Behavior Profile: Insecticide-Treated Net Use
1. Reduce malaria mortality by one-third from 2015 levels in PMI-supported countries, achieving a greater than 80 percent reduction from PMI’s original 2000 baseline levels. 2. Reduce malaria morbidity in PMI-supported countries by 40 percent from 2015 levels.
Population sleeps under an insecticide-treated net (ITN) correctly and consistently
Percentage of pregnant women who slept under an insecticide-treated net (ITN) the night before the survey
Percentage of children under age five who slept under an insecticide-treated net (ITN) the night before the survey

Behavior Analysis

Strategy

BEHAVIOR AND STEPS

What steps are needed to practice this behavior?

Population sleeps under an insecticide-treated net (ITN) correctly and consistently

  1. Acquire sufficient ITNs to cover every sleeping space
  2. Hang ITNs appropriately
  3. Retreat, repair, or replace the net as needed

FACTORS

What factors may prevent or support practice of this behavior?
Structural
Accessibility: Populations cannot access ITNs because ITNs are unavailable.
Social
Norms: Populations do not sleep under ITNs because malaria is considered normal and unavoidable.
Norms: Some populations do not sleep under ITNs when there is insufficient supply as they are not prioritized.
Internal
Attitudes and Beliefs: Populations do not sleep under ITNs because they fear possible adverse outcome from insecticides.
Attitudes and Beliefs: Populations do not sleep under ITNs because ITNs make them hot or uncomfortable, especially during the hot season.
Knowledge: Populations do not acquire or use ITNs because they do not know when or how to do so.
Knowledge: Populations do not sleep under ITNs because they do not understand the benefits of using an ITN to prevent malaria.

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior, and what actions must they take?
Institutional
Policymakers: Add local requirements for ITNs (i.e. color, length, shape preference, hanging considerations) to the procurement process.
Managers: Couple distribution of ITN with counseling and ongoing monitoring of correct and consistent use, especially in non-permanent sleeping spaces (such as outside, kitchens, etc.)
Logistics Personnel: Use available tools (e.g. NetCALC) to ensure sufficient supply of ITNs for mass and continuous distribution.
Providers: Counsel caregivers on the use of ITNs in traditional and non-traditional settings.
Community
Community and Religious Leaders: Advocate for correct and consistent use of ITNs, especially in non-permanent sleeping spaces (e.g. outside, kitchens, etc.)
Household
Family Members: Obtain, hang, and ensure everyone, especially pregnant women and children under five, sleeps under an ITN.

POSSIBLE PROGRAM STRATEGIES

What strategies will best focus our efforts based on this analysis?

Strategy requires Communication Support

Enabling Environment
Financing: Monitor and ensure continuous availability of free nets to ensure that the most vulnerable populations have access to ITNs.
Policies and Governance: Ensure accountability of health care providers, facilities, and system (e.g. availability of commodities, quality of services, adherence to protocols, etc.) to ensure that targeted population has access to ITNs.
Systems, Products and Services
Products and Technology: Procure ITNs based on housing and population needs to ensure that targeted population has access to ITNs.
Supply Chain: Procure and distribute adequate ITNs for mass campaigns and routine distribution channels including at antenatal care and EPI visits to ensure that the most vulnerable populations have access to ITNs.
Quality Improvement: Prioritize the importance of proper procurement, distribution and counseling with providers during in-service training, supportive supervision pre-service training.
Demand and Use
Advocacy: Leverage community data to motivate communities and to create social accountability for ITN use.
Communication: Employ appropriate SBCC activities to reinforce caregivers’ knowledge on the importance, efficacy, and benefits of ITN use.
Collective Engagement: Engage community members in local ownership of malaria control efforts to ensure community access to ITNs.
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