title: Impact of a behaviour change communication programme on net durability in eastern Uganda.
abstract: BACKGROUND
  The importance of net durability and the average useful life of a net is increasingly recognized as one of the critical factors that determine how often nets need to be replaced. A study to assess the effect of a net care and repair behaviour change communication (BCC) programme on net durability was conducted in one district in Eastern Uganda with a district in a neighbouring region serving as a comparison. Both districts had received LLINs in September of 2012.
  
  
  METHODS
  The intervention was comprised of radio programmes, school and community events. Two-stage cluster sampling household surveys to assess net condition, exposure to BCC messages, and attitudes towards net care and repair were conducted in both districts at baseline (2-3 months post net distribution) and endline (20-21 months post distribution). Net condition was assessed using the proportionate hole index, with nets being classified as either serviceable or too torn.
  
  
  RESULTS
  The intervention led to an additional 31.2 % increased exposure to net care and repair messages in the intervention district. Respondents in the intervention district had a more positive attitude towards net care and repair (32 % of respondents were classified as having a very positive attitude compared to 10 % in the comparison district), which was positively associated with the number of channels through which messages had been received (P < 0.001). Nets belonging to respondents with a very positive attitude were more often categorized as serviceable (80.2 %) compared to respondents with a poor/average attitude (66.4 %; odds ratio: 2.05, P = 0.028); however, this was only observed for the net brand with the greater physical integrity. Additionally, socio-economic status was a significant predictor of net condition. Although nets in the intervention district had significantly more repairs done per net, the act of repairing alone did not improve net condition.
  
  
  CONCLUSIONS
  In conclusion, the evaluation showed that the BCC programme resulted in improved knowledge and attitudes towards care and repair, which impacted positively on net condition. Repairs alone were not sufficient to improve net condition. Additional research on which care behaviours and attitudes are most associated with improved net condition would help BCC planners hone their campaigns.
authors.affiliation: Malaria Consortium, Kampala, Uganda. m.helinski@malariaconsortium.org.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Helinski
authors.affiliation: Malaria Consortium, Kampala, Uganda. g.namara@malariaconsortium.org.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Namara
authors.affiliation: Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.
authors.forename: Hannah
authors.initials: H
authors.lastname: Koenker
authors.affiliation: Tropical Health LLP, Montagut, Spain. albert@trophealth.com.|Malaria Consortium, London, UK. albert@trophealth.com.
authors.forename: Albert
authors.initials: A
authors.lastname: Kilian
authors.affiliation: Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. gabrielle.hunter@jhu.edu.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Hunter
authors.affiliation: Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. aacosta4@jhu.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Acosta
authors.affiliation: Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. leahscandurra@gmail.com.
authors.forename: Leah
authors.initials: L
authors.lastname: Scandurra
authors.affiliation: Malaria Consortium, Kampala, Uganda. atoselby@gmail.com.|Johns Hopkins University Center for Communication Programs, Nairobi, Kenya. atoselby@gmail.com.
authors.forename: Richmond Ato
authors.initials: RA
authors.lastname: Selby
authors.affiliation: Johns Hopkins University Center for Communication Programs, Kampala, Uganda. kmulondo@hotmail.com.|John Snow International, Kampala, Uganda. kmulondo@hotmail.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mulondo
authors.affiliation: United States Agency for International Development, Washington DC, USA. mfotheringham@usaid.gov.
authors.forename: Megan
authors.initials: M
authors.lastname: Fotheringham
authors.affiliation: Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. mlynch@jhu.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lynch
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D009549:Nigeria; D016896:Treatment Outcome