Determinants for Exposure to Mosquitoes and Bed Net Use Behavior in the Context of the New Nets Project In Rwanda

Abstract

AbstractBackground: The effectiveness of any insecticide-treated mosquito net (ITN) or long-lasting insecticidal net (LLIN) is greatly influenced by the consistency of its use. Insights from user perspectives are crucial for monitoring and informing implementation strategies, including effective marketing and educational campaigns focused on using nets to reduce malaria transmission. Using qualitative data from Rwanda, this study seeks to understand how daily activities are related to risk of malaria transmission as well as understand facilitators and barriers to effective LLIN usage. Methods: Research Assistants conducted 18 key informant interviews (KIIs) and three focus group discussions (FGDs) with a total of 46 participants. KIIs and FGDs used semi-structured interview guides that covered topics related to activities that participants engaged in at various times of the day, knowledge of malaria treatment and prevention, beliefs around which types of people are more likely to get malaria, direct experience with malaria, and bed net acquisition and use. KIIs and FGDs were conducted in Kinyarwanda, and audio recorded. The research team used NVivo 1.3.1 to code transcripts. Results: Participants reported engaging in routine activities which put them at risk for malaria during times when Anopheles mosquitoes were more likely to bite, such as leaving early in the morning to work in the hills, preparing dinner in the evening, coming home from the market late, working as night security guards, fetching water, going out to bars or visiting friends. Study participants were well aware that mosquitoes caused malaria, knew about or had directly experienced malaria symptoms, and knew why and how to use a bed net. The biggest barrier to using a net was lack of access. Other common reasons for not using a net include physical discomfort or concerns with the net chemicals, logistical challenges of hanging the net, or engaging in routine work or social activities during mosquito biting times. Conclusions: The largest barrier to net use was lack of access to one, which could be remedied by allowing all socioeconomic groups to be eligible to receive a net, and to ensure that there is one net distributed per sleeping space. Government distributions of nets should include both conical and rectangular nets as options to reduce logistical barriers of hanging a net. Results from this study could assist the National Malaria Control Program in Rwanda and to improve the impact of its bed net program.