Population Preference of Net Texture prior to Bed Net Trial in Kala-Azar–Endemic Areas

Murari L Das,Shyam Sundar,Veerle Vanlerberghe,Marleen Boelaert,Suman Rijal,Shri P Singh,Prahlad Karki,Madhukar Rai

doi:10.1371/journal.pntd.0000100

Abstract

Prior to a community-based efficacy trial of long-lasting insecticidal nets (LLINs) in the prevention of visceral leishmaniasis (VL; also called kala-azar), a pilot study on preference of tools was held in endemic areas of India and Nepal in September 2005.LLINs made of polyester and polyethylene were distributed to 60 participants, who used the nets sequentially for 7 d. Acceptability and preference were evaluated via indirect indicators through questionnaires at three defined time points before and after use of the LLINs and through focus group discussions (FGDs). In the latter, preferences for color and size were also assessed. Untreated bed nets were owned by 87% of the households prior to the study. All users liked textures of both LLIN types after 7 d of use, but had a slight preference for those made of polyester if they were to recommend a LLIN to relatives or friends (p<0.05), mainly because of their relatively greater softness in comparison to polyethylene LLINs. Users reported that both net types reduced mosquito bites and number of insects, including sand fly (bhusana; genus Phlebotomus), inside the house. Side effects were minor and disappeared quickly.The large-scale intervention trial considered the preferences of the study population to decide on the best tool of intervention—light-blue, rectangular, polyester LLINs of different sizes.

Highlights

500,000 new cases of visceral leishmaniasis (VL, called kala-azar), with 59,000 deaths, are reported in 62 countries
long-lasting insecticidal nets (LLINs) are pretreated bed nets that do not need retreatment after washing and have insecticidal activity lasting for a number of years
More than 90% of the reported VL cases occur in the Sudan and the Indian subcontinent, where it is considered a problem of great public health importance

Summary

Introduction

500,000 new cases of visceral leishmaniasis (VL, called kala-azar), with 59,000 deaths, are reported in 62 countries. Insecticide-treated nets (ITNs) have shown their effectiveness in the prevention of malaria and cutaneous leishmaniasis [3,4,5,6]. To evaluate the efficacy of these tools on VL transmission, a large-scale randomized controlled community intervention trial implementing long-lasting insecticidal nets (LLINs) was planned in VL-endemic areas of India and Nepal. LLINs are pretreated bed nets that do not need retreatment after washing and have insecticidal activity lasting for a number of years. This pilot study was undertaken with the objective of assessing community preferences for size, color, and brand (texture) of net, which information was used in launching the large-scale community efficacy trial

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Results

Discussion

Conclusion