Effect of bed net colour and shape preferences on bed net usage: a secondary data analysis of the 2017 Malawi Malaria Indicator Survey

Abstract

Background Malaria remains a significant cause of morbidity and mortality in the paediatric population in Malawi. Insecticide-treated bed nets are a key vector malaria control intervention, however, advancement towards universal access is progressing slowly. Malawi Malaria indicator surveys (MMIS) show diverse user preferences of bed net shape and colour. The objective of this work was to understand if bed net shape and colour preferences affect usage. Methods This is a secondary analysis of data from households that participated in the 2016–2017 MMIS. The main outcome variable was net usage defined, at net level, whether someone slept under a particular net on the night before the survey. The main exposure variables were preference attributes, whether a particular net is of a preferred colour or shape as defined by the household respondent. Both bivariate and multivariate logistic regression analyses were done to determine the association between the exposure and outcome variables. Results A total of 3729 households with 16,755 individuals were included in this analysis. There were a total 7710 bed nets in households that participated in the survey of which 5435 (70.5%) of these nets had someone sleep under them the previous night before the survey. Bed nets that are of a preferred shape have 3.55 times higher odds of being used than those not preferred [AOR 3.55 (95% CI 2.98, 4.23; p value < 0.001)]. Bed nets that are of a preferred colour have 1.61 times higher odds of being used than those that are not of a preferred colour [AOR 1.61 (95% CI 1.41, 1.84; p value < 0.001]. Conclusions The results indicate that if a bed net is of a preferred colour or shape, it is more likely to be used. Bed net purchase by malaria stakeholders need to balance more factors on top of preferences such as price and efficacy.

A Survey of Ownership and Utilization of Insecticide Treated Nets (ITNs) among Pregnant Women Attending Anc Clinic

“…However, the pregnant women never had guidance and education concerning ITN usage at the ANC clinic. These findings validate the findings of several other previous studies that also identified institutional factors that influenced ITN usage [4,19,[20][21][22][23][24][25][26][27][28][29].…”

“…The findings of the current study indicated that the pregnant women felt heat and warmth when sleeping under the ITN, they itched and had rashes when sleeping under the ITN, they had difficulty in hanging their ITNs, and they also had difficulty in breathing when sleeping under the ITN. These findings concord with the findings of several other previous studies that also identified personal factors that influence the usage of ITNs among pregnant women [4,7,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Also, in two rural communities in the Greater Accra region of Ghana, a randomized control trial by found that more than 90% of respondents found ITNs to be uncomfortable to use because they trap heat, especially during warm weather or dry seasons where 75% of respondents could not sleep under an ITN without a fan.…”

The effect of long-lasting insecticidal nets (LLINs) physical integrity on utilization

“…Conical-shaped LLINs were preferred and more likely to be used than rectangular ones in Ethiopia [ 12 , 13 , 21 ]. Bed nets that matched the preferred colour of individual users were more likely to be used in Malawi [ 22 ].…”

Unravelling the impact of insecticide-treated bed nets on childhood malaria in Malawi

“…Furthermore, gaps may exist between policy and implementation [19], with human behaviour one of the most complex variables involved in malaria transmission. The local population might accept, but not use and maintain nets, use nets for other purposes or migrate to areas with higher malaria risk [20][21][22]. Further reasons include social factors, such as autonomy in health care decisions [23], bed net integrity and insecticide degradation [24].…”