"Should We Take Them or Leave Them?" A Qualitative Study to Understand the Social, Cultural, and Ethical Issues Associated With the Lifecycle Management of Insecticide-Treated Nets in Tanzania

Abstract

Background: Insecticide-treated nets (ITNs) are highly effective in reducing morbidity and mortality from malaria. However, it is widely accepted that ITNsif not re-treatedlose their effectiveness with time and eventually need to be replaced. This study sought to determine the social, ethical, and cultural issues related to the lifecycle of ITNs, which includes net ownership, usage, maintenance, reuse, recycling, disposal, and replacement. Methods: In this qualitative study, conducted in the districts of Mtwara Rural, Kilombero, and Muheza, Tanzania, we collected information about bed nets, including usage habits, types, treatment status, materials used, brands, acquisition sources, and perceptions thereof. We conducted 23 key informant interviews and 20 focus group discussions with village leaders, other influential people in the community, and district health-care personnel. Results: ITNs were deemed acceptable and used by most community members in the participating communities. Alternative uses and disposal practices of used bed nets were also common among community members; however, participants had limited knowledge regarding the health and environmental risks associated with these practices. Most participants did not perceive bed net recycling as a sustainable option. Recycling was considered feasible, however, if effective infrastructure for collection and disposal could be established. Poverty was identified as a major driving force towards alternative uses of bed nets. Financial constraints also meant that not all household members were able to sleep under bed nets; pregnant mothers, children under 5 years old, and the elderly were prioritised. Conclusion: Our findings may inform the National Malaria Control Programme and other stakeholders as they develop country-specific and environmentally friendly bed net replacement strategies. Appropriate strategies will help ensure sustained protection of vulnerable populations against malaria, while considering local social, ethical, and cultural issues related to the recovery of bed nets. Insecticide-Treated Net Lifecycle Management in Tanzania www.eahealth.org

Challenges of Proper Disposal of Old Long-Lasting Insecticidal Nets and its Alternative Uses in Rural South-Eastern Tanzania

“…Mostly in rural areas, it was observed small strips made out of polyester netting were used during as ropes tied with branches and woods on mud houses (huts). Similarly LLINs alternative uses had been documented across other areas in sub-Saharan Africa [9,[44][45][46][47][48][49]. Numerous motives for the bed net alternative uses were revealed from the study; poverty and need for alternative materials being the most common, as LLIN is considered to be a steady fabric material and durable.…”

“…Mutalemwa et al, proposed that, in order to dissipate these concerns and misconceptions, all bed net users and recipients should be informed that, when used correctly, the insecticides embedded in LLINs kill and repel mosquitos while remaining safe for humans [9].…”

“…Several other studies have also reported on these concerns and misconceptions about the use of LLINs, particularly the potential risks and impotence (infertility) posed by the insecticides embedded in the bed nets [54–58]. Mutalemwa et al ., proposed that, in order to dissipate these concerns and misconceptions, all bed net users and recipients should be informed that, when used correctly, the insecticides embedded in LLINs kill and repel mosquitos while remaining safe for humans [9].…”

“…Collection strategies should be agreed upon earlier with community members prior to the net replacement. Evaluation studies conducted in Tanzania and Madagascar on collection of expired LLINs demonstrated that collecting worn-out or retired LLINs may be appropriate if community collection strategies are agreed upon prior to the replacement of new bed nets based on community preferences [9,65]. As a result, the above-mentioned factors should be considered when developing LLINs collection strategy so as to broaden and scale-up the collection of worn-out or retired LLINs.…”

“…The primary aim of using LLIN is to protect people against mosquito bites, malaria transmission and other mosquito borne infections [4]. Though, in several parts of Africa, LLINs have been reported to be used for fencing vegetable gardens and chicken huts, sieving grains, and as fishing nets and alternative building materials, which may lead to environmental harm [5][6][7][8][9]. However, the insecticides (pyrethroids and pyrroles) embedded in the LLINs though have low mammalian toxicity, if not properly disposed, it may be toxic to aquatic life and other untargeted species.…”