Why using bed nets is a challenge among minority populations in Central Vietnam

Abstract

Background Despite freely distributed insecticide-treated nets (ITNs) and health information campaigns to increase their use among populations at risk, malaria transmission persists in forested areas in Vietnam, especially among ethnic minority communities. A mixed-methods study was conducted in four villages of Ca Dong and M’nong ethnicity in Central Vietnam between 2009 and 2011 to assess factors limiting the uptake of ITNs. Methods The mixed-methods research design consisted of a qualitative study to explore the context and barriers to ITN use, and a cross-sectional household survey (n = 141) to quantify factors for limited and appropriate net use. Results The Ca Dong and M’nong’s livelihood was dependent on swidden farming in the forest. Poverty-related factors, including the lack of beds, blankets, the practice of sleeping around the kitchen fire and deteriorated ITNs due to open housing structures, were reasons for alternative and non-use of ITNs. When household members stayed overnight in plot huts at fields, ITNs were even more unavailable and easily deteriorated. 72.5% of households reported having received one net for every two persons, and 82.2% of participants reported to have used ITNs the night before the survey. However, only 18.4% of participants were estimated to be effectively protected by ITNs after accounting for the availability of torn ITNs and the way ITNs were used, for example as blankets, at both village and fields. Multi-variable logistic regression showed the effect of four significant factors for appropriate ITN use: i) being female (AOR = 8.08; p = 0.009); ii) aware of mosquito bites as the sole cause of malaria (AOR = 7.43; p = 0.008); iii) not sleeping around the kitchen fire (AOR = 24.57; p = 0.001); and iv) having sufficient number of ITNs in the household (AOR = 21.69; p = 0.001). Conclusion This study showed how social factors rooted in poverty and swidden agriculture limited the effective use of ITNs, despite high coverage, among ethnic minority populations in Central Vietnam. An in-depth understanding of the local context is essential to develop specific indicators for measuring ITN use.

Ownership and use of insecticide-treated nets in Myanmar: insights from a nationally representative demographic and health survey

“…Likewise, in this study, despite high rates of net ownership and the use of any type of net, access to and use of ITNs remain relatively rare. The observed synergy between ownership and ITN use, indicates the need to expedite the distribution of ITNs while also promoting their use [ 19 , 28 ]. The implementation of a microstratification plan detailing the malaria situation and related corresponding distribution strategies is essential for maximising the coverage of preventive measures in populations at risk of malaria.…”

“…However, the use of ITN remains suboptimal, particularly in relation to specific populations in Myanmar: 9.0%–13.0% in migrant workers [ 15 ], 15.9% in pregnant women [ 16 ], and 44.0% in children under 5 years old [ 17 ]. Several challenges hinder ITN use, including inadequate ownership rates for ITNs and difficulty setting up nets at workplaces, particularly for those who work during night-time hours [ 12 , 13 , 18 , 19 ]. Incorrect beliefs regarding ITNs also contribute to low rates of usage, where some individuals rejecting ITN use to maintain privacy, in protect against cold weather, and in fear of potential allergies or other negative reactions to the insecticide in the nets [ 13 , 18 , 20 , 21 ].…”

“…The misconceptions at the bottom of these negative attitudes can significantly impact ITN utilisation. In addition, the individual characteristics of age, sex, and socioeconomic status have crucial roles to play in influencing the appropriate use of ITNs [ 12 , 19 , 22 ]. To address these challenges and enhance effective ITN use, interventions must be tailored to the specific needs of the target population.…”