Introduction
Malaria is unarguably the one most common disease of mankind especially in sub-Saharan Africa where the disease has taken its tolls (Okwa, 2014).Due to the challenging health problems associated with the disease, different methods have been designed to control its scourge among which includes the use of Insecticide treated bed nets (ITNs) which were introduced in Nigeria in the year 2000 following a meeting of the African Heads of States in Abuja, the capital city of Nigeria (Roll Back Malaria [RBM], 2010).
Despite reports of reduced incidence of malaria, studies in Nigeria and other third world countries have shown that the use of ITNs has remained poor in spite of the increased health education and awareness campaign mounted by government agencies. Consequently, the prevalence of malaria has been reported to be high over the years with its attendant complications (Mbanugo & Okorudo, 2015).
The high prevalence of malaria has been greatly linked with the poor knowledge, attitude and practice concerning the preventive measure of the disease which includes the poor attitude towards the use of ITNs. Minakawa, Dida and Sonya (2012) in a report lamented the misuse of ITNs in villages along Lake Victoria in Tanzania where rural women were seen using ITNs which were distributed to them under the Roll Back Malaria free distribution of ITNs scheme as fishing nets. They stated that this very disappointing situation is due to fact that so many people that got the freely distributed ITNs were not adequately health educated on the importance, hence the resultant gross misuse of the ITNs.
Conceptual framework
Gamble, Ekwaru and Kuile (2014), described insecticide-treated nets (ITNs) are a form of personal protection against mosquito bites through the use of bed nets to form a protective barrier around people sleeping under them. The insecticides that are used for treating ITN skill mosquitoes, as well as other insects. The insecticides also repel mosquitoes, reducing the number that enter the house and attempt to feed on people inside. Only pyrethroid insecticides are approved for use on ITNs. These insecticides have been shown to pose very low health risks to humans and other mammals, but are toxic to insects and kill them, even at very low doses.
When that net is treated with insecticide, it provides greater protection by repelling mosquitoes and killing those that land on it.High ownership and use of ITNs reduces the incidence of uncomplicated malaria episodes. When a community has a high level of ITNs use – which is associated with greatly reduced populations of mosquitoes that transmit malaria – the risk of malaria infections can be reduced even among those not using an ITN. While the average life of an ITN depends upon local conditions, Roll Back Malaria (RBM) recommends that countries plan to replace long-lasting ITNs after three years and the universal coverage is commonly defined as one ITN for every two people (RBM, 2010).
Historical perspectives of ITNs
ITNs is an advance of the historic mosquito netting which was used in China in 2700BC mainly for the protection against the malaria transmitting vector, Anopheles gambiae which was the first record of case malaria-like symptoms. The vector for this disease was not identified until 1880 when Charles Louis Alphonse Laveran identified mosquitos as a vector for malaria (Murray, 2008).
Mosquito netting has a long history. Though use of the term dates from the mid-18th century, Indian literature from the late medieval period has references to the usage of mosquito nets in ritual Hindu worship. Poetry composed by Annamayya, the earliest known Telugu musician and poet, references domatera, which means mosquito net in Telugu.Use of mosquito nets has been dated to prehistoric times. It is said that Cleopatra, the last active pharaoh of Ancient Egypt, also slept under a mosquito net.Mosquito nets were used during the malaria-plagued construction of the Suez Canal (Tawrell, 2012).
Types of ITNs
Salaudeen and Jimoh (2012) classified ITNs into two types which are:
- Conventionally treated nets
- Long-lasting insecticide nets (LLIN)
- Conventionally treated nets
A conventionally treated net is a mosquito net that has been treated by dipping in a pyrethroid insecticide. Dipping is often done at the village level, by health workers or communities themselves. However, to ensure its continued insecticidal effect, the net needs to be re-treated after three washes, or at least every six months (Salaudeen & Jimoh, 2012).
- Long-lasting insecticide nets (LLIN)
LLIN is a much better alternative is the long-lasting insecticidal net. LLINs are factory-treated mosquito nets made with a netting material that has insecticide incorporated into the fibres, or as a coating on the fibres. LLINs are effective against mosquitoes for at least 20 standard washes, or three to five years under field conditions. As the lifespan of most nets is three to four years, the insecticides in LLINs remain effective for the whole life of the net. Therefore, there is no need to re-treat LLINs (Salaudeen & Jimoh, 2012).
Empirical studies on the knowledge, attitude and practice on the use of ITNs
A study carried out by Ukibe, Ikeako, Mbanugo, Obi-Okaro and Ukibe (2014) in study carried in Anambra State discovered that despite the high awareness level of women concerning the use of ITNs and the relatively high level of ownership which has increased over the years in malaria endemic countries, majority of the respondents refused to use the nets for one reason or the other.Most of the women interviewed (40.3%)refused to use ITNs because it caused excessive heat and made sleeping uncomfortable. In their report, excessive heat from poor ventilation is indeed a serious barrier against peoples utilization of ITNs even when these nets are distributed free of charge by governments.
In Nigeria, this is a genuine reason for people to refuse the use of ITNs in preference to the nuisance and disease caused by mosquitoes considering the tropical nature of the climate and the attendant temperature generated especially during the dry seasons. This matter is made worse
By lack of or inadequate supply of electricity which makes it impossible for residents to use their fans or air conditioners for those who can afford them. Moreover residential accommodations are often inadequate thereby promoting overcrowding with its attendant problems hence a significant proportion of the population people do not use the nets as a result of unsuitable accommodations to hang the nets (Ukibe et al., 2014).
In another study, Zangypo, Zangypo and Poulsen (2011) reported that people fail to make use of ITNs for complains of itching or skin irritation. This itching or skin irritation was suspected to result from the chemical components or as a manifestation of hypersensitivity reaction from the physical component of the nets which serves as a foreign body. This particular problem calls for more investigations.
Some of the respondents failed to use ITNs simply because they “heard” ITNs killed someone or they “do not work”. This notion suggests high degree of misconception and misinformation. This reason for non-usage of ITNs was popular among people with poor educational background and is a very important barrier militating against the use of ITNs in this part of the world (Baume & Marin, 2012).
In rural communities with higher level of illiteracy, the problem of misconception and poor perception will be made worse by cultural beliefs and practices. For instance, in a particular study in villages along Lake Victoria, mosquito nets were used by the indigenes for fishing instead of protection against malaria (Minakawa et al., 2012). A reasonable people had no specific reason why they refused to use ITNs despite the ownership. Some simply said they “did not like ITNs”. This is another case of misconception and poor attitudes which could be fuelled by illiteracy and ignorance.
Guyat and Ochola (2013) cited low level of acquisition of nets as a major hindrance to the use of ITNs. In sub-Saharan Africa, the poverty level is such that most people cannot afford a three square meal a day. In this circumstance, it becomes a luxury for one to purchase a mosquito net from the open market. Even when these nets are given to people free of charge, some of them sell the nets to generate income to solve other pressing needs.
Measures to improve the use of ITNs
Adeyemi, Adekande and Akinola (2014), suggested measures to improve the use of ITNs which include:
- There should be a massive distribution of free ITNs and adequate awareness campaign especially at the rural communities to strengthen the people on the benefits of their usage.
- Apart from the massive free distribution, there should be adequate awareness on their utilization. This can be effective if the message is channelled in a medium to is generally acceptable to the people such as the involvement of the heads of the family, youth leaders, elders forum and community leaders.
- Since most people shy away from the use of ITNs due to poor perception on the use of ITNs, all relevant stakeholders should inculcate into the RBM programme strategies of demystifying some of these poor perceptions
- Families should be educated on how to improve ventilation of their homes to guide against poor utilization of ITNs due to complain of excessive due to hot weather.
- Government should also ensure that there is adequate provision of electricity to solve the problem of non-utilization of ITNs as a result of heat.
References
Adeyemi, A. S., Adekande, D. A. & Akinola, S. E. (2014). Use and prevalence of insecticide treated mosquito bed nets among pregnant population in Osogbo, Nigeria. Nig Med Pract., 52(2), 29-32.
Baume, C. A. & Marin, M. C. (2012). Gains in awareness, ownership and use of insecticide treated net in Nigeria, Senegal, Uganda and Zambia. Mal J 8, 7:158.
Gamble, C. L. Ekwaru, J. P. & Kuile, F. O. (2014). Insecticide treated nets for preventing malaria in pregnancy. Cochrane database of systemic reviews 2014, retrieved on 13th January, 2017 from http://www.cochraine.org/reviews/en
Guyat, H. & Ochola, S. (2013) Use of bed nets given free to pregnant women in Kenya. Lancet, 362,1549-1550
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Ukibe, S. N., Ikeako, L. C., Mbanugo, J. I. Obi-Okaro, A. C. & Ukibe, N. R. (2014). Knowledge, attitude and practice of pregnant women concerning the use of Insecticide Treated Bed Nets (ITNs) in Anambra State, South-east Nigeria. Journal of Applied Medical Sciences, 3(1),15-22.
Zangypo, K., Zangypo, N. & Poulsen, K. (2011). A study on knowledge, attitude and practice about malaria awareness and bed net use. J Bhutan Studies, 11, 135-146.
