Motivation for buying and using impregnated mosquito nets in a stable malaria area Burundi

In Burundi, the purchase, acceptance and utilization of impregnated bed nets sold at a promotion price (2 $US) were evaluated in a stable malaria area (South-Imbo, district of Nyanza Lac) where this method of protection was previously unknown to the inhabitants. The sale of the impregnated nets differed between the administrative subdivisions (so-called 'collines') of the area with a coverage varying from 10 to 70% of families. Moreover, in one of these collines with a high overall coverage rate (62%) a difference was also found between the three administrative regions (so-called 'sous-collines') which were socially and economically similar. However, these sous-collines (SC) differed in their geographical location and were found at different altitudes. The real coverage corresponding with the percentage of families showing at least one installed bed net, was calculated far each SC. This coverage was 77% in the SC-1 situated in the low wet area and decreased gradually to 14% in the SC-3 at the highest altitude. The purchase of a bed net does not necessarily mean that people will use them. About 30% of the bed nets bought at the promotion price could not be found and most of them were resold in the neighbouring country (Tanzania). Between 7 (SC-1) and 47% (SC-3) of the bed nets were still packed and not in use. The motivation for buying and using impregnated nets appears to depend essentially on the nuisance level caused by mosquitoes, as shown by the abundance of the mosquitoes in the SC-1 situated in the low wet area (75 bites/man/night) compared to that observed in the SC-2 located at a higher altitude (1 bite/man/night). The authors conclude that appropriate health education and information should be developed and promoted by health staff, local authorities and teachers in order not only to improve comfort by decreasing the insect nuisance, but also to decrease the considerable malaria burden in the community.