How Are Insecticide-Treated Bednets Used in Ugandan Households? A Comprehensive Characterization of Bednet Adherence Using a Remote Monitor
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
The American Journal of Tropical Medicine and Hygiene
Abstract
Long-lasting insecticide-treated bednets are widely used and promoted for malaria control. Limitations in
measurement methods have resulted in a poor understanding of how bednets are used in practice. We deployed a novel
remote monitoring tool in Uganda to obtain, for the first time, a comprehensive characterization of bednet use in
households at risk for malaria. Ten households each used one SmartNet adherence monitor over a commonly used
sleeping area for 6 weeks. SmartNet continuously measures and records bednet use every 15 minutes. Bednet use was
monitored for a total of 9,258 hours overall, with an average of 42 nights per household (SD: 3.5). Average duration of
bednet use was 9 hours 49 minutes per night (SD: 1 hour 56 minutes), and adherence was 85–90% from 2100 to 0600.
Bednets were not used at all on 4.5% (19/418) of observation nights. Overall, the average clock time that bednets were
unfurled was 2034 (SD: 1 hour 25 minutes) and they were folded up at 0743 (SD: 43 minutes). The rate of interruptions per
night observed in all households was 0.23 (86/369), with an average duration of 48 minutes (SD: 49 minutes). There was
substantial heterogeneity between households, and some households had consistently poorer adherence relative to
others. Variations in bednet use behaviors are a potentially important, and under-researched, component of long-lasting
insecticide-treated bednet effectiveness. Remote bednet use monitors can provide novel insights into how bednets are
used in practice, helping identify both households at risk of malaria due to poor adherence and also potentially novel
targets for improving malaria prevention.
Description
Keywords
Insecticide-Treated Bednets, Ugandan Households, Bednet Adherence, Remote Monitor
Citation
Krezanoski, P. J., Agaba, A., Dorsey, G., Bangsberg, D. R., & Carroll, R. W. (2019). How are insecticide-treated bednets used in ugandan households? A comprehensive characterization of bednet adherence using a remote monitor. The American Journal of Tropical Medicine and Hygiene, 101(2), 404. doi:10.4269/ajtmh.19-0032