In starvation, a bone can also be meat”: a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania

Abstract

Background: Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribu tion. This study investigated the factors associated with the decision of users to discard LLINs. Methods: A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years), younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organi zation (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulflled the criteria, thus data from only 117 participants are analysed in this study. Results: In FGDs, integrity of LLIN infuenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The fndings were seen in the quantitative analysis. For every addi tional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR=1.05 (95%CI (1.04–1.07)), p<0.001]. Younger age group [OR=4.97 (95%CI (3.25–7.32)), p<0.001], male-headed households [OR=6.85 (95%CI (4.44 –10.59)), p<0.001], and wealthy households [OR=3.88 (95%CI (2.33–6.46)), p<0.001] were more likely to discard LLINs.