Background
Methods
Study design
Setting
Data collection procedures
Participant selection
No | Type of group | Ward | Discussion held | Age average | Gender | Participants |
---|---|---|---|---|---|---|
1 | Malaria positive, bed net absent, window screen present | Mwananyamala | 1 | [27–59] | F | 12 |
2 | Malaria negative, bed net absent, window screen present | Hananasif | 1 | [24–56] | F | 10 |
3 | Malaria positive, bed net present, window screen present | Kinondoni | 1 | [31–78] | F | 12 |
4 | Malaria negative, bed net present, window screen present | Mkwajuni | 1 | [22–48] | F | 11 |
Data analysis
Results
Reasons for bed net use
“We use bed nets to protect ourselves against malaria” (Mkwajuni, participant 1)
“We also use bed nets to protect ourselves from flying insects like houseflies, and also against cold weather” (Ukwamani, participant 2)
Reasons for not using a bed net
“Some cannot afford to buy a net. They cannot even feed their household well, let alone buying a bed net” (Ukwamani, participant 9)
“Some cannot afford to buy a bed net. They find them expensive” (Hananasif, participant 7)
“People have well-made houses. Their houses have multiple doors before you get to the bedrooms. Their front and back doors have mosquito mesh and their roofs have well-sealed ceilings. On top of that, they also use mosquito repellents. Such households do not use bed nets. Being bitten by a mosquito in such houses is very unusual. But many people cannot afford such houses” (Hananasif, participant 3)
“Some use sprays and believe that it’s enough, so they do not need a bed net” (Hananasif, participant 9)
“Some shut their doors properly so that mosquitoes cannot get into the house. These kinds of people may sleep without bed nets and will not be bothered by mosquitoes to a great extent” (Mwananyamala, participant 2)
“But there are fewer homes of this type, the houses that can be closed properly to prevent mosquitoes from getting in” (Mkwajuni, participant 10)
“Yes, people buy bed nets for their children and family’s visitors to use, but not for other household adults use” (Mkwajuni, participant 1).
“Others may not use bed nets because of frequent attacks of malaria. Some had constantly used bed nets but they constantly get malaria. This leads to despair because they feel that the nets do not work. They feel that bed net use has not prevented them from getting malaria and so they become negligent. These kinds of people are those who are also diagnosed with malaria every time they get to the hospital” (Mwananyamala, participant 3)
Stimuli and reminders to use bed nets
“It is malaria that reminds us to use bed nets. Those who have been suffering from malaria remember the most to use bed nets. Just like someone under medication remembers to take his medicine” (Ukwamani, participant 6)
“The family that is frequently attacked by malaria tends also to use bed nets frequently. Treatment is expensive, so the family tries to protect itself against malaria. Therefore, repeated malaria attacks compel the family to buy bed nets. Treatment is expensive and it is more expensive if many family members are involved. In order to avoid this, we buy bed-nets” (Mwananyamala, participant 3)
“It is malaria. When you get malaria repeatedly, you will end up buying a net. You just give up and try to avoid death. Many like to buy bed nets but they are expensive. The freely given nets are not easy to get and some are small, and do not fit in most beds” (Mkwajuni, participant 1)
“There are people out there who use bed nets regardless of malaria infection. However, generally people who have experienced malaria tend to use bed nets more” (Hananasif, participant 11)
“People who take good care of their health usually use bed nets. Some are raised that way and they are likely to always use a bed net, without needing to be reminded” (Mwananyamala, participant 6)
“Health education on malaria also reminds us to use bed nets. Sometimes one can forget, and does not give net use a high priority, but when you hear from the campaigns about the importance of bed net use and the consequences of not using one, you immediately buy or start using a bed net” (Ukwamani, participant 8)
Perceived reasons for catching malaria despite using a bed net
“People who share bed nets are more likely to get malaria than those who don’t. For example a man and his wife; the man may tuck-in the net but the wife may un-tuck it simply because she does not like it. One part of the net will be hanging loose. As they keep sleeping later at night the whole bed net is left loose” (Mwananyamala, participant 8)
“Some have bed nets and use them, but if you share a bed with someone and s/he comes late to sleep, and gets into the bed carelessly and does not tuck-in the net correctly, then mosquitoes get inside” (Mkwajuni, participant 7)
Ward | Bed net shared, one occupant comes late to sleep, and does not tuck in the net | One person shares the bed but does not use the net, pushing it away to other side | Ineffective bed net use habits, ulalavi, sleeper touches the net or leaves a limb hanging outside of it | Small bed nets which become un-tucked at night | Bed nets with holes large enough to allow mosquitoes to pass | Going to bed late after already being bitten outdoors | N | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | ||
Mwananyamala | 10 | 83 | 9 | 75 | 7 | 58 | 4 | 33 | 3 | 25 | 3 | 25 | 12 |
Hananasif | 7 | 70 | 6 | 60 | 8 | 80 | 2 | 20 | 3 | 30 | 4 | 40 | 10 |
Kinondoni | 9 | 75 | 8 | 67 | 10 | 83 | 5 | 42 | 5 | 42 | 2 | 17 | 10 |
Mkwajuni | 6 | 54 | 8 | 73 | 6 | 55 | 3 | 27 | 2 | 18 | 2 | 18 | 12 |
Overall (%) | 71 | 68 | 68 | 31 | 28 | 24 |
“Some of the bed nets have larger holes and allow mosquitoes to go through. One day we observed this: A mosquito tried to get into the net and eventually succeeded” (Ukwamani, participant 5).
“Also some tuck in their bed nets but do not take it out [un-tuck it] in the morning. So if there are mosquitoes trapped inside it, they remain and will probably bite the owner on the second night when s/he comes to sleep” (Hananasif, participant 5)
“Because of cleanliness, some husbands do not like dirty bed nets. They want nets to be washed every few days. So if he gets home and finds that the bed net has not been washed, he will put it away. This may result the family or couples sleeping without a bed net” (Mkwajuni, participant 9)
“Sometimes we travel and some homes that host us may have no bed nets, so when you stay for some days in these homes you are likely to get malaria” (Hananasif, participant 1)
“For example, I use a bed net and I still get malaria. But the nets do not cause malaria, it may be because I stayed outside and got bitten or I was bitten when I was indoors before going to bed. I may still get bitten while indoors unless I go to bed and draw a net” (Mwananyamala, participant 9)
“Most people use nets, but they use them differently to the way they are supposed to. For example, my mother will fix the net on the bed but she will leave her face outside of the bed net. She has difficulty in breathing when she sleeps fully under the bed net. She gets bitten on the face, and in the morning we find some mosquitoes inside the net too” (Ukwamani, participant 8)