The underlying reasons for very high levels of bed net use, and higher malaria infection prevalence among bed net users than non-users in the Tanzanian city of Dar es Salaam: a qualitative study

Abstract

BackgroundBed nets reduce malaria-related illness and deaths, by forming a protective barrier around people sleeping under them. When impregnated with long-lasting insecticide formulations they also repel or kill mosquitoes attempting to feed upon sleeping humans, and can even suppress entire populations of malaria vectors that feed predominantly upon humans. Nevertheless, an epidemiological study in 2012 demonstrated higher malaria prevalence among bed net users than non-users in urban Dar es Salaam, Tanzania.MethodsFocus group discussions were conducted with women from four selected wards of Dar es Salaam city, focusing on four major themes relating to bed net use behaviours: (1) reasons for bed net use, (2) reasons for not using bed nets, (3) stimuli or reminders for people to use a bed net (4) perceived reasons for catching malaria while using a bed net. An analytical method by framework grouping of relevant themes was used address key issues of relevance to the study objectives. Codes were reviewed and grouped into categories and themes.ResultsAll groups said the main reason for bed net use was protection against malaria. Houses with well-screened windows, with doors that shut properly, and that use insecticidal sprays against mosquitoes, were said not to use bed nets, while frequent attacks from malaria was the main stimulus for people to use bed nets. Various reasons were mentioned as potential reasons that compromise bed net efficacy, the most common of which were: (1) bed net sharing by two or more people, especially if one occupant tends to come to bed late at night, and does not tuck in the net 71%; (2) one person shares the bed but does not use the net, moving it away from the side on which s/he sleeps 68%; (3) ineffective usage habits, called ulalavi, in which a sprawling sleeper either touches the net while sleeping up against it or leaves a limb hanging outside of it 68%. Less common reasons mentioned included: (1) Small bed nets which become un-tucked at night (31%); (2) Bed nets with holes large enough to allow mosquitoes to pass (28%); and (3) Going to bed late after already being bitten outdoors (24%).ConclusionsBehaviours associated with bed net use like; bed sharing, bed net non compliant-bedfellow, sleeping pattern like ulalavi and some physical bed net attributes compromise its effectiveness and supposedly increase of malaria infection to bed net users. While some well-screened houses looked to instigate low malaria prevalence to non-bed net users.

Household Predictors of Incidence of Malaria in Northern Uganda: Its Implication for Future Malaria Control

“…This increment could be attributed to Uganda national malaria control program interventions of universal coverage of bed nets in the region as recommended by World Health Organization policy on ITN and accompany by free nets to pregnant women and infants in the country [5,30,31]. Our ndings are consistent with reports carried out in Tanzania with 80% bed net coverage [32,33] and other parts of the world [3] but higher than those reported in Kenya and other parts of Tanzania [33][34][35]. Our results also show that the incidence of malaria in children and adult were strongly related to lack of bed net or lack of use thereof and directly associated with the number of individuals spending a night together in a house which is similar to that observed in other studies in Africa [36,37].…”

“…What was very surprising is that despite achieving high coverage of IRS and ITNs in the study area, there was still high malaria incidence reported among the local communities which is similar to what has been observed in other African countries [34,35]. Of the 605 total number of individuals, 255 had malarial in the three months prior to this study, 171 of which were children (67%, a ratio of 3:2).…”

A population‐based study of the prevalence and risk factors of low‐grade Plasmodium falciparum malaria infection in children aged 0–15 years old in northern Tanzania

“…Our finding of a null association in the univariate analysis between pfPR and ownership of mosquito bed nets or using them the night before interview echoes our findings in Uganda [23] and Kenya [27] obtained using similar methodology as well as other reports in Tanzania [28,29] and elsewhere [23,27,30]. These results highlight an emerging concern that mosquito bed nets are losing their effectiveness as a key tool for malaria control, while the successful implementation of bed nets programs provides a false sense of security.…”

‘We spray and walk away’: wall modifications decrease the impact of indoor residual spray campaigns through reductions in post-spray coverage

“…In addition, current vector control tools face several challenges, which include sub-optimal user compliance [5] the rapid spread of insecticide resistance [6,7] mosquito behavioural changes after implementation of interventions [8], and implementation costs. All these factors combined greatly undermine the effectiveness of current intervention packages [2].…”