Mixed method study to evaluate factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania

Abstract

Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs)were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are generally discarded 2 years post-distribution. This study investigated the factors associated with the decision of users to discard LLINs. A mixed-methods sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) was used to collect information on experiences, views, reasons, how and when LLINs are discarded as well as gather knowledge on net care and repair from the participants. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8-10 adults were conducted; older women (40–60 years), older men (40-60 years), younger women (18-39 years), and younger men (18-39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on the proportionate hole Index (PHI) recommended by the World Health Organization guidelines on LLIN testing, the nets were brought to the discussion, and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analyzed in this study. In FGDs, the Physical condition of LLIN influenced the decision to discard or keep a net. Those of older age, women and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR=1.05 (95%CI (1.04 – 1.07)), p<0.001]. Younger age group [OR=4.97 (95%CI (3.25 – 7.32)), p<0.001], male-headed households [OR=6.85 (95%CI (4.44 –10.59)), p<0.001], and wealthy households [OR=3.88 (95%CI (2.33 – 6.46)), p<0.001] were more likely to discard LLINs: Physical condition of LLINs was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with the socioeconomic status of the household, and the age and gender of respondents. WHO “too torn” nets are encouraged to be used instead of none until replaced, and disposal of nets should be based on recommendation.