Households' role in mosquito bed net maintenance: Key behaviors, barriers and motivators, and implications for malaria prevention

In the context of decreasing funding for malaria control, maintaining nets' integrity is increasingly important. Modeling has shown that an extension of the average useful life of nets would create massive savings. Household behaviors such as washing and mending can extend the life of nets, but there is little data on their prevalence and related barriers and motivators. The NetWorks Project is evaluating a behavior change communication campaign that uses community, radio, and school activities to promote net care and repair in one district in Eastern Uganda with a second district as a control site. Messages will focus on repairing holes, tying up nets when not in use, and proper washing. Messages are informed by a 2012 representative baseline survey with 884 households which showed that, out of 1,429 nets assessed for physical damage three months after distribution, though 95% were in good condition, 12% of nets had holes, and only 5% of those nets showed signs of repair. Though 58% of nets had ever been washed, 14% were washed more than twice, suggesting that some nets are being over-washed. A 2014 survey will assess the intervention's impact on net integrity. We will present results from a mid-line qualitative assessment which uses in-depth interviews and observations with 30 households across both districts to understand how the program has affected net users' perceptions and practices. Results will focus on exposure to the campaign, perceptions of nets in varying conditions, and the uptake, feasibility, and acceptability of care and repair behaviors.