Table 2 Current challenges to using insecticide-treated bed nets as reported in community-forums
Key themes | Sub-themes | Focus groups reporting theme | Representative quote |
|---|---|---|---|
Access | Distance | H2, H3, L10 | “The health clinic is far from the community members, up to 7 km, therefore going to buy a net is far and it leads to impulse buying of other items needed.” H3 |
Cost | H1, H2, H3, H5, L9 | “Once distributed to the people on warranty no chances of getting replacement unless you dig deep into your pockets.” L9 | |
Age-restrictions | H1, H2, H3, H4, H5, H6, L10 | “There are problems getting a bed net because they are only given at the health facility on the condition that they belong to pregnant women and children under 5 years” H5 | |
Stock-outs | H1, H3, L7 | “The greatest problem is that statistics taken for bed net supply doesn’t correspond to the actual nets brought for distribution hence most people don’t get the bed nets.” L7 | |
Replacement | H1, H6 | “In some region the bed nets are sold and others given freely.it therefore kill the morale of others to acquire the nets.” H6 | |
Effectiveness | Wears out too soon | H1, H2, H4, H5, L7, L8, L9, L10 | “After the washing of the nets the effectiveness of the mosquito repellant fade away and that make it not effective.” L7 |
Difficult to maintain/damage easily | H1, H2, H3, H6 | “Most nets get burned with tin lamps creating a hole making the net not effective to use” H3 | |
Quality of distributed nets | H2, L8, L9 | “Some of the nets have less effective chemical repellent since they are not retreated and are [ineffective] even though not in bad condition” L9 | |
Side effects | Suffocation | H2, L7, L8, L10 | “It also suffocates small children and leads to difficulty in breathing.” L7 |
Heat | H4, L8, L10 | “We don’t always use a bed net because during the dry spell season it is hot and people do not use the bed net.” H4 | |
Rash/allergy | H1, H2, H3, H4, H5, H6, L7, L8, L9, L10 | “Once one gets into contact with the net which the repellant is still strong, the skin rashes are developed causing discomfort to the skin.” L7 | |
Family planning | H2 | “The belief that the chemical in the bed net is for family planning [keeps them from using it]” H2 | |
Bad dreams | H4 | “Sleeping under a bed net gives one to dream bad dreams.” H4 | |
Lack of knowledge | Don’t understand transmission or importance of using bed net | H1, H2, H4, H6 | “[In our] culture [we] believe that we used to sleep without nets why use it now?” H2 |
Not aware of how to maintain bed net | H1, H2, H3, H4, H6, L7, L8 | “Those who distributed them never taught us how to use them.” L8 | |
Use for other purposes | H1, H2, H4, H5, H6 | “A bed net is a multi-purpose item. Some use it for decoration and curtains, fishing, rope to tie animals.” H4 | |
Logistical/convenience | Hanging | H1, H2, H3, H4, H5, H6, L7, L8, L9, L10 | “Hanging a bed net is a problem especially one without a ring. It is difficult because at night when you are tired you simply sleep.” L10 |
Not attractive | H1, H2 | “Some people are attractive to certain colours when a bed net is dull they don’t go for it.” H1 | |
Difficult to keep clean | L8, L10 | “They become dirty very easily and they are difficult to [re]hang” L10 | |
Sleeping space too small | H1, L8 | “Squared bed net consume space therefore some rooms are not enough.” H1 | |
Believe only for use with bed | H3, H4 | “Some believe that bed net is used only on bed net on sleeping on the floor.” H3 |