Abstract:
Background: Malaria remains a major public health problem in Ethiopia. The use of LLINs is an effective approach
to reducing transmission. Persistent use of LLINs is determined by numerous factors. Quantitative studies have
assessed LLIN ownership and utilization, but the behavioral, socio-cultural, socioeconomic and net distribution
contexts that impact their use have not been examined in depth. This study aimed to explore barriers of persistent
LLIN use among communities around Lake Tana.
Methods: Twenty-three community residents who owned LLINs (15) or not (8) during the study period and 38 key
informants were interviewed from April to June 2017. Phenomenological study was employed to explore the local
contexts and factors that influence persistent use of LLINs. Individuals were purposefully selected to capture
different views. Community residents were selected based on their permanent residence and LLIN use experience.
Key informants were health extension workers, local leaders, students, and health professionals. The data were
managed using QSR International NVivo Version 10 software and coded, and themes were identified.
Results: Killing ability of nets against arthropods other than mosquitoes reportedly made use of LLINs a favored
malaria prevention method despite their ineffectiveness after 3 months. Conical nets were preferred due to their
compatibility with varied sleeping structures. Numerous factors influenced persistent use, notably erroneous
perceptions about LLINs, malaria and mosquitoes; bedbug infestation; inconvenience; unintended uses; distribution
problem of nets; and socio-cultural and economic factors. Unintended uses were often associated with local needs
and seldom linked with social issues and deficiencies in information about malaria and LLINs. Collateral benefits
were considered important, principally in terms of disinfestation of bedbugs.
Conclusions: Non-persistent LLIN use was associated with inconvenient bed net design and early damage; nonpotency
of the insecticide against other arthropods; facilitation of bedbug infestation; unintended uses; wrong
perceptions about malaria, mosquitoes, and LLINs; and inadequate follow-up regarding LLINs utilization. Distribution
of conical nets and provision of adequate information on LLINs and malaria may promote persistent use. Using an
insecticide that also kills arthropods other than mosquitoes may reduce unintended uses and increase persistent use.
Keywords: Malaria, Mosquitoes, LLINs, In-depth interviews, Conical nets, Bedbug infestation
