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The Peruvian Ministry of Health has distributed insecticide-treated nets (ITNs) in the country’s Amazon region since 1999. Net use is nearly universal among mestizo communities in this area, but residents traditionally use non-impregnated muslin nets. We evaluated the cultural acceptability of Ministry ITNs using qualitative methods. Our results show that nets serve various functions for users: protection against insect bites, warmth, privacy, and a sense of security for young children. Because the Ministry-distributed ITNs could not fulfill these functions as well as traditional nets, many recipients disliked or rejected the ITNs they received. Also, because the ITN fabric stains rapidly, recipients washed their nets frequently rather than waiting 6 months as recommended. We propose a two-pronged approach that balances user and health system expectations of bed nets and that should lead to more widespread and effective ITN use in the study communities.
Received August 14, 2008. Accepted for publication August 16, 2008.
Acknowledgments: The authors thank the study participants in Loreto, Peru, who were generous with their time and patient with interviewers through the several rounds of interviews. Robert Gilman, Lilia Cabrera Rojo, Paula Maguiña, and others at A.B. PRISMA in Peru provided crucial support throughout this study as did the Loreto Regional Directorate of Health and the U.S. Naval Medical Research Center Detachment, Lima.
Financial support: Support for the research described here was provided by Proyecto Vigia, a joint MOH-USAID initiative, under USAID Grant 527-G-00-01-00007-00.
Disclosure: The project, titled "Socio-Anthropological Factors that Affect Malaria Prevention in Selected Areas of the Province of Maynas, Department of Loreto, Peru," was a joint effort by the Johns Hopkins Bloomberg School of Public Health (JHSPH) and the DISA Loreto.
* Address correspondence to Peter J. Winch, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E5030, 615 North Wolfe Street, Baltimore, MD 21205-2103. E-mail: pwinch{at}jhsph.edu
Authors’ addresses: Steven A. Harvey, URC-CHS, 7200 Wisconsin Ave, Suite 600, Bethesda, MD 20901, Tel: 301-941-8441. Maribel Paredes Olórtegui, Global Disease Control and Prevention Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room W5515, 615 N. Wolfe St., Baltimore, MD 21205-2103, Tel: 410-614-3959. Elli Leontsini, Social Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E5034, 615 N. Wolfe St., Baltimore, MD 21205-2103, Tel: 410-502-6733. Clara Bustamante and Luz Marina Olóregui, Dirección Regional de Salud de Loreto, Av. 28 de Julio s/n, La Punchana, Iquitos, Peru. Peter J. Winch, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E5030, 615 North Wolfe Street, Baltimore, MD 21205-2103, Tel: 410-955-9854, Fax: 410-502-6733, E-mail: pwinch{at}jhsph.edu.
Reprint requests: Peter J. Winch, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E5030, 615 North Wolfe Street, Baltimore, MD 21205-2103, Tel: 410-955-9854, Fax: 410-502-6733, E-mail: pwinch{at}jhsph.edu.
* Many people kill insects that get inside a bed net by burning them with a cigarette, a match, or a mechero flame. As one informant explained, "When you want to burn a mosquito that’s landed on the net, you wind up burning the fabric. A cigar would put a hole in the net, melt it."
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