title: A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania.
abstract: BACKGROUND
  The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence.
  
  
  METHODS
  Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM.
  
  
  RESULTS
  Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets.
  
  
  CONCLUSIONS
  Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms.
authors.affiliation: Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. netta.beer@gmail.com
authors.forename: Netta
authors.initials: N
authors.lastname: Beer
authors.forename: Abdullah S
authors.initials: AS
authors.lastname: Ali
authors.forename: Helena
authors.initials: H
authors.lastname: Eskilsson
authors.forename: Andreas
authors.initials: A
authors.lastname: Jansson
authors.forename: Faiza M
authors.initials: FM
authors.lastname: Abdul-Kadir
authors.forename: Guida
authors.initials: G
authors.lastname: Rotllant-Estelrich
authors.forename: Ali K
authors.initials: AK
authors.lastname: Abass
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Anders
authors.initials: A
authors.lastname: Björkman
authors.forename: Karin
authors.initials: K
authors.lastname: Källander
mesh_terms: D000328:Adult; D000368:Aged; D001512:Bedding and Linens / Q000706:statistics & numerical data*; D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D036301:Qualitative Research; D013636:Tanzania / Q000453:epidemiology