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

Abstract

Background In Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge. Different household-level factors have been identified as associated with LLIN use. However, the contribution of LLIN physical integrity to their utilization is not well investigated and documented. This study aimed to assess the association between the physical integrity of LLINs and their use. Methods This study employed a nested case-control design using secondary data from the Ethiopian LLIN durability monitoring study conducted from May 2015 to June 2018. LLINs not used the night before the survey were identified as cases, while those used the previous night were categorized as controls. The physical integrity of LLINs was classified as no holes, good, acceptable, and torn using the proportionate hole index (pHI). A Generalized Estimating Equation (GEE) model was used to assess and quantify the association between LLIN physical integrity and use. The model specifications included binomial probabilistic distribution, logit link, exchangeable correlation matrix structure, and robust standard errors. The factors included in the model were selected first by fitting binary regression, and then by including all factors that showed statistical significance at P-value less than 0.25 and conceptually relevant variables into the multivariate regression model. Results A total of 5277 observations fulfilled the inclusion criteria. Out of these 1767 observations were cases while the remaining 3510 were controls. LLINs that were in torn physical condition had higher odds (AOR [95% CI] = 1.76 [1.41, 2.19]) of not being used compared to LLINs with no holes. Other factors that showed significant association included the age of the LLIN, sleeping place type, washing status of LLINs, perceptions towards net care and repair, LLIN to people ratio, economic status, and study site. Conclusion and recommendation LLINs that have some level of physical damage have a relatively higher likelihood of not being used. Community members need to be educated about proper care and prevention of LLIN damage to delay the development of holes as long as possible and use available LLINs regularly.

Long-lasting insecticidal nets provide protection against malaria for only a single year in Burundi, an African highland setting with marked malaria seasonality

“… 48 The loss of physical integrity of LLINs will impact the use of the nets as shown in a study in Ethiopia where damaged LLINs were less commonly used. 17 Also, torn nets are used for other purposes in Burundi and are no longer kept in the houses (WVB and CL, personal observations), further decreasing LLIN use. Studies in different African settings also showed that the effective lifespans of LLINs in the field are often shorter than 3 years, and rather depends on local conditions (influenced by living conditions and local behaviour of net maintenance that impact damage) than related to a specific LLIN brand.…”

“…The reasons for the fast decline of the LLINs effect, before the three full years of expected lifespan, in the highland setting of Burundi might be multiple and related to the fast loss of physical integrity of the nets 48. The loss of physical integrity of LLINs will impact the use of the nets as shown in a study in Ethiopia where damaged LLINs were less commonly used 17. Also, torn nets are used for other purposes in Burundi and are no longer kept in the houses (WVB and CL, personal observations), further decreasing LLIN use.…”

“…Effectiveness assesses the performance of the intervention under real-life operational conditions. Hence, the results vary depending on the actual operational, epidemiological and socioeconomic context including human behaviour and maintenance of the LLINs 15 17. In Burundi, the effectiveness of LLINs has not been evaluated.…”

Pengetahuan, Sikap, Dan Perilaku Masyarakat Tentang Malaria Di Kabupaten Ogan Komering Ulu Dan Lahat

“…Penggunaan kelambu, terutama kelambu berinsektisida (long-lasting insecticidal nets/LLINs) cukup efektif untuk mencegah penularan malaria serta dapat diterima oleh masyarakat 13 . Kampanye penggunaan kelambu serta pembagian kelambu berinsektisida perlu disertai dengan penyuluhan tentang perawatan kelambu yang digunakan agar kelambu tetap efektif dalam mencegah penularan malaria [14][15][16] . Hasil penelitian di Sumatera Selatan mendapatkan bahwa masyarakat banyak yang menggunakan kelambu untuk mencegah gigitan nyamuk meskipun dengan cara membeli sendiri sehingga kelambu yang digunakan adalah kelambu yang tanpa insektisida 5 .…”

Reported reasons for non-use of insecticide-treated nets in large national household surveys, 2009-2020

“…Children under ve years of age and women of reproductive age are consistently prioritized for ITN use, particularly when households don't have enough ITNs, with adolescents (especially boys) the least prioritized [15]. The condition of an ITN, related to its age and the development of holes and tears, is associated with early discarding of ITNs and therefore lack of use [16][17][18][19]; the decay rate of ITNs is a critical component of overall trends in ITN access, determining how quickly coverage declines following mass distribution campaigns and other large-scale distributions [2,5]. Pulford et al [6] reviewed 22 available studies in 2011 for reasons why nets went unused, nding that discomfort due to heat and perceived low risk of malaria due to low mosquito density were the primary reasons cited, but noted that ndings were tentative given the dearth of published studies.…”