Monitoring Net Use: Ensuring a Major Investment Pays Off

wmd2015logoJohn Orok, the Director of Akwa Ibom State’s Malaria Control Program in Nigeria, and colleagues have shared with us the follow-up survey results following a mass LLIN distribution campaign in his state in late 2014. Unless we monitor our investments in nets, we will not “Defeat Malaria.”

While long lasting insecticide-treated nets (LLINs) have made a major dent in the incidence of malaria in Africa, LLINs need to be replaced at intervals. Akwa Ibom State Ministry of Health (SMOH) conducted a mass net distribution in 2010 during which 1.8 million LLINs were handed out in the 31 Beneficiary hang her Net 2015local government areas (LGAs/Districts). An estimated 2.7 million nets were acquired with Global Fund support for replacement distribution in November and December 2014. In an effort to learn about the outcome of the exercise, the SMOH organized a follow-up household survey in all LGAs in January 2015.

The state formed a technical working group which developed a checklist and interview guide for to gather follow-up information on the number of households that acquired nets, hung the nets, slept under the nets, their reasons for not using nets and sources of information about nets. Interviewers were recruited for each LGA and trained to use the checklist and recognize appropriate net hanging and use. Twelve interviewers were assigned to each Ward of each LGA.

Who Sleeps Under LLINs in Akwa Ibom StateA total of 2,696,476 net cards were issued to households based on approximately two nets per household, and 2,626,966 nets (97.4%) were redeemed. Retention rate in the sampled households was 97.1%, while hanging rate of those retained was 71.8%%. Overall 69.6% household members reported that they slept under a net the previous night. A greater proportion of pregnant women (92.1%) reported using nets compared to children below 5 years of age (82.3%) and other household members (63.3%). Main reasons for not using nets included feeling hot (44.5%), inability to hang the net (19.7%) and concern about the chemical used to treat the net (11.4%).

Akwa Ibom is located in Nigeria’s highest malaria transmission zone, and hence there is need to use LLINs throughout the year. The contrast with 2013 DHS, where only 14.1% of residents overall slept under an LLIN, results is stark and implies that net use may likely decline as nets age beyond an ideal replacement schedule of every 2-3 years. Even 1-2 months out from a campaign there are people who are not hanging and using nets. Continuous systems for community level education and reinforcement and health system-based routine distribution for periods between campaigns are needed to ensure this major investment in controlling malaria pays off..

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