Household determinants of durability and use of insecticide treated nets in Tanzania

With increasing donor fatigue, it is crucial that the lifespan of existing insecticide-treated nets (ITNs) is maximized. Effectiveness and longevity (durability) of ITNs is enhanced by appropriate use and personal responsibility to maintain bednets in good condition. Factors associated with durability and overall maintenance are identified in order to reinforce current efforts to extend universal coverage of ITNs to its maximum potential. This study investigated the changes of net ownership, access and use within households over time and assessed how household members define and practice net care and repair activities. Data was collected through a mix of qualitative and quantitative research methods. First, a household survey was conducted to assess the status of mosquito net coverage in Tanzania, two years after the last mass campaign in 2011 to investigate how households adapt when nets are not continuously distributed. The households were given new ITNs to cover all sleeping spaces identified in the household. Twenty-two months post distribution, another household survey was conducted to determine 1) how households allocate nets to sleeping spaces in the face of diminishing access and/or as new nets arrive in households, and 2) the effect of the number of people sleeping under an ITN on net use and serviceability of ITNs. Through a mix of in-depth interviews, focus group discussions and participatory activities, local perceptions influencing net care and repair practices were also investigated. The average rate at which households in Tanzania lose nets was higher than the rate at which they receive nets. Study findings indicate that when ITNs are available, household members use them and sometimes more people sleep under the same ITN. A linear trend was observed that as the number of people under a net increased so was the level of damage. This insight on how household members adapt to changing population access to nets provides crucial information to policy makers supporting an increased frequency of keep-up campaigns and appropriate behavioural change campaign messaging. Qualitative findings indicated that net care was not directly associated with prevention of damage and net repair was performed as a temporary measure. Targeted health education through health facilities and community change agents were reported as potential means to overcome barriers to net care and repair.