Determining and addressing obstacles to the effective use of long-lasting insecticide-impregnated nets in rural Tanzania.

Malar J. 2009 Dec 31;8(1):315

Authors: Widmar M, Nagel CJ, Ho DY, Benziger PW, Hennig N


ABSTRACT: BACKGROUND: The objective of this project was to achieve high, sustainable levels of net coverage in a village in rural Tanzania by combining free distribution of long-lasting insecticide-impregnated nets (LLINs) with community-tailored education. In Tanzania, malaria is the leading cause of morbidity and mortality. Although malaria bed nets have a well-established role in reducing disease burden, few rural households have access to nets, and effective use depends on personal practices and attitudes. METHODS: Five practices and attitudes inconsistent with effective LLIN use were identified from household interviews (n=10). A randomized survey of villagers (n=132) verified local prevalence of these practices and attitudes. Community leaders held an educational session for two members of every household addressing these practices and attitudes, demonstrating proper LLIN use, and emphasizing behaviour modification. Attendees received one or two LLINs per household. Surveys distributed three weeks (n=104) and 15 months (n=104) post-intervention assessed corrected practices and attitudes. Project efficacy was defined by correction of baseline practices and attitudes as well as high rates of reported daily net use, with statistical significance determined by chi-square test. RESULTS: Baseline interviews and surveys revealed incorrect practices and attitudes regarding 1) use of nets in dry season, 2) need to retreat LLINs, 3) children napping under nets, 4) need to repair nets, and 5) net procurement as a priority, with 53- 88.6% incorrect responses (11.4-47% correct responses). A three-week follow-up demonstrated 83-95% correct responses. Fifteen-month follow-up showed statistically significant (p