NETMARK FORMATIVE QUALITATIVE RESEARCH IN UGANDA
SUMMARY OF FINDINGS

STUDY FINDINGS:

General knowledge about malaria was good. The English term "malaria" was universally recognized and respondents named symptoms of malaria that are generally consistent with biomedical definitions of the illness. Most but not all respondents considered malaria to be serious. Respondents had good general knowledge that children (but not necessarily children between 0-5) are vulnerable to a serious case of the malaria. Awareness that pregnant women are especially vulnerable appeared lower. Almost everyone knew that mosquitoes cause malaria, but some thought there were other causes as well.

Mosquitoes were perceived as a major problem, and almost everyone, even in rural areas, used some kind of commercial mosquito control product (e.g., coils or aerosols). Respondents had relatively negative perceptions of all mosquito control methods, including nets, although more respondents had positive things to say about nets than they did about other products.

The main reasons respondents liked nets were because they protect against mosquitoes/other insects, protect against illness/malaria, and are "long-lasting." Respondents (net owners and non-owners) viewed net owners as "knowledgeable" and net owners saw themselves as economically savvy, "health conscious" and "caring." Nets were also viewed as a luxury item, reserved for the rich and educated.

The main disadvantages to owning or sleeping under a net were that respondents perceived nets as hot, restrictive, expensive, unable to protect the entire family, ineffective, and inconvenient to get in and out of or to hang. Some respondents said nets were difficult to use with children (e.g., children could become trapped or suffocate, were hard to keep under the net, might damage the net). The main reason non-owners gave for lack of net ownership was cost, but a few said nets were either unavailable or unnecessary when other insect control products were used.

There was evidence of limited access to adult-size nets. Net owners and traders were relatively easy to locate in urban areas, but much more difficult to find in rural areas. Nets were sold mostly in open-air markets and by hawkers and most net owners reported buying their nets from these sources. Some net traders sold a variety of net sizes, shapes, and colors, but others had a very limited selection. Only one trader sold treated nets. Consumers generally preferred rectangular nets to conical ones. Rectangular nets were liked because they are roomy and fit the shape of the bed. Conical nets were liked because they are easy to hang. Consumers also preferred light-colored nets. Although most consumers owned double- and single-size nets, they generally preferred large sizes (double, king/family, or for a bunk bed). Net prices varied widely. Traders reported selling nets for between US$3.80 and $12.70, depending on the size, shape, color, and material. Consumers reported buying single-size nets for between US$3.20 and $9.50 and double-size nets for US$4.40 and $13.90. Both fathers and mothers made the decision to buy and purchased nets. Baby-net ownership was not common.¹

Nets were not necessarily used year-round; some households reported using them only in rainy season. Vulnerable groups were generally given priority for sleeping under a net; almost all net owners reported that all their children under five slept under a net the prior night. Two women in net-owning households were pregnant and both slept under a net the prior night.

Nets were generally washed at least once a month, typically with water and soap, along with other clothes in a basin used for this purpose or for bathing. A few people added bleach and nets were often soaked in "Omo" (a brand of lye-based detergent soap) before washing and were hung in the sun to dry. Some respondents worried about how washing would affect treated nets and about the required frequency of treatment purchase.

The concept of treating nets with insecticide was largely unknown and no consumer had ever done so. Traders and consumers generally liked the idea of insecticide treated materials (ITNs), but parents were very concerned about their potential danger, especially to children and pregnant women. Some respondents also expressed strong distrust of manufacturers’ motivations for bringing such chemicals to market. However, consumers said they would feel better if assured by a range of credible sources and activities (e.g., product demonstrations) that the treatment products were safe.

Insecticide treatments appeared to be unavailable in the commercial sector; no insecticide treatment traders were found and only one trader was selling pretreated nets. Some traders had never heard of treating nets with insecticide. Although most traders interviewed were enthusiastic about and interested in selling the treatments, some said they could not do so because the market for nets and insecticides is specialized; traders who sold nets generally did not sell other insect control products, such as coils and aerosols.  

Traders of insect control products often sold more expensive goods. Net traders said they often gave their customers advice about nets, but this advice was about washing, not about malaria protection. Net traders were motivated to sell nets because of high consumer demand, potential for profit, and a desire to help prevent malaria. Traders said they would be inclined to purchase goods from specific suppliers if they received special incentives.

Consumers and traders wanted net treatments that thoroughly covered/saturated the net; were easy to use, fast, and convenient; required no mixing; dried easily; were safe to use, especially around children; had no bad odor; caused no irritation; and were not wasted in the air. Respondents were shown four dipping products (a tablet, granules in a sachet, liquid in a sachet, and liquid in a bottle) and two spraying options (an aerosol and a flit-gun sprayer). Consumers strongly preferred dipping products to the flit-gun sprayer but expressed no clear preference for dipping products over the aerosol spray. Traders overwhelmingly preferred the aerosol spray to any other option. They liked this product because it was easy to use, already mixed, and was not time consuming. Among the dipping options, consumers expressed no strong preference for one product over others, but traders strongly preferred the liquid in a bottle to any other dipping product. The liquid in a bottle was liked because it dissolved easily in water, and came with a plastic bag with a water demarcation line. Consumers worried about products that could spill, that were perceived to be in insecure packaging, and that children could easily swallow.

1. Baby nets are very small, umbrella-shaped nets that stand alone and only fit an infant.

Ghana 2004 Household Survey
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