Abstract
BackgroundWhile some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net.MethodsThe study used an intervention-control design with before-after assessment through repeated cross-sectional household surveys with two-stage cluster sampling following Nasarawa State’s December 2010 mass campaign. All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN). Baseline, midline, and endline surveys occurred at one-year intervals, in March 2012, March 2013, and April 2014, respectively. Outcome measures were the proportion of confirmed campaign nets with observed repairs, and the proportion in serviceable condition, measured with proportionate hole index (pHI) and according to WHO guidelines.ResultsFor all respondents, exposure to BCC messages was strongly correlated with increased positive attitude towards care and repair, and increases in attitude were positively correlated with observed net repairs, and with the proportion of nets in serviceable condition. In a multivariate regression model, positive care and repair attitude (OR 6.17 p = 0.001) and level of exposure (1 source: OR 4.00 p = 0.000; 3 sources: OR 9.34 p = 0.000) remained the most significant predictors of net condition, controlling for background and environmental factors. Nets that were tied up had 2.70 higher odds of being in serviceable condition (p = 0.001), while repairs made to nets were not sufficient to improve their pHI category. Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.ConclusionExposure to multiple channels of a comprehensive BCC intervention was associated with improved attitude scores, and with improved net condition at endline. It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan. Care and repair messages are easily incorporated into existing malaria BCC platforms, and will help contribute to improved net condition, providing, in principle, more protection from malaria.
Highlights
While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net
While a 2006 case study describes a behavioural change communication (BCC) intervention and its effect on prevalence of repairs to nets [15], no data at all are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether BCC could significantly impact on median net lifespan
Household characteristics At baseline and at endline the two Local Government Area (LGA) were similar in household size, number of children under five years old, household head level of education, radio and TV ownership, and ownership and population access of long-lasting insecticidal nets (LLIN) (Table 2)
Summary
While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net. As many countries have achieved high ownership coverage with LLIN and are approaching the universal coverage target of one net for every two people of the population at risk as recommended by WHO, the question of how these successes can be sustained, i.e., high coverage levels be maintained, becomes the focus of discussion In this context the importance of net durability and the ‘average useful life’ of a net is increasingly recognized as one of the critical factors that determines the frequency at which nets need to be replaced. While a 2006 case study describes a behavioural change communication (BCC) intervention and its effect on prevalence of repairs to nets [15], no data at all are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether BCC could significantly impact on median net lifespan
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