Skip to main content

Table 3 Summary of key determinants of insecticide-treated wall lining acceptability, identified through qualitative community surveys

From: Insecticide-treated durable wall lining (ITWL): future prospects for control of malaria and other vector-borne diseases

Field site(s), country (sample size)

Intervention (insecticide)

Study duration

Key determinants of intervention acceptability

Supporting quotations

Additional observations

References

Huambo province, Angola (60); Enugu (60), Kano (57) and Lagos (61), Nigeria

Blue polyethylene woven shade cloth (ZeroVector®) (Deltamethrin)

12 months

Immediate entomological efficacy

‘The thing is picking insects the way I can’t explain. It’s picking them like a magnet. It was very very effective.’ (Female 18–29 years, rural Enugu)

ITWL was commended for being a single preventative measure which could alleviate the use of multiple strategies incorporated into daily routine

[52]

Aesthetic value

‘Since we have put that thing, it has beautified my house.’ (Female 18–29 years, rural Enugu)

Higher levels of acceptability in Nigeria may be attributable to overall greater awareness of malaria and preventative measures

Blue laminated polyethylene plastic sheeting (ZeroFly®) (Deltamethrin)

Angolan participants, despite reporting positive feedback, ultimately removed their ITPS once it was perceived as ineffectual

A dichotomy emerged between rural and urban householders; the latter rejected the use of wall linings based on objections to their aesthetics and installation feasibility

Blue polyester netting (Deltamethrin)

Of the three prototype materials, ZeroVector® was the most popular because of its ease of installation and resemblance to local materials

Río Muni, Equatorial Guinea (40), Obuasi municipality, Ghana (60), Koulikoro, Mali (24), Mpumalanga South Africa (12) and Hoa Binh province, Vietnam (12)

Blue polyethylene woven shade cloth (ZeroVector®) (Deltamethrin)

12–15 months

Immediate and sustained entomological efficacy

‘This fabric was very helpful because the mosquitoes have fled. The flies also leave us alone.’ (Mali, female)

Majority of participants expressed interest in keeping the ITWL for decoration even if it did not kill mosquitoes or other nuisance insects

[53]

Aesthetic value

‘The textile is very good because in addition to its insecticidal activity, it makes the room more beautiful.’ (Mali, female)

When offered the choice of other vector control interventions (IRS or insecticide-treated curtains), ITWL was the most popular, irrespective of earlier household allocation

Potential protection from malaria

‘Since the textile arrived I have not seen a case of malaria.’ (Mali, female)

Highland and lowland, Papua New Guinea (40)

Blue polyethylene woven shade cloth (ZeroVector®) (Deltamethrin)

1 month

Immediate and sustained entomological efficacy

‘The first day after [ITPS] a installation I saw mosquitoes flying into the house, contact the material and then just fall off and die. The cockroaches climbed up the [ITPS covered] wall and died instantly.’ (Lowlands village, male)

Participants appreciated the ITPS acting as additional building material, blocking holes in walls, reducing draughts, noise and dust entering the house

[57]

Potential protection from malaria

‘We do not want to be sick with malaria. If the kids are sick, we will struggle to walk a long way to go to the hospital. We do not want this to happen. This plastic sheeting will help protect us and our children from getting sick with malaria.’ (Lowlands village, male)

Many recipients ceased LLIN use, perceiving the ITPS to be sufficient and/or superior for protection

Aesthetic value

‘When I opened the door and went into the house it looked a lot different [following ITPS installation]. My house looked beautiful and was glowing.’ (Highlands urban, male)

It was difficult to establish ‘routine’ installation due to heterogeneous house size, shape and construction

Ownership prestige

‘One of my sisters came and saw the durable lining sheets and liked it and said she wished she could have got one like this too.’
(Islands village, female)

Householders raised concerns about the products flammability, fragility and possibility of theft by the installation team

Few observable side effects

‘I have a small child and I was worried that the insecticide on the durable lining sheet might have a bad effect on my child.’
(Islands village, female)

ITPS was exposed to smoke from internal, unventilated fires which may result in more rapid degradation, reduction in aesthetic appeal and impact insecticidal longevity and potency

Highland and lowland, Papua New Guinea (38)

Blue polyethylene woven shade cloth (ZeroVector®)

36 months

Immediate and sustained aesthetic value

‘Yes, initially it [the DL] looked very nice. It made the house look nice, but now that it is losing its colours or maybe the dust covered it so its colours are fading. But it’s still looking nice on the wall as it is.’ (Highlands urban, 36 months)

Despite reductions in perceived effectiveness over time, householders did not remove the material and most expressed interest in obtaining a new one

 

Despite reductions in perceived aesthetic value over time, householders still felt their home interior was enhanced. However, no participants expressed interest in installing a DL for appearance sake alone, suggesting perceived entomological effectiveness was important for initial and continued acceptability

(Deltamethrin)

Potential protection from malaria

‘For myself, when this thing [DL] was there I see that me or my family members had never been sick with malaria since this thing was installed. Not one of us was infected with malaria. This is why I like that thing.’ (Islands village, 36 months)

Householders from the cooler highland region suggested that the material warmed the house, which was considered a desirable function. This ‘warming’ benefit was not reported by those in the lowlands

[58]

Ease of use and perceived effectiveness compared to other malaria control methods

‘Previously we used to do the work of tying up nets and sleep and even in the night to wake up and tie up nets and now this green net is here, sorry blue net [DL], that we do not have the hard work of tying the nets. It’s [DL] on the wall helping us to kill mosquitoes so we just sleep relaxing’

(Highlands village, 36 months)

Many recipients reported ceasing LLIN use, perceiving the ITPS to be sufficient and/or superior for protection. Householders made no indication to suggest awareness that this reduction in net use might increase risk of malaria

‘[DL] is better than the mosquito net and the other thing is that I can breathe properly when I’m sleeping, but in the mosquito net I feel that I am breathing in all the medicine/treatment from the net. Now that we are using this [the DL], we don’t want to use the mosquito net, our nets are piling up there. I am ready to sell mine. We don’t really like mosquito nets. These nets [DL] are better than mosquito nets. For me and my families good I’m saying this.’ (Islands village, 12 months)

Few observable side effects compared to other malaria control methods

‘I don’t like using the mosquito net. Sometimes I have shortness of breath.’ (Islands village, 12 months)

Due to the type of housing material used in PNG, DL durability may be longer than average house lifespan, suggesting that effective duration would be largely determined by the age and condition of the house at the time of installation, rather than the product itself

Bioefficacy testing demonstrated no loss in insecticidal activity after 36 months indicating that participant perceptions of reduced product effectiveness are not necessarily synonymous with actual ineffectiveness

Limpopo province, South Africa (40)

Green, orange, brown, or purple polyethylene monofilament (deltamethrin or alpha-cypermethrin)

6 months

Immediate and sustained entomological efficacy

‘Net b helps a lot because there are not as many mosquitoes like before. Like nets for both rooms.’ (Female, age 28, house with green lining)

Majority of participants ceased using other methods to prevent malaria, including spraying insecticides and burning mosquito coils and other materials

[59]

‘The net is helping us because mosquitoes are not as many as before when there is no lining.’ (Female, age 73, hut with brown lining)

Householders disagreed over whether ITWL should cover the entire wall or only the top portion, out of reach of children and potential damage

Smoke damage and soot accumulation from cooking over open, unventilated fires was raised as an issue which might impact ITWL long-term aesthetic appeal and insecticidal efficacy

Aesthetic value

‘The net is too much good. It decorate my room and it kill mosquitoes and cockroaches.’ (Female, age 48, house with orange lining)

The ability to remove and re-install ITWL would overcome logistical problems associated with IRS in the area, namely the annual or bi-annual mud re-smearing, re-painting or washing of walls that occurs during the festive season

  1. DL durable lining, IRS indoor residual spraying, ITPS Insecticide-treated plastic sheeting, ITWL insecticide-treated durable wall lining, LLIN long-lasting insecticidal net
  2. aIn the study by Pulford et al. ITPS is used to refer to ZeroVector® ITWL, not to ZeroFly® ITPS
  3. bIn the study by Kruger et al. net is used to refer to the mesh ITWL, not to LLINs or other mosquito nets