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Solving the Challenge of Non-Use of Mosquito Nets Already in African Homes

In recognition of World Malaria Day, AED and Bayer Environmental Science jointly sponsored a workshop in Washington, DC on April 21. Participants included representatives from commercial companies, government agencies, and nongovernmental organizations discussed ways of increasing the use of long-lasting insecticide treated nets (LLINs), particularly in African households that are not using all the nets already in their homes.

Bayer“In recent years, governments and donors have done a tremendous job of getting LLINs into millions of African homes to prevent malaria,” said AED Vice President Dr. Will Shaw. “However, we have been discovering that many of these nets are not being used consistently or at all. Too many of these nets are still in their packages months later.”

An increasing number of studies in Africa indicate that 15% to 30% of households that own a net have at least one net that is not being used. The reasons given for non-use range from perceptions that a net was unnecessary when there were fewer mosquitoes, that malaria was not a serious illness, that the net was uncomfortable or no longer effective, and that is was hard to hang.

“No matter how many millions of nets we make available, we won’t maximize our impact on malaria until we convince African families to use these nets consistently during the malaria transmission season. This is a major problem we need to address immediately,” said Shaw. During the group discussion and small group exercises, the workshop participants noted that there is not a “one size fits all” solution that can be scaled up across countries. Different cultural dynamics, value systems, and personal perspectives require tailored approaches. The participants probed to identify the barriers to the use of nets in different contexts and why families would want to change their behavior.

“For thousands of years people did not sleep under bednets. The fact that so many people are now doing so shows that people are open to change if they believe that the change will benefit them and their families,” said facilitator Amnon Levav.

Levav introduced the 21 participants to a systematic methodology to stimulate inventive thinking and solutions. Participants began the process of identifying points in a chain of undesirable effects that if broken could help solve the problem of non-use of bednets. Ideas included producing multi-purpose nets, using nets to convey messages, and marketing an easy to assemble net that does not need to be hung and fits into rooms of different shapes. Participants also focused on messages that tap into values that motivate behavior change.

“Increasing use of bed nets requires inventive thinking. Bringing together people to apply various lenses to the problem and open themselves to new ways of thinking is a good first step, “ said Nadim Mohr of Bayer Environmental Science. Bayer will continue the discussion through workshops in Europe and Africa.

AED is one of the few organizations that has field tested approaches to increasing the use of nets in the household. In Ghana, AED designed and implemented an eight-week intervention that increased the use of nets among children under five and pregnant women by at least 23% and greatly increased demand for new LLINs. AED is disseminating the approach and results of the Ghana intervention through several publications and is looking for more opportunities to apply it in the field.

Posted May 2010

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