A new study from Zambia reports that despite mass distribution efforts towards achieving universal coverage only half the children in houses with nets slept under them the night before the survey. When the researchers checked for nets they discovered that, “… ITNs in poor condition are more likely to be observed hanging than ITNs in new or good condition.”
The proposed solution for this dilemma was, “In the context of free mass distribution of ITNs, behaviour change communication and activities are necessary to improve use. Results suggest campaigns and messages that persuade recipients to hang up their ITNs would contribute towards closing the gap between ownership and use.”
Coincidentally, another study set in several malaria-endemic countries examined the complaints that people often give when explaining why they do not use nets – ‘thermal discomfort’.
The researchers found that, “Bed nets reduce airflow, but have no influence on temperature and humidity. The discomfort associated with bed nets is likely to be most intolerable during the hottest and most humid period of the year, which frequently coincides with the peak of malaria vector densities and the force of pathogen transmission.”
Airflow is crucial because even a little breeze can make one feel cooler even if the temperature is not objectively different inside or outside the net. Not surprisingly denser mesh size reduced airflow even more.
These researchers took a different approach to solving the net use problem – instead of blaming the user, they suggested considering architectural issues like housing ventilation and net design issues that would increase airflow without jeopardizing protection against mosquitoes.
Sometimes it is the scientists, manufacturers and the program managers who need to change, not the community members.