What are the Reasons behind the Inconsistent Use of Insecticide Treated Bed Nets in South-Eastern Nigeria? A Qualitative Study

Insecticide-treated bed nets (ITNs) have been shown to effectively protect against malaria when used appropriately. Armed with this information donation have been made and structures to ensure easy access to ITNs have been put in place across Nigeria. Nonetheless, data shows that the ITNs are not being used reliably. This paper seeks to share findings from a qualitative study designed to unpack the reasons why Nigerians from the southeastern region of the country chose not to use ITNs consistently despite having one. In total 7 Focus Group Discussion (FGDs) were conducted with participants purposively selected. About 37 participants were selected for the In-Depth Interviews (IDI). An inductive methodology was employed during the analysis. Reasons for inconsistent use of ITNs were identified at the personal and external levels. At the personal level, perceived risk of the disease, ITNs, perceived usefulness of the ITN, knowledge, acceptance, perception of older ITNs, and ITN use based on climatic seasons were identified as impediments to bed net use. At the external level, house structure and arrangement, insufficient amount of ITNs per home, and non-use due to spousal influence were reported as main barriers to consistent ITN use. Although most participants did not lack knowledge about malaria and ITNs use, inconsistent use of the ITN still occurred. This underpins the fact that people’s attitude to consistent ITN use may be driven by their perceived lack of fear for the disease as a result of day-to-day experience with the disease. To address this challenge, there is a need to combine a behavior change intervention with other interventions where appropriate in a bid to deal with the drivers of inconsistent ITN use and the persistent malaria challenge as a whole. As the reasons for inconsistent use of the ITN traverses both the personal and external levels, there is also a need for a multi-level intervention that not only targets beliefs and skills to motivate ITN use in the at-risk population but also decision-makers in the communities where people live to implement measures that mitigate identified external factors that hinder ITN use.