title: Traditional nets interfere with the uptake of long-lasting insecticidal nets in the Peruvian Amazon: the relevance of net preference for achieving high coverage and use.
abstract: BACKGROUND
  While coverage of long-lasting insecticide-treated nets (LLIN) has steadily increased, a growing number of studies report gaps between net ownership and use. We conducted a mixed-methods social science study assessing the importance of net preference and use after Olyset® LLINs were distributed through a mass campaign in rural communities surrounding Iquitos, the capital city of the Amazonian region of Peru.
  
  
  METHODS
  The study was conducted in the catchment area of the Paujil and Cahuide Health Centres (San Juan district) between July 2007 and November 2008. During a first qualitative phase, participant observation and in-depth interviews collected information on key determinants for net preference and use. In a second quantitative phase, a survey among recently confirmed malaria patients evaluated the acceptability and use of both LLINs and traditional nets, and a case control study assessed the association between net preference/use and housing structure (open vs. closed houses).
  
  
  RESULTS
  A total of 10 communities were selected for the anthropological fieldwork and 228 households participated in the quantitative studies. In the study area, bed nets are considered part of the housing structure and are therefore required to fulfil specific architectural and social functions, such as providing privacy and shelter, which the newly distributed Olyset® LLINs ultimately did not. The LLINs' failure to meet these criteria could mainly be attributed to their large mesh size, transparency and perceived ineffectiveness to protect against mosquitoes and other insects, resulting in 63.3% of households not using any of the distributed LLINs. Notably, LLIN usage was significantly lower in houses with no interior or exterior walls (35.2%) than in those with walls (73.8%) (OR = 5.2, 95CI [2.2; 12.3], p<0.001).
  
  
  CONCLUSIONS
  Net preference can interfere with optimal LLIN use. In order to improve the number of effective days of LLIN protection per dollar spent, appropriate quantitative and qualitative methods for collecting information on net preference should be developed before any LLIN procurement decision is made.
authors.affiliation: Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. kpeeters@itg.be
authors.forename: Koen Peeters
authors.initials: KP
authors.lastname: Grietens
authors.forename: Joan
authors.initials: J
authors.lastname: Muela Ribera
authors.forename: Veronica
authors.initials: V
authors.lastname: Soto
authors.forename: Alex
authors.initials: A
authors.lastname: Tenorio
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoibak
authors.forename: Angel Rosas
authors.initials: AR
authors.lastname: Aguirre
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Toomer
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodriguez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Llanos Cuentas
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Dionicia
authors.initials: D
authors.lastname: Gamboa
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
mesh_terms: D001294:Attitude to Health; D002755:Choice Behavior; D002980:Climate; D005191:Family Characteristics; D006798:Housing; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000295:instrumentation* / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010568:Peru; D012424:Rural Population; D012621:Seasons; D011795:Surveys and Questionnaires