A stitch in time: a cross-sectional survey looking at long lasting insecticide-treated bed net ownership, utilization and attrition in SNNPR, Ethiopia (Malaria Journal)

Background: Since 2002/03, an estimated 4.7 million nets have been distributed in the Southern Nations,Nationalities and Peoples Region (SNNPR) among an at risk population of approximately 10million people. Evidence from the region suggests that large-scale net ownership rapidlyincreased over a relatively short period of time. However, little is known about how coverageis being maintained given that the last mass distribution was in 2006/2007. This study soughtto determine the status of current net ownership, utilization and rate of long lastinginsecticide-treated nets (LLIN) loss in the previous three years in the context of planning forfuture net distribution to try to achieve sustainable universal coverage. Methods: A total of 750 household respondents were interviewed across malarious, rural kebeles ofSNNPR. Households were randomly selected following a two-stage cluster sampling designwhere kebeles were defined as clusters. Kebeles were chosen using proportional populationsampling (PPS), and 25 households within 30 kebeles randomly chosen. Results: Approximately 67.5% (95%CI: 64.1-70.8) of households currently owned at least one net.An estimated 31.0% (95%CI 27.9-34.4) of all nets owned in the previous three years hadbeen discarded by owners, the majority of whom considered the nets too torn, old or dirty(79.9%: 95%CI 75.8-84.0). Households reported that one-third of nets (33.7%) were lessthan one year old when they were discarded. The majority (58.8%) of currently owned netshad `good` structural integrity according to a proportionate Hole Index. Nearly two-thirds ofhouseholds (60.6%) reported using their nets the previous night. The overriding reason fornot using nets was that they were too torn (45.7%, 95% CI 39.1-50.7). Yet, few householdsare making repairs to their nets (3.7%, 95% CI: 2.4-5.1). Conclusions: Results suggest that the life span of nets may be shorter than previously thought, with littlemaintenance by their owners. With the global move towards malaria elimination it makessense to aim for sustained high coverage of LLINs. However, in the current economicclimate, it also makes sense to hark back to simple tools and messages on the importance ofcareful net maintenance, which could increase their lifespans.