Abstract
BackgroundThe distribution of long-lasting insecticidal nets (LLINs) through universal coverage campaigns is a widely adopted approach for the prevention of malaria at scale. While post-distribution surveys play a valuable role in determining cross-sectional levels of LLIN retention and use, as well as frequently cited reasons for non-use, few studies have explored the consistency of LLIN use over time, within the expected lifespan of the net, and the factors which may drive this.MethodsIn this qualitative study, 74 in-depth interviews were conducted with (male) household heads and (female) caregivers of children in LLIN recipient households, as well as community health workers, in Buliisa, Hoima and Kiboga districts in Uganda, 25–29 months following a LLIN mass campaign distribution. A triangulation approach to data analysis was taken, incorporating thematic analysis, most significant change and positive deviance.ResultsThe factors found to be most influential in encouraging long-term LLIN use were positive experience of net use prior to the distribution, and appreciation or awareness of a range of benefits arising from their use, including protection from malaria as well as importantly, other health, lifestyle, social and economic benefits. Social support from within the community was also identified as an important factor in determining continued use of LLINs. Net use appeared to be more consistent amongst settled urban and rural communities, compared with fishing, pastoralist, refugee and immigrant communities.ConclusionsA multitude of interplaying factors encouraged consistent LLIN use in this setting. Whilst the protection of malaria remains a powerful motivator, social and behaviour change (SBC) strategies should also capitalize on the non-malaria benefits of net use that provide a long-term rationale for consistent use. Where supplies are available, SBC campaigns should promote replacement options, emphasizing ongoing net care and replacement as a household responsibility, thus reducing dependence on free distributions. The triangulation approach to qualitative data analysis enabled increased confidence in the validity of findings and an enhanced contextual understanding of the factors promoting consistent net use in mid-western Uganda. The approach should be considered when designing future studies to explore factors driving net retention and use trends.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1101-4) contains supplementary material, which is available to authorized users.
Highlights
The distribution of long-lasting insecticidal nets (LLINs) through universal coverage campaigns is a widely adopted approach for the prevention of malaria at scale
While such surveys can play a valuable role in determining cross-sectional levels of LLIN retention and use, and frequently cited reasons for non-use [9], few studies have explored the consistency of LLIN use over the longer term, relating to the field-level expected lifespan of the net (2–4 years [11,12,13]), and importantly the factors which may affect this
Cross-sectional quantitative surveys indicated that while net ownership and use initially increased, it trailed off over time; household ownership of at least one net rose from 22.2 % prior to the campaign to 91.6 % 7 months post-distribution, fell to 79.4 % 18 months post-distribution, and 62.2 % 36 months post distribution; and the proportion of children under five sleeping under an insecticide-treated nets (ITN) the previous night rose from 13.7 % at baseline to 68, 59.6 and 45.2 % respectively [Malaria Consortium, unpublished data]
Summary
The distribution of long-lasting insecticidal nets (LLINs) through universal coverage campaigns is a widely adopted approach for the prevention of malaria at scale. Qualitative evaluations have tended to remain sub-components of quantitative surveys [9] which are often conducted at specific time points post-distribution considered optimal for measuring net retention and use, such as within the first year following distribution and during the transmission season While such surveys can play a valuable role in determining cross-sectional levels of LLIN retention and use, and frequently cited reasons for non-use [9], few studies have explored the consistency of LLIN use over the longer term, relating to the field-level expected lifespan of the net (2–4 years [11,12,13]), and importantly the factors which may affect this. While some non-use of LLINs is, expected over time, such inquiry is valuable for informing ongoing effective social and behaviour change (SBC) strategies to promote consistent net use, as well as the design of appropriate follow-up LLIN supply strategies
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