A qualitative study on the acceptability and preference of three types of long-lasting insecticide-treated bed nets in Solomon Islands: implications for malaria elimination

Abstract

BackgroundIn March 2008, the Solomon Islands and Vanuatu governments raised the goal of their National Malaria Programmes from control to elimination. Vector control measures, such as indoor residual spraying (IRS) and long-lasting insecticidal bed nets (LLINs) are key integral components of this programme. Compliance with these interventions is dependent on their acceptability and on the socio-cultural context of the local population. These factors need to be investigated locally prior to programme implementation.MethodTwelve focus group discussions (FGDs) were carried out in Malaita and Temotu Provinces, Solomon Islands in 2008. These discussions explored user perceptions of acceptability and preference for three brands of long-lasting insecticide-treated bed nets (LLINs) and identified a number of barriers to their proper and consistent use.ResultsMosquito nuisance and perceived threat of malaria were the main determinants of bed net use. Knowledge of malaria and the means to prevent it were not sufficient to guarantee compliance with LLIN use. Factors such as climate, work and evening social activities impact on the use of bed nets, particularly in men. LLIN acceptability plays a varying role in compliance with their use in villages involved in this study. Participants in areas of reported high and year round mosquito nuisance and perceived threat of malaria reported LLIN use regardless of any reported unfavourable characteristics. Those in areas of low or seasonal mosquito nuisance were more likely to describe the unfavourable characteristics of LLINs as reasons for their intermittent or non-compliance. The main criterion for LLIN brand acceptability was effectiveness in preventing mosquito bites and malaria. Discussions highlighted considerable confusion around LLIN care and washing which may be impacting on their effectiveness and reducing their acceptability in Solomon Islands.ConclusionProviding LLINs that are acceptable will be more important for improving compliance in areas of low or seasonal mosquito nuisance and malaria transmission. The implications of these findings on malaria elimination in Solomon Islands are discussed.

Impact of long-lasting insecticide-incorporated screens onColorado potato beetle and plum curculio

“…The high efficacy and reduced impact of LLISs on nontarget organisms has been best demonstrated in their use for mosquito control in areas affected by malaria: LLISs have reduced cases of malaria by 62%, and child mortality has dropped to 29% in some areas (Lengeler, 2004). LLISs are now promoted as a key method to fight malaria and its vector (Atkinson et al, 2009). Although the efficacy and potential of LLISs for wide applications is undisputed, their use has mostly been limited to controlling household pests and insect vectors such as mosquitoes and flies (Baume and Marin, 2008;Okumu and Moore, 2011).…”

Ownership and disuse of bed nets in Kenyan children under five years of age

“…16,[22][23][24][25] The fact that ITN can reduce the risk of malaria may not be well recognized in some areas and individuals have consistently reported using ITN because they regard mosquitoes to be a nuisance, not to prevent transmission of malaria. 22,23,26 This may be due to lack of knowledge about malaria transmission and/or a lower perceived risk of the disease .5,23,26,27 Discomfort, particularly in higher temperature climates and inconvenience are other frequently cited reasons for not using mosquito nets.…”

“…16,[22][23][24][25] The fact that ITN can reduce the risk of malaria may not be well recognized in some areas and individuals have consistently reported using ITN because they regard mosquitoes to be a nuisance, not to prevent transmission of malaria. 22,23,26 This may be due to lack of knowledge about malaria transmission and/or a lower perceived risk of the disease .5,23,26,27 Discomfort, particularly in higher temperature climates and inconvenience are other frequently cited reasons for not using mosquito nets. 21 We undertook an analysis of the 2008 Kenya Demographic and Health Survey data (KDHS) to determine factors associated with three categories of children under five years of age not sleeping under a bed net: i) Ownership: the child does not sleep under a bed net because there are none in the household; ii) Intrahousehold bed net access: all bed nets are being used and there is none for the child to sleep under; iii) Non-use: there are bed nets available in the home that are not being used.…”

Combining malaria control with rural electrification : social and behavioural factors that influenced the design, use and sustainability of solar-powered mosquito trapping systems (SMoTS) for malaria elimination on Rusinga Island, western Kenya

“…A similar observation was made when mothers did not associate an ITN trial with child health despite the emphasis placed on the link and actual population level improvements in child health . This may be because the main purpose of protection from mosquitoes seems to be to avoid nuisance biting rather than to prevent malaria (Aikins, Pickering et al 1994;Van Bortel, Barutwanayo et al 1996;Okrah, Traore et al 2002;Atkinson, Bobogare et al 2009). Savings which could be re-directed to other pressing expenses was of utmost importance; this is consistent with findings that people tend to look for practical benefits personally experienced than more strategic benefits such as malaria control (Winch, Makemba et al 1994;Minja 2001;.…”

“…Success of vector control interventions as a public health measure for infectious disease control depend on their acceptability and perceived value to affected communities (Agyepong and Manderson 1999;Atkinson, Bobogare et al 2009;Montgomery, Munguambe et al 2010). Drawing from experiences with studies of insecticide-treated nets (ITNs) use for malaria prevention, understanding facilitators and barriers to increased adherence is necessary to encourage and maintain long-term use (Okrah, Traore et al 2002;Toe, Skovmand et al 2009).…”