Exploratory assessment of alternative use of bed nets within the Arisi zone in Ethiopia: Findings from household interviews and observations

Background: Distribution of long lasting insecticide-treated nets (LLINs) is one of four malaria prevention interventions being scaled up in sub-Saharan Africa. Correct and consistent use of LLINs by households is central to the success of such interventions. Use of ITNs for purposes other than sleeping is often described anecdotally, but almost no studies have examined alternative use systematically.

Purpose: The objectives were to determine the prevalence of alternative use of bed nets, and to provide recommendations for designing related communication activities.

Methods: Interviews and observations were conducted in 138 intervention and 140 comparison households, with the help of the female head of household. LLIN distribution was accompanied by Social and Behavior Change Communication activities within the past two years in the intervention but not comparison area. Two-stage cluster sampling was used to select communities and households.

Results: Alternative use was higher in comparison than in intervention communities. Alternative uses included ways likely to provide some protection against malaria (as bedding, curtains) and ways unlikely to provide any protection (as rope, to cover grain). A higher proportion of protective alternative uses was observed in the comparison group. Nets were used correctly in more than twice as many intervention as comparison households.

Discussion: The results suggest that intervention efforts are positively influencing alternative and correct use. Further refining existing communication strategies is recommended for ongoing SBCC programs with low to moderate alternative use. Examining the prevalence and determinants of correct use, non-use and alternative use is essential for all programs.