Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 8, 315

Determining and Addressing Obstacles to the Effective Use of Long-Lasting Insecticide-Impregnated Nets in Rural Tanzania


Determining and Addressing Obstacles to the Effective Use of Long-Lasting Insecticide-Impregnated Nets in Rural Tanzania

Maria Widmar et al. Malar J.


Background: The objective of this project was to achieve high, sustainable levels of net coverage in a village in rural Tanzania by combining free distribution of long-lasting insecticide-impregnated nets (LLINs) with community-tailored education. In Tanzania, malaria is the leading cause of morbidity and mortality. Although malaria bed nets have a well-established role in reducing disease burden, few rural households have access to nets, and effective use depends on personal practices and attitudes.

Methods: Five practices and attitudes inconsistent with effective LLIN use were identified from household interviews (n = 10). A randomized survey of villagers (n = 132) verified local prevalence of these practices and attitudes. Community leaders held an educational session for two members of every household addressing these practice and attitudes, demonstrating proper LLIN use, and emphasizing behaviour modification. Attendees received one or two LLINs per household. Surveys distributed three weeks (n = 104) and 15 months (n = 104) post-intervention assessed corrected practices and attitudes. Project efficacy was defined by correction of baseline practices and attitudes as well as high rates of reported daily net use, with statistical significance determined by chi-square test.

Results: Baseline interviews and surveys revealed incorrect practices and attitudes regarding 1) use of nets in dry season, 2) need to retreat LLINs, 3) children napping under nets, 4) need to repair nets, and 5) net procurement as a priority, with 53- 88.6% incorrect responses (11.4-47% correct responses). A three-week follow-up demonstrated 83-95% correct responses. Fifteen-month follow-up showed statistically significant (p < 0.01) corrections from baseline in all five practice and attitudes (39.4-93.3% correct answers). 89.4% of respondents reported using their nets every night, and 93.3% affirmed purchase of nets as a financial priority.

Conclusions: Results suggest that addressing community-specific practices and attitudes prior to LLIN distribution promotes consistent and correct use, and helps change attitudes towards bed nets as a preventative health measure. Future LLIN distributions can learn from the paradigm established in this project.


Figure 1
Figure 1
Percent correct responses to surveys assessing community-specific practices and attitudes. This graph depicts percent correct responses to survey questions assessing attitudes and practices regarding proper malaria net use. "Post-Education" and 15-month follow-up survey results show significant increases in "correct" responses from baseline.

Similar articles

See all similar articles

Cited by 13 PubMed Central articles

See all "Cited by" articles


    1. USAID-CDC. President's Malaria Initiative. Tanzania Rapid Assessment. Tanzania: USAID-CDC; 2005.
    1. USAID. President's malaria initiative: FY 2007 Malaria Operational Plan (MOP) Tanzania. Tanzania: USAID. 2006.
    1. Global Partnership to Roll Back Malaria. Malaria & Children: Progress in Intervention Coverage. New York, NY: UNICEF; 2007.
    1. Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), Macro International Inc. Tanzania HIV/AIDS and Malaria Indicator Survey 2007-08. Dar es Salaam: National Bureau of Statistics; 2008.
    1. Malaney P, Spielman A, Sachs J. The malaria gap. Am J Trop Med Hyg. 2004;71:141–146. - PubMed

Publication types

LinkOut - more resources