded, and 34% were given away. Only 255 of the discarded nets were reported used for other purposes, representing less than 1% of the total sample of nets. The majority (62.5%) of nets given away were given to or taken by relatives, while 31.1% were given to non-relatives. Campaign nets were almost six times (OR 5.95, 4.25-8.32, p < 0.0001) more likely to be given away than non-campaign nets lost during the same period. Nets were primarily given away within the first few months after distribution. The overall rate of net redistribution was 5% of all nets.Discussion and conclusionIntra-household re-allocation of nets does occur, but was sensitive to current household net ownership and the time elapsed since mass distribution. These factors can be addressed programmatically to further facilitate reallocation within a given community. Secondly, the overwhelming majority of nets were used for malaria prevention. Of the repurposed nets (<1% overall), the majority were already considered too torn, indicating they had already served out their useful life for malaria prevention. National programmes and donor agencies should remain confident that overall, their investments in LLIN are being appropriately used.

Risk Factors for Malaria Infection Prevalence and Household Vector Density between Mass Distribution Campaigns of Long-Lasting Insecticidal Nets in Northern Tanzania

“…An increase in malaria infection was also observed in other regions. After the initial decrease in malaria infection to 9% (ranging 1-25%), malaria prevalence increased to 14% (ranging from 1-41%) across seven LLINs becoming torn over time and the poor access to new LLINs, which is consistent with findings from other studies [27]. Even with good access to LLIN malaria infection prevalence was still 59%, indicating loss of effectiveness due to other reasons.…”

Risk factors for malaria infection prevalence and household vector density between mass distribution campaigns of long-lasting insecticidal nets in North-western Tanzania

“…While good household access to LLINs and self-reported individual LLIN use were both associated with reduced risk of malaria infection in the risk factor analysis, the reduction in LLIN coverage and usage in the years after the campaign would have contributed to the observed increase in malaria prevalence in 2014. The reported reasons for not using LLINs included: LLINs becoming torn over time and the poor access to new LLINs, which is consistent with ndings from other studies [27]. Even in households with adequate access to LLINs malaria infection prevalence was still 59%, indicating loss of effectiveness of LLINs due to other reasons.…”

Monitoring the durability of the Long-Lasting Insecticidal Nets MAGNet and Royal Sentry in three ecological zones of Mozambique

“…In addition to the increasing age of the LLIN, this is likely also related to the in ux of new campaign LLINs particularly in Nampula but also in the other sites prior to the 36-month round. LLINs sold, stolen, or used for other purposes were a relatively small share of all-cause attrition, similar to continent-wide ndings [16]. LLIN were discarded earlier in Inhambane, while in Tete and Nampula households tended to hold on to them longer.…”