Ifakara Health Institute, Dar-es-Salaam, Tanzania.
London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2018 Oct 22;17(1):375. doi: 10.1186/s12936-018-2528-6.
The rate of physical deterioration of long-lasting insecticidal nets (LLINs) varies by household practices, net brand and environment. One way to sustain the protection provided by LLINs against malaria is through day-to-day care, and repairing holes as and when they occur. To ensure LLIN coverage is high between mass campaigns and, as international donor funds decrease, personal responsibility to maintain nets in good condition is becoming more important. This study aimed to understand local barriers and motivators to net care and repair in southern Tanzania in a community that receives free LLINs through a school-based distribution mechanism.
Qualitative research methods were applied in a rural and peri-urban village in Ruangwa district. Focus group discussions (FGDs) were conducted for five groups of 8-12 participants; (1) key informants, (2) young men (18-24 years old), (3) women (> 18 years) with children under the age of five, (4) older men (> 25 years), and (5) older women with or without children (> 25 years). In each village, five men, five women with or without children, and five women with children under the age of five were recruited for in-depth interviews (IDIs). After each IDI and FGD with women with young children, participants were guided through a participatory activity. The study also counted the number and size of holes in nets currently used by IDI participants to determine their physical degradation status.
A general willingness to care and repair mosquito nets was observed in Ruangwa district for the love of a good night's sleep free of mosquito bites or noises. Net care was preferred over repair, especially among women who were the primary caretakers. The main motivation to look after nets was protection against mosquito bites and malaria. Washing nets occurred as frequently as every other week in some households to ensure cleanliness, which prevented other dirt-related problems such as sneezing and headaches. Barriers to net care included care not being a priority in the day-to-day activities and lack of net retreatment kits. Net repair was reported to be a temporary measure and necessary as soon as a hole was identified. However, during the net assessment and participatory activity, it became clear that people did not actually repair smaller holes. Protection against mosquitoes, malaria and cost saving from replacing nets were identified as motivators for net repair. Barriers to net repair included it not being a priority to repair holes that could be tucked under the mattress and lack of knowledge on when to repair nets.
In Ruangwa, net care was defined as overall net maintenance, such as cleanliness, and not directly associated with the prevention of damage as reported in other studies. Net repair was reported as a temporary measure before the acquisition of a new net, hence not a priority in a busy household. Inconsistencies were observed between reported intentions to repair mosquito nets and current net condition. Targeted education through health facilities and community change agents are potential means to overcome barriers to net care and repair.
长效杀虫蚊帐（LLINs）的物理退化率因家庭习惯、蚊帐品牌和环境而异。维持 LLINs 对疟疾的保护的一种方法是日常护理，并在出现孔时进行修补。为了确保在大规模运动之间保持高的 LLIN 覆盖率，随着国际捐助资金的减少，个人维护蚊帐良好状况的责任变得更加重要。本研究旨在了解坦桑尼亚南部一个社区中 LLIN 护理和修复的当地障碍和动机，该社区通过基于学校的分发机制免费获得 LLINs。
在鲁昂瓦区的一个农村和城市周边村庄应用定性研究方法。进行了五组 8-12 名参与者的焦点小组讨论（FGD）；（1）主要知情人，（2）18-24 岁的年轻男性，（3）有 5 岁以下儿童的妇女（>18 岁），（4）年龄较大的男性（>25 岁）和（5）有或没有孩子的年龄较大的妇女（>25 岁）。在每个村庄，招募了五名男性、五名有或没有孩子的妇女和五名有 5 岁以下儿童的妇女进行深入访谈（IDI）。在对有年幼子女的妇女进行每次 IDI 和 FGD 后，参与者都被引导参加一项参与性活动。该研究还统计了 IDI 参与者目前使用的蚊帐的孔数和大小，以确定其物理退化状况。
在鲁昂瓦地区，人们普遍愿意照顾和修复蚊帐，因为这样可以保证一夜好眠，免受蚊虫叮咬或噪音干扰。与修复相比，人们更喜欢照顾蚊帐，尤其是作为主要照顾者的妇女。照顾蚊帐的主要动机是防止蚊虫叮咬和疟疾。一些家庭每隔一周就会频繁地洗蚊帐，以确保清洁，防止其他与污垢有关的问题，如打喷嚏和头痛。照顾蚊帐不是日常活动的优先事项，缺乏蚊帐再处理包是照顾蚊帐的障碍。报告说，修复蚊帐只是一种临时措施，一旦发现孔就必须进行修复。然而，在蚊帐评估和参与性活动中，很明显人们实际上并没有修复较小的孔。防止蚊虫叮咬、疟疾和节省更换蚊帐的费用被确定为修复蚊帐的动机。修复蚊帐的障碍包括将无法塞在床垫下的小孔塞紧并不是当务之急，以及缺乏关于何时修复蚊帐的知识。
在鲁昂瓦，蚊帐护理被定义为整体蚊帐维护，例如清洁度，而不是像其他研究中那样直接与预防损坏有关。修复蚊帐被报告为在获得新蚊帐之前的临时措施，因此在繁忙的家庭中不是优先事项。报告的修复蚊帐的意图与当前蚊帐状况之间存在不一致。通过卫生设施和社区变革代理人进行有针对性的教育是克服蚊帐护理和修复障碍的潜在手段。
