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Msangi SJ, Mponzi WP, Muyaga LL, Nkya JD, Mwalugelo YA, Msuya HM, Lwetoijera DW, Kaindoa EW. Challenges of proper disposal of old long-lasting insecticidal nets and its alternative uses in rural south-eastern Tanzania. PLoS One 2024; 19:e0279143. [PMID: 38358973 PMCID: PMC10868818 DOI: 10.1371/journal.pone.0279143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/05/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Insecticide-treated nets (ITNs), specifically long-lasting insecticidal nets (LLINs), are the most commonly used, scalable, and cost-effective tools for controlling malaria transmission in sub-Saharan Africa. However, the multiple alternative uses of retired LLINs have been associated with poor disposal practices. The World Health Organization (WHO) has provided guidelines and recommendations for the proper management of worn-out LLINs. This study assessed the existing alternative uses and disposal practices of old LLINs. METHODS An explanatory sequential mixed-methods approach was used to assess LLINs existing alternative uses, disposal practices, knowledge, and perceptions regarding WHO recommendations on proper disposal of old LLINs among stakeholders in Kilombero and Ulanga districts, south-eastern Tanzania. A survey questionnaire was administered to 384 participants. Furthermore, the study employed focus group discussions (FGD) and key informant interviews (KII) to elucidate responses regarding existing disposal practices, associated challenges, and alternative uses of LLINs. The insights derived from both study components were subsequently used for inferential analysis. RESULTS The major challenge influencing the proper disposal of LLINs was limited awareness of how to properly dispose of them. Of the 384 people surveyed, 97.0% were not aware of the WHO recommendations for the proper disposal of old LLINs. All key informants were unaware of the WHO guidelines for proper disposal of old LLINs. The common methods used to dispose of LLINs were burning (30.7%), disposing them into garbage pits (14.8%), and alternative uses (12.2%). Of the 239 respondents with LLINs, 41.0% had alternative use, while 59.0% had no alternative use. The common alternative uses were ropes for tying or covering items (20.9%), garden fencing (7.5%), chicken coops (5.0%), and 7.5% for other minor alternative uses. CONCLUSION Strengthening awareness and education on proper LLIN disposal practices among community members and key stakeholders is essential for enhancing malaria control efforts and preventing environmental pollution.
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Affiliation(s)
- Sheila J. Msangi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Life Sciences and Bio Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Winifrida P. Mponzi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Letus L. Muyaga
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Joel D. Nkya
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Yohana A. Mwalugelo
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- Department of Biomedical Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Hajirani M. Msuya
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Dickson W. Lwetoijera
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Life Sciences and Bio Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Emmanuel W. Kaindoa
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Life Sciences and Bio Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Faculty of Health Sciences, School of Pathology, National Institute for Communicable Diseases, University of the Witwatersrand and the Centre for Emerging Zoonotic and Parasitic Diseases, Johannesburg, South Africa
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Millat-Martínez P, Gabong R, Balanza N, Luana S, Sanz S, Raulo S, Elizah A, Wali C, Paivu B, Dalmas J, Tabie S, Karl S, Laman M, Pomat W, Mitjà O, Baro B, Bassat Q. Coverage, determinants of use and repurposing of long-lasting insecticidal nets two years after a mass distribution in Lihir Islands, Papua New Guinea: a cross-sectional study. Malar J 2021; 20:336. [PMID: 34348727 PMCID: PMC8336363 DOI: 10.1186/s12936-021-03867-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal coverage with long-lasting insecticidal nets (LLINs) is an essential component of malaria control programmes. Three-yearly mass distribution of LLINs in Papua New Guinea (PNG) has been successful in reducing infection transmission since 2009, but malaria prevalence ramped up from 2015 onwards. Although LLIN universal coverage is mostly achieved during these campaigns, it may not be related with net use over time. Uses given to LLINs and non-compliance of this strategy were evaluated. METHODS A knowledge, attitude and practice (KAP) cross-sectional study was conducted in Lihir Islands, PNG, 2-2.5 years after the last LLIN mass distribution campaign. Data on bed net ownership, use and maintenance behaviour was collected using a household questionnaire administered by trained community volunteers. Logistic regression models were used to identify factors associated with owning at least one LLIN and sleeping under a LLIN the previous night. RESULTS Among 2694 households surveyed, 27.4 % (95 % CI: 25.8-29.2) owned at least one LLIN and 8.7 % (95 % CI: 7.6-9.8) had an adequate LLIN coverage (at least one LLIN for every two people). Out of 13,595 individuals in the surveyed households, 13.6 % (95 % CI: 13.0--4.2) reported having slept under a LLIN the preceding night. Determinants for sleeping under LLIN included living in a household with adequate LLIN coverage [adjusted OR (aOR) = 5.82 (95 % CI: 3.23-10.49)], household heads knowledge about LLINs [aOR = 16.44 (95 % CI: 8.29-32.58)], and female gender [aOR = 1.92 (95 % CI: 1.53-2.40)] (all p-values < 0.001). LLIN use decreased with older age [aOR = 0.29 (95 % CI: 0.21-0.40) for ≥ 15 year-olds, aOR = 0.38 (95 % CI: 0.27-0.55) for 5-14 year-olds] compared to < 5 year-olds (p-value < 0.001). Knowledge on the use of LLIN was good in 37.0 % of the household heads. Repurposed nets were reported serving as fishing nets (30.4 %), fruits and seedlings protection (26.6 %), covering up food (19.0 %) and bed linen (11.5 %). CONCLUSIONS Two years after mass distribution, LLIN coverage and use in Lihir Islands is extremely low. Three yearly distribution campaigns may not suffice to maintain an acceptable LLIN coverage unless knowledge on maintenance and use is promoted trough educational campaigns.
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Affiliation(s)
- Pere Millat-Martínez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. .,Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea.
| | - Rebecca Gabong
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Núria Balanza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Sakaia Luana
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Sergi Sanz
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Basic Clinical Practice, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Raulo
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Arthur Elizah
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Chilaka Wali
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Benjamin Paivu
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Julian Dalmas
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Samson Tabie
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, Papua New Guinea
| | - Stephan Karl
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, Australia.,Papua New Guinea Institute of Medical Research, Goroka/Madang, Papua New Guinea
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka/Madang, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka/Madang, Papua New Guinea
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| | - Bàrbara Baro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020. Nat Commun 2021; 12:3589. [PMID: 34117240 PMCID: PMC8196080 DOI: 10.1038/s41467-021-23707-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/12/2021] [Indexed: 02/05/2023] Open
Abstract
Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published. Using data from multiple sources, we generate high-resolution maps of ITN access, use, and nets-per-capita annually from 2000 to 2020 across the 40 highest-burden African countries. Our findings support several existing hypotheses: that use is high among those with access, that nets are discarded more quickly than official policy presumes, and that effectively distributing nets grows more difficult as coverage increases. The primary driving factors behind these findings are most likely strong cultural and social messaging around the importance of net use, low physical net durability, and a mixture of inherent commodity distribution challenges and less-than-optimal net allocation policies, respectively. These results can inform both policy decisions and downstream malaria analyses.
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