A cluster randomized controlled cross-over bed net acceptability and preference trial in Solomon Islands: community participation in shaping policy for malaria elimination

Abstract

Background: A key component of the malaria elimination strategy in Solomon Islands (SI) is widespread coverage of long-lasting insecticidal nets (LLINs). The success of this strategy is dependent on LLIN acceptability and compliance. There has been unresolved debate among policy makers and donors as to which type of LLIN would be most appropriate for large-scale distribution in SI, and anecdotal reports of a lack of acceptability of certain brands of LLINs. A cluster randomized controlled crossover bed net acceptability and preference trial was therefore carried out from July to September, 2008 to inform policy and to facilitate community engagement and participation in the selection of the most appropriate LLIN for use in SI.

Method: A three-stage sampling method was used to randomly select the study population from Malaita Province, SI. Three brands of LLINs were assessed in this study: Olyset, PermaNet and DuraNet. Bed net acceptability and preference were evaluated through surveys at three defined time points after short and longer-term trial of each LLIN.

Results: The acceptability of PermaNet after short-term use (96.5%) was significantly greater than Olyset (67.3%, p < 0.001) and DuraNet (69.8%, p < 0.001). The acceptability of DuraNet and Olyset after short-term use was not significantly different at the 5% level. LLINs that were perceived not to prevent mosquito bites were significantly less acceptable than LLINs that were perceived to prevent mosquito bites (OR 0.15; 95%CI 0.03 to 0.6). LLINs that allow a pleasant night's sleep (OR 6.3; 95%CI:3.3-12.3) and have a soft texture (OR 5.7; 95%CI:1.9-20.5) were considered more acceptable than those that did not. Olyset's acceptability decreased over time and this was due to net wrinkling/shrinkage after washing resulting in reduced efficiency in preventing mosquito bites. The increase in DuraNet acceptability was a result of a reduction in minor adverse events following longer-term use.

Conclusion: This research was conducted to inform LLIN procurement as part of the national malaria control and elimination programme in SI. The success of malaria elimination in the Pacific and elsewhere relies on provision of acceptable interventions, consideration of local-level realities and engagement of communities in strategy development.

Trial registrations: Clinical trials ACTRN12608000322336.

Figure 1

Map of region showing study area.

Figure 2

Satellite imagery used for cluster randomisation in Buma village, Malaita Province.

Figure 3

Coastal village in Malaita Province showing typical housing composition.

Figure 4

Study profile (participant flow).

Figure 5

Acceptability of Duranet^®, Olyset^® and Permanet^® LLINs by survey round and gender.

Figure 6

Pruned classification tree of variables associated with acceptability of LLINs over all three survey rounds*. * The ability of LLINs to provide a pleasant night's sleep was the primary determinant of acceptability. This variable was removed from the classification tree to avoid over fitting and reduce complexity of the figure. In addition, ability of the LLIN to provide a pleasant night's sleep is considered to be a product of the other remaining variables in the classification tree. † n = 579.