Volume 88, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Long-lasting insecticidal net (LLIN) use is a proven malaria prevention method. Mass distribution has greatly expanded LLIN access in sub-Saharan Africa, but a gap remains between LLIN ownership and use. Furthermore, LLINs wear out more quickly than anticipated. This paper suggests a participatory research strategy—trials of improved practices (TIPs)—that could identify locally appropriate approaches to prolonging net life and increasing effective use. We used TIPs to overcome barriers to optimal net use in the Peruvian Amazon. Working with 15 families in three villages, we tested home treatment of cotton nets, use of an alternative netting fabric, and alternative washing and care instructions. TIPs helped confirm feasibility of these interventions. Although our findings are time- and context-specific, TIPs could help improve consistency and effectiveness of current LLIN use and prolong net lifespan in sub-Saharan Africa and elsewhere. This would help maximize the value of shrinking donor resources for malaria.


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  1. Lengeler C, , 2004. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev 2: CD000363. [Google Scholar]
  2. Alonso PL, Lindsay SW, Armstrong JRM, de Francisco A, Shenton FC, Greenwood BM, Conteh M, Cham K, Hill AG, David PH, Fegan G, Hall AJ, , 1991. The effect of insecticide-treated bed nets on mortality of Gambian children. Lancet 337: 14991502.[Crossref] [Google Scholar]
  3. Binka FN, Kubaje A, Adjuik M, Williams LA, Lengeler C, Maude GH, Armah GE, Kajihara B, Adiamah JH, Smith PG, , 1996. Impact of permethrin impregnated bednets on child mortality in Kassena-Nankana district, Ghana: a randomized controlled trial. Trop Med Int Health 1: 147154.[Crossref] [Google Scholar]
  4. D'Alessandro U, Olaleye B, McGuire W, Langerock P, Bennett S, Aikins M, Thomson M, Cham M, Greenwood B, , 1995. Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 345: 479483.[Crossref] [Google Scholar]
  5. Guerin PJ, Olliaro P, Nosten F, Druilhe P, Laxminarayan R, Binka F, Kilama WL, Ford N, White NJ, , 2002. Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development. Lancet Infect Dis 2: 564573.[Crossref] [Google Scholar]
  6. Nevill CG, Some ES, Mung'ala VO, Mutemi W, New L, Marsh K, Lengeler C, Snow RW, , 1996. Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Health 1: 139146.[Crossref] [Google Scholar]
  7. Phillips-Howard PA, Nahlen BL, Kolczak MS, Hightower AW, ter Kuile FO, Alaii JA, Gimnig JE, Arudo J, Vulule JM, Odhacha A, Kachur SP, Schoute E, Rosen DH, Sexton JD, Oloo AJ, Hawley WA, , 2003. Efficacy of permethrin-treated bed nets in the prevention of mortality in young children in an area of high perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68: 2329. [Google Scholar]
  8. World Health Organization, 2011. World Malaria Report 2011. Geneva: WHO Global Malaria Programme. [Google Scholar]
  9. Tobin-West CI, Alex-Hart BA, , 2011. Insecticide-treated bednet ownership and utilization in Rivers State, Nigeria before a state-wide net distribution campaign. J Vector Borne Dis 48: 133137. [Google Scholar]
  10. Githinji S, Herbst S, Kistemann T, Noor AM, , 2010. Mosquito nets in a rural area of western Kenya: ownership, use and quality. Malar J 9: 250.[Crossref] [Google Scholar]
  11. Pulford J, Hetzel MW, Bryant M, Siba PM, Mueller I, , 2011. Reported reasons for not using a mosquito net when one is available: a review of the published literature. Malar J 10: 83.[Crossref] [Google Scholar]
  12. Chuma J, Okungu V, Ntwiga J, Molyneux C, , 2010. Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya. BMC Public Health 10: 137.[Crossref] [Google Scholar]
  13. Seidel R, , 2005. Behavior Change Perspectives and Communication Guidelines in Six Child Survival Interventions. Washington, DC: Academy for Educational Development and the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs. [Google Scholar]
  14. BASF Chemical Company, 2012. Interceptor Long-Lasting Insecticidal Net Brochure. Available at: http://www.publichealth.basf.com/pv_obj_cache/pv_obj_id_C792E746D5305416EDD3F50362CF6FF0AF701E00/filename/165261_Interceptor_Brochure_Ansicht_06.pdf. Accessed September 21, 2012. [Google Scholar]
  15. BestNet, 2012. NetProtect. Available at: http://www.bestneteurope.com/Netprotect%C2%AE/Netprotect-2.aspx. Accessed September 21, 2012. [Google Scholar]
  16. Sumitomo Chemical Co., Ltd., 2012. OlysetPlus. Available at: http://www.olyset.net/pdf/Olyset_Plus_Technical_Brochure_ENG.pdf. Accessed September 21, 2012. [Google Scholar]
  17. Vestergaard Frandsen, 2012. PermaNet 3.0 Brochure. Available at: http://www.vestergaard-frandsen.com/component/docman/cat_view/51-product-brochures/61-permanetr/63-permanetr-30?orderby=dmdate_published&ascdesc=DESC. Accessed September 21, 2012. [Google Scholar]
  18. Kilian A, Byamukama W, Pigeon O, Atieli F, Duchon S, Phan C, , 2008. Long-term field performance of a polyester-based long-lasting insecticidal mosquito net in rural Uganda. Malar J 7: 49.[Crossref] [Google Scholar]
  19. Allan R, O'Reilly L, Gilbos V, Kilian A, , 2012. An observational study of material durability of three World Health Organization-recommended long-lasting insecticidal nets in eastern Chad. Am J Trop Med Hyg 87: 407411.[Crossref] [Google Scholar]
  20. Kweka E, Himeidan Y, Mahande A, Mwang'onde B, Msangi S, Mahande M, Mazigo H, Nyindo M, , 2011. Durability associated efficacy of long-lasting insecticidal nets after five years of household use. Parasit Vectors 4: 156.[Crossref] [Google Scholar]
  21. Atieli FK, Munga SO, Ofulla AV, Vulule JM, , 2010. Wash durability and optimal drying regimen of four brands of long-lasting insecticide-treated nets after repeated washing under tropical conditions. Malar J 9: 248.[Crossref] [Google Scholar]
  22. Atieli FK, Munga SO, Ofulla AV, Vulule JM, , 2010. The effect of repeated washing of long-lasting insecticide-treated nets (LLINs) on the feeding success and survival rates of Anopheles gambiae . Malar J 9: 304.[Crossref] [Google Scholar]
  23. Pigott DM, Atun R, Moyes CL, Hay SI, Gething PW, , 2012. Funding for malaria control 2006–2010: a comprehensive global assessment. Malar J 11: 246.[Crossref] [Google Scholar]
  24. Leach-Kemon K, Chou DP, Schneider MT, Tardif A, Dieleman JL, Brooks BP, Hanlon M, Murray CJ, , 2012. The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. Health Aff 31: 228235.[Crossref] [Google Scholar]
  25. Dickin K, Griffiths M, Piwoz E, , 1997. Prepared for the Health and Human Resources Analysis (HHRAA) Project. Washington, DC: The Manoff Group and the Academy for Educational Development. Available at: http://www.manoffgroup.com/resources/Designing%20by%20Dialogue.pdf. Accessed March 16, 2013. [Google Scholar]
  26. The Manoff Group, 2005. Trials of Improved Practices (TIPs): Giving Participants a Voice in Program Design. Washington, DC: The Manoff Group. [Google Scholar]
  27. Creed de Kanashiro H, Fukumoto M, Bentley M, Jacoby E, Verzosa C, Brown K, , 1991. Use of recipe trials and anthropological techniques to create a home made weaning food in the central Peruvian highlands. J Nutr Educ 23: 3035.[Crossref] [Google Scholar]
  28. Haider R, Rasheed S, Sanghvi TG, Hassan N, Pachon H, Islam S, Jalal CS, , 2010. Breastfeeding in infancy: identifying the program-relevant issues in Bangladesh. Int Breastfeed J 5: 21.[Crossref] [Google Scholar]
  29. Rasheed S, Haider R, Hassan N, Pachon H, Islam S, Jalal CS, Sanghvi TG, , 2011. Why does nutrition deteriorate rapidly among children under 2 years of age? Using qualitative methods to understand community perspectives on complementary feeding practices in Bangladesh. Food Nutr Bull 32: 192200.[Crossref] [Google Scholar]
  30. Paul KH, Dickin KL, Ali NS, Monterrosa EC, Stoltzfus RJ, , 2008. Soy- and rice-based processed complementary food increases nutrient intakes in infants and is equally acceptable with or without added milk powder. J Nutr 138: 19631968. [Google Scholar]
  31. Valle NJ, Santos I, Gigante DP, Goncalves H, Martines J, Pelto GH, , 2003. Household trials with very small samples predict responses to nutrition counseling intervention. Food Nutr Bull 24: 343349.[Crossref] [Google Scholar]
  32. Parlato RP, Darmstadt GL, Tinker A, , 2004. Saving Newborn Lives: Tools for Newborn Health (Qualitative Research Methods to Improve Newborn Care Practices). Washington, DC: Save the Children. [Google Scholar]
  33. Sherman C, Fernandez EA, Chan AS, Lozano RC, Leontsini E, Winch PJ, , 1998. La Untadita: a procedure for maintaining washbasins and drums free of Aedes aegypti based on modification of existing practices. Am J Trop Med Hyg 58: 257262. [Google Scholar]
  34. Padilla MB, , 2001. Qualitative Evaluation of a Behavior Change Tool: Experiences with the “NEPRAM” Method among Planners of the Dengue Prevention Strategy in the Dominican Republic. Santo Domingo, Dominican Republic: Emory University Department of Anthropology. [Google Scholar]
  35. Fernandez EA, Leontsini E, Sherman C, Chan AS, Reyes CE, Lozano RC, Fuentes BA, Nichter M, Winch PJ, , 1998. Trial of a community-based intervention to decrease infestation of Aedes aegypti mosquitoes in cement washbasins in El Progreso, Honduras. Acta Trop 70: 171183.[Crossref] [Google Scholar]
  36. Winch PJ, Leontsini E, Rigau-Perez JG, Ruiz-Perez M, Clark GG, Gubler DJ, , 2002. Community-based dengue prevention programs in Puerto Rico: impact on knowledge, behavior, and residential mosquito infestation. Am J Trop Med Hyg 67: 363370. [Google Scholar]
  37. Winch PJ, Leontsini E, Lloyd LS, Halstead SB, , 2008. Dengue. , ed. Mosquito Control: Behavioral and Community Interventions. London, UK: Imperial College Press, 407424. [Google Scholar]
  38. Leontsini E, Rosenbaum J, Báez C, Solís A, Valera C, Gonzálvez G, , 2004. NEgociación de PRÁcticas Mejoradas—NEPRAM (Negotiation of Improved Practices): the development of a national behaviour change strategy for community-based prevention of dengue fever in the Dominican Republic. Dengue Bull 28: 2225. [Google Scholar]
  39. Harvey SA, Olortegui MP, Leontsini E, Pezo CB, Pezantes LM, Winch PJ, , 2008. The whole world will be able to see us: determining the characteristics of a culturally appropriate bed net among mestizo communities of the Peruvian Amazon. Am J Trop Med Hyg 79: 834838. [Google Scholar]
  40. Harvey SA, , 2006. The Whole World Will Be Able to See Us: Cultural Factors Affecting Insecticide-Treated Bed Net Use for Malaria Control in the Peruvian Amazon. Baltimore, MD: Johns Hopkins University, 226. [Google Scholar]
  41. Harvey SA, Paredes Olórtegui M, Winch PJ, Leontsini E, Gilman RH, , 2000. Insecticide-treated bed nets for malaria control in the Iquitos region of the Peruvian Amazon: formative research for an efficacy trial - November 1999 - July 2000: report on social, economic and cultural factors. Unpublished project report to the Peruvian Ministry of Health, the Peruvian National Malaria Control Program, and the United States Agency for International Development, Lima, Peru.
  42. Quinn Patton M, , 2002. Qualitative Research & Evaluation Methods. London, UK: Sage Publications. [Google Scholar]

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  • Received : 18 Oct 2012
  • Accepted : 16 Feb 2013
  • Published online : 05 Jun 2013

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