Decreased motivation in the use of insecticide-treated nets in a malaria endemic area in Burkina Faso.
BACKGROUND
The use of insecticide-treated nets (ITN) is an important tool in the Roll Back Malaria (RBM) strategy. For ITNs to be effective they need to be used correctly. Previous studies have shown that many factors, such as wealth, access to health care, education, ethnicity and gender, determine the ownership and use of ITNs. Some studies showed that free distribution and public awareness campaigns increased the rate of use. However, there have been no evaluations of the short- and long-term impact of such motivation campaigns. A study carried out in a malaria endemic area in south-western Burkina Faso indicated that this increased use declined after several months. The reasons were a combination of the community representation of malaria, the perception of the effectiveness and usefulness of ITNs and also the manner in which households are organized by day and by night.


METHODS
PermaNet 2.0 and Olyset were distributed in 455 compounds at the beginning of the rainy season. The community was educated on the effectiveness of nets in reducing malaria and on how to use them. To assess motivation, qualitative tools were used: one hundred people were interviewed, two hundred houses were observed directly and two houses were monitored monthly throughout one year.


RESULTS
The motivation for the use of bednets decreased after less than a year. Inhabitants' conception of malaria and the inconvenience of using bednets in small houses were the major reasons. Acceptance that ITNs were useful in reducing malaria was moderated by the fact that mosquitoes were considered to be only one of several factors which caused malaria. The appropriate and routine use of ITNs was adversely affected by the functional organization of the houses, which changed as between day and night. Bednets were not used when the perceived benefits of reduction in mosquito nuisance and of malaria were considered not to be worth the inconvenience of daily use.


CONCLUSIONS
In order to bridge the gap between possession and use of bednets, concerted efforts are required to change behaviour by providing accurate information, most particularly by convincing people that mosquitoes are the only source of malaria, whilst recognising that there are other diseases with similar symptoms, caused in other ways. The medical message must underline the seriousness of malaria and the presence of the malaria vector in the dry season as well as the wet, in order to encourage the use of bednets whenever transmission can occur. Communities would benefit from impregnated bednets and other vector control measures being better adapted to their homes, thus reducing the inconvenience of their use.
Toé
Léa Paré
LP
Institut de Recherche en Science de Santé/Centre Muraz, BP 390, Bobo-Dioulasso, Burkina Faso. lea_toe@yahoo.com
Skovmand
Olé
O
Dabiré
Kounbobr Roch
KR
Diabaté
Abdoulaye
A
Diallo
Yveline
Y
Guiguemdé
Tinga Robert
TR
Doannio
Julien Marie Christian
JM
Akogbeto
Martin
M
Baldet
Thierry
T
Gruénais
Marc-Eric
ME
D000293:Adolescent; D000328:Adult; D000818:Animals; D002050:Burkina Faso / Q000453:epidemiology; D019353:Endemic Diseases / Q000517:prevention & control; D005260:Female; D006801:Humans; D007306:Insecticides / Q000494:pharmacology*; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011482:Protective Devices / Q000706:statistics & numerical data*; D055815:Young Adult
D007306:Insecticides