Overview of Net Care & Repair

1. Overview of Net Care & Repair • Huge scale-up of LLIN distribution in Uganda. Need to sustain gains. • The recommended survival of LLINs in Uganda is 3 years. Nets however could be lasting less than 2 years. Implication – Huge costs to donorsand governments. • Modeling: if we increase the survival of nets from 2-4 years, then we would save ~$101 million in procurement costs. • Can human behavior improve LLIN survival? • Operations research - hypothesis - An intensive BCC campaign will be able to increase the proportion of existing LLIN that are defined as in good condition by at least 10 percentage points compared to those not exposed to the messages. • Serere district is the intervention site and Kaliro the control • Intervention will last 14 months. • There will be a baseline survey (Dec 2012), mid-term qualitative (March 2013), and endline survey (April 2013).

2. Net Care and Repair Behaviors • Household-level behaviors to protect the fabric and insecticide by preventing and fixing damage. • Causes of damage – rats, children, daily handling, over-washing • Care– folding up when not in use, washing sparingly, reinforcing areas prone to damage, careful handling, and keeping rats away. • Repair – inspecting for holes often, close holes with needle and thread, patch, knot, elastic or string, close holes immediately before they get bigger • Benefit: good night’s sleep, lower risk of malaria, a nice-looking net

3. Overview of Uganda Culture of Net Use Study A longitudinal, qualitative, mixed methods study • Phase 1 in Nebbi and Luwerodistricts* • Phase 2 in January, 2013 in two other districts • Phase 3- all four districts Phase 1 had: • 12 IDIs • 4 FGDs (both observed and reported behaviors) • 37 (observation) questionnaires on sleeping spaces *Limitation: not in Serere district

4. Phase I Results: Net Use and Access Knowledge of malaria prevention: nets commonly used and valued. Understand their protective effect against malaria. Barriers to net access: cost and lack of availability Barriers to net use- discomfort and seasonality- “saving” nets for use during periods of higher malaria transmission to prolong the life of the net - not used during funerals- people sleep outside and belief that one is showing off, not culturally acceptable Motivators to net use: health, comfort, economic- prevention cheaper than treatment

5. Phase I Results: Net Care and Repair Net Care: • A lot of confusion over proper washing • Belief that there is a need to retreat nets • 40% of nets were washed every week Net Repair: • Not very rich data –respondents may have few thoughts and feelings or experiences with it • Types of possible repairs mentioned were sewing, patching, tying knots • Materials readily accessible in the home • Out of 24 nets observed with holes, only 30% showed signs that they had ever been repaired.

6. Phase I Results: Other Topics • Re-purposing or end of life - People repurpose or consider a net unusable based on its condition. A net may be called “old” not due to its age but due to its condition. • Allocation - nets in best condition given to PW & CU5, occasionally elderly and middle-aged men (“bread winners”); nets in mediocre condition given to adolescents; nets in worst condition given to middle-aged men • Shape preferences varied- both conical and rectangular • Misconceptions on etiology- Understood that mosquitoes cause malaria but believe that dirty water, and dirty environment in combination with mosquitoes cause malaria

7. Recommendations for Care and Repair BCC • Clear instructions for washing • Discourage frequent washing • Retreatment not needed • Encourage repair • Discourage “saving” of nets and encourage year-round use • Emphasize multiple benefits of nets- health, comfort, economic (“prevention cheaper than treatment”) • Provide instructions on how to transform nets into desired shape (and to reinforce for areas weakened by transformations)