title: Physical durability of PermaNet 2.0 long-lasting insecticidal nets over three to 32 months of use in Ethiopia.
abstract: BACKGROUND
  Ethiopia scaled up net distribution markedly starting in 2006. Information on expected net life under field conditions (physical durability and persistence of insecticidal activity) is needed to improve planning for net replacement. Standardization of physical durability assessment methods is lacking.
  
  
  METHODS
  Permanet®2.0 long-lasting insecticidal bed nets (LLINs), available for distribution in early 2007, were collected from households at three time intervals. The number, size and location of holes were recorded for 189 nets used for three to six months from nine sites (2007) and 220 nets used for 14 to 20 months from 11 sites (2008). In 2009, a "finger/fist" sizing method classified holes in 200 nets used for 26 to 32 months from ten sites into small (<2 cm), medium (> = 2 to < =10 cm) and large (>10 cm) sizes. A proportionate hole index based on both hole number and area was derived from these size classifications.
  
  
  RESULTS
  After three to six months, 54.5% (95% CI 47.1-61.7%) of 189 LLINs had at least one hole 0.5 cm (in the longest axis) or larger; mean holes per net was 4.4 (SD 8.4), median was 1.0 (Inter Quartile Range [IQR] 0-5) and median size was 1 cm (IQR 1-2). At 14 to 20 months, 85.5% (95% CI 80.1-89.8%) of 220 nets had at least one hole with mean 29.1 (SD 50.1) and median 12 (IQR 3-36.5) holes per net, and median size of 1 cm (IQR 1-2). At 26 to 32 months, 92.5% of 200 nets had at least one hole with a mean of 62.2 (SD 205.4) and median of 23 (IQR 6-55.5) holes per net. The mean hole index was 24.3, 169.1 and 352.8 at the three time periods respectively. Repairs were rarely observed. The majority of holes were in the lower half of the net walls. The proportion of nets in 'poor' condition (hole index >300) increased from 0% at three to six months to 30% at 26 to 32 months.
  
  
  CONCLUSIONS
  Net damage began quickly: more than half the nets had holes by three to six months of use, with 40% of holes being larger than 2 cm. Holes continued to accumulate until 92.5% of nets had holes by 26 to 32 months of use. An almost complete lack of repairs shows the need for promoting proper use of nets and repairs, to increase LLIN longevity. Using the hole index, almost one third of the nets were classed as unusable and ineffective after two and a half years of potential use.
authors.forename: Aprielle B
authors.initials: AB
authors.lastname: Wills
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Smith
authors.forename: Gedeon Y
authors.initials: GY
authors.lastname: Anshebo
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Graves
authors.forename: Tekola
authors.initials: T
authors.lastname: Endeshaw
authors.forename: Estifanos B
authors.initials: EB
authors.lastname: Shargie
authors.forename: Mesele
authors.initials: M
authors.lastname: Damte
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Aryc W
authors.initials: AW
authors.lastname: Mosher
authors.forename: Amy E
authors.initials: AE
authors.lastname: Patterson
authors.forename: Yohannes B
authors.initials: YB
authors.lastname: Tesema
authors.forename: Frank O
authors.initials: FO
authors.lastname: Richards
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
mesh_terms: D005002:Ethiopia; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control; D009032:Mosquito Control / Q000295:instrumentation*