Why Using Bed Nets is a Challenge amongst Minority Populations in Central Vietnam

Abstract

Background: Despite free distribution of insecticidal-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) to populations at-risk, malaria transmission persists in forested areas in Vietnam especially amongst ethnic minority communities. A study was conducted between April 2009 and December 2010 in four villages of Ca Dong and M’nong ethnicity located in Central Vietnam with persistent malaria transmission. The objective was to assess the feasibility of bed net use in forest settings with a specific emphasis on contrasting people’s willingness/choice to use nets versus structural limitations to the uptake of the intervention. Methods: The study used an exploratory mixed-method design for complementarity. The qualitative strand included participant observation, informal interviews, in-depth interviews, and group discussions to explore contextual barriers to bednet use. The quantitative strand consisted of a cross sectional household survey (n=141) in a selected village with direct access to bed nets and the health centre. The main outcome was bednet use and related risk factors (using survey logistic regression), and secondary outcomes included the quantification of contextual factors identified during the qualitative strand. Results: Despite self-reported bednet coverage (72.5% of households had sufficient net coverage) and appropriate betnet use the night before the survey (82.2% of HHMs), only 18.4% of HHMs were effectively protected by nets in both the village home and the forest field. The distribution of LLINs and ITNs was not accounted for multiple residency and sleeping places linked to slash-and-burn agriculture, and contextual factors including open-housing structured, high poverty, and animistic beliefs contributing to inappropriate use and shorter lifespan of nets. Health messages promoting bednet use were provided to the population but only 19.8% of respondents considered mosquito bites as the sole cause of malaria. The multi-variable logistic regression showed the effect of four significant factors to appropriate bednet use: being female (AOR=8.08; p=0.009); having knowledge of mosquito bites and malaria link (AOR=7.43; p=0.008); not sleeping in the kitchen (AOR=24.57; p=0.001); and, having sufficient number of bednets in the household (AOR=21.69; p=0.001). Conclusion: This study identified contextual factors that constrains effective bednet use amongst ethnic minority populations living in forested areas of Central Vietnam and calls for multi-sectoral interventions to address the complexity of residual malaria transmission and reach the malaria elimination goal of 2030.