LLINs in Pakistan

Assessment of Community Preferences and Acceptances for Use of Different Types of LLINs in Pakistan.

The use of Long Lasting Insecticidal Bednet (LLINs) has become one of the best interventions for vector control around the globe. Since 2004/05 Directorate of Malaria Control (DoMC)-Pakistan is promoting the use of LLINs in Pakistan. During 2008/09 DoMC decided to scale up LLINS in the country and planned distribution of 2.1 millions LLINs out of which 0.8 million were to be distributed by its partners in the country focusing high risk districts of Pakistan.

Presently in Pakistan only polyester-made rectangular LLIN are being used. Other shaped nets e.g. circular or conical has not yet been tried Similarly polyethelene-made LLINs have also not been tried. Studies carried out in Afghan Refugees and in the local population has provided valuable information on socio demographic aspects of the communities using these nets. However, since only one type of nets have been introduced in the country (i.e. rectangular shaped polyester madeITNs/ LLINs), the community preferences/acceptances for other type of nets e.g. poly- etheline and or different shapes of nets is not locally known. This type of information is urgently required to develop/design strategies (that are community friendly) for scaling the LLINS in the country.

Keeping in view these findings and observations Directorate of Malaria Control (DoMC) designed a cross-sectional community-based survey in all four provinces and FATA during peak transmission and low transmission periods with the major objective to assess the community acceptance and preferences for polyester or polyethylene made circular and rectangular LLINs and to identify the major barriers and obstacle in scaling up the use of LLINs with the overall goal to formulate rational strategic frame work for scaling up the coverage of LLINs in Pakistan. Two main groups A & B in selected communities will be provided polyester and polyethylene made LLINs and within each main group thee sub-groups A-I, A-II and A-III and B-I, B-II and B-III comprised of 20 household will be identified and will be provided with circular and rectangular LLINs and third will get both types of LLINs. In each province 20 households will also be selected and will be provided untreated traditional LLINs as control, reaching the total number of households 700 in all four provinces and FATA.

Comprehensive information regarding use of LLINs will be provided at the time of distributions and Focused Group Discussion (FGD). Prior to survey FGDs will be held with community to understand the local terminology; local beliefs and practices for mosquito protection and use of bednets. For all experimental groups LLINs will be donated by manufacturers; however, they don’t have any role in study design, questionnaire designing, field surveys for data collection, analysis, decision to publish, or preparation of manuscript.

Data will be collected using a structured questionnaire and through focused Group Discussions (FGD) to assess the demographic variables relevant to bed net usage including sleeping habits, washing, drying, storing practices, acceptance and preference for polyester and polyethylene made LLINs for shape (circular and rectangular), color, size etc. Indepth interviews will be conducted with heath authorities and policy makers to indentify the barriers and obstacle that may hinder the implementation/promotion of this intervention. Informations will be collected from community regularly on bi-weekly basis throughout the study period that would cover both peak transmission (October-December) and low transmission (May-June) periods.

A preliminary survey will also conducted in the selected areas to assess the fever prevalence and community knowledge about malaria, bednets and LLINs. The designed questionnaire will be pre-tested and FGD and information collected will be further used to refine the questionnaire and other tools. During year 1, 2, and 3 a sample of the LLINs distributed to the communities will be collected to determine their long lasting efficacy through bioassay test after use in local settings. Data will be compared among all six study groups to understand community knowledge, acceptances and preferences towards different types of LLINs. The data will also be analyzed to find out any differences between two transmission periods so as to evaluate the utilization rate.

It is expected that the study will generate new knowledge on community acceptance and preference for different types of LLINs and their rate of utilization in different seasons. The outcome of this study will inform the national policy review and refine the existing strategies for further scaling up and monitoring the implementation of LLINs in the country.