Addressing the gap between net ownership and use: Lessons from the culture of net use study

Mass distribution of long-lasting insecticidal nets (LLINs) is used as a key strategy for malaria prevention. By rapidly distributing free nets to communities, countries can reach levels of LLIN coverage needed to reduce transmission. However, it is the consistent and effective use of these nets that is essential for malaria control. The Culture of Net Use (CONU) study in Senegal is a longitudinal, multiple method study that aims to understand the context of net use, including barriers and facilitators of consistent use. During the first phase of data collection, 24 extended family compounds in four regions were sampled. While questionnaire data showed a majority of hanging nets were used the previous night, barriers to use were largely related to user discomfort. One of the most salient barriers was concern about the insecticide and of associated side effects including rashes, itching, and feelings of suffocation. Others mentioned heat as a barrier or explained their seasonal use of nets. Other possible barriers included preferences for certain net shapes based on the location and other daytime uses of the sleeping area. The distinction between a free net and a purchased net also surfaced as a factor influencing net use. Respondents preferred nets purchased from the pharmacy over those distributed free, citing durability and preferred dose of insecticide (both higher and lower) in purchased nets. Understanding barriers to net use and implementing targeted behavior change communication messaging is critical to building a consistent and effective net use culture towards achieving malaria elimination in Senegal.