N-player mosquito net game: Individual and social rationality in the misuse of insecticide-treated nets

Abstract

Many governmental and non-governmental organizations have distributed insecticide-treated nets (ITNs) to malaria endemic areas, which contributed to the reduction of malaria deaths. However, some people in malaria endemic areas used ITNs for alternative purposes such as fishery and agriculture. It is unclear why people threatened by malaria misuse ITNs. Here we develop a N -player mosquito net game, and theoretically show that the misuse of ITNs might be underpinned by individual and social rationality. In the mosquito net game, each player uses ITNs for malaria prevention or alternative purposes. The proper ITN use decreases the probability of malaria infection, while the improper ITN use increases the player's labor productivity. Each player's expected payoff is influenced by other players' strategies. We found that the misuse of ITNs can be a Pareto efficient Nash equilibrium. The * Corresponding author Email address: keita_honjo@ees.hokudai.ac.jp (Keita Honjo) maximum number of players using ITNs for malaria prevention is limited by insecticidal effectiveness of ITNs and extra income from ITN misuse. Furthermore, we found that players in a low-income community are attracted to the misuse of ITNs even if the probability of malaria infection is high.Introduction of a tax on ITN misuse was shown to be effective to motivate the players to use ITNs for malaria prevention. Our results demonstrate that understanding decision making of people in malaria endemic areas is essential to design more effective malaria control programs.

“After those nets are torn, most people use them for other purposes”: an examination of alternative bed net use in western Kenya

“…Additionally, among nets within the home, less than 1% of functioning bed nets were reported as having been alternatively used in both sites. Previous reports also found rare misuse [5] and suggest it occurs for economically beneficial reasons [6,22], particularly where misused for fishing [13,14,23]. There were no observations or self-reported instances of misused nets for fishing, though interestingly nearly 50% of households in the lowlands reported seeing others using nets for fishing.…”

“…Additionally, among nets within the home, less than 1% of functioning bed nets were reported as having been alternatively used in both sites. Previous reports also found rare misuse [ 5 ] and suggest it occurs for economically beneficial reasons [ 6 , 22 ], particularly where misused for fishing [ 13 , 14 , 23 ].…”

An Evolutionary Game Model of Sex-Dependent Antipredator Signaling

“…We developed an evolutionary game model of the signaling strategies of a solitary prey population, such as the population of the Chinese grasshopper, based on the framework of the bednet use model for malaria protection (Honjo et al 2013;Honjo and Satake 2014). We found that the underlying mathematical structures of the bednet use model and evolutionary game model of signaling are the same and extended the former to the latter.…”

Achieving net benefits: A road map for cross-sectoral policy development in response to the unintended use of mosquito nets as fishing gear

“…Goals of universal coverage (UC) and the methods employed to achieve UC do little to limit the presence of excess nets in distribution areas (Bhatt et al, 2015b) or to address the choices people make as to whether to use a net on their bed or for fishing (Honjo & Satake, 2014); something we need to understand much better. Aiming for universal coverage may be seen as a pragmatic approach to achieving levels of coverage that drive a 'mass effect' on mosquitoes, whereby mortality rates from insecticide contact may have a populationlevel effect and improve the effective protective range of nets (Howard et al, 2000).…”