Insecticide-treated nets ownership, utilization, and associated barriers during the dry season among urban residents of Jabi Tehnan District, northwest Ethiopia

Malaria is a disease carried by mosquitoes that continues to challenge public health efforts in many parts of the world. To stop the spread, health workers often distribute insecticide-treated nets, which are bed nets coated with a substance that kills or repels mosquitoes. These nets act as a physical shield, stopping bites while also reducing the number of mosquitoes that survive to bite again. While having these nets is the first step, their true power lies in how consistently people use them. In many places, people might own a net but only use it when they feel sick or when they hear mosquitoes buzzing, rather than every single night. This gap between owning a net and sleeping under it every night is a critical puzzle for scientists, especially during the dry season when people often believe the risk of malaria has disappeared, even though mosquitoes can still be active.

In the Jabi Tehnan District of northwest Ethiopia, a team of researchers set out to understand this gap among city dwellers during the dry season. They focused on three urban towns within the district: Finote Selam, Mankusa, and Jiga. These areas are known to have water sources like rivers and ponds that can sustain mosquito breeding even when the rains have stopped. The researchers wanted to know if families in these towns owned the nets, whether they actually used them, and what stopped them from using them if they had them. To find the answers, they visited 405 households, speaking with the head of each family or an adult representative. They asked detailed questions about their home, their sleeping arrangements, and their habits regarding the nets. The study took place in March, a time of year when malaria transmission is typically lower, making it a crucial moment to see if protection was being maintained.

The results showed that most families in these towns had access to the nets. About 84 percent of the households surveyed owned at least one insecticide-treated net. Among those who owned a net, the vast majority said they used it, with a reported usage rate of nearly 97 percent. However, the researchers found that this high number of users did not always mean consistent protection. When they looked closer at how often the nets were used, they discovered that only about 44 percent of the households that owned nets used them every single night. A significant number of net-owning families, about 34 percent, said they only used the nets when they heard mosquitoes, while another 21 percent used them only during the main malaria season. This pattern suggests that many people adjust their behavior based on what they perceive the risk to be, rather than following a strict routine of protection every night.

When the researchers asked the families who did not use their nets why they didn't, the most common reason was surprisingly simple: they did not have a net to use. Among the 76 households that reported not using a net, 85 percent said it was because there was no net in the house at all. For the small group that had nets but still didn't use them, the main complaints were physical discomfort, such as feeling too hot or suffocated inside the net. The study also revealed that where a family lived and how many nets they had made a big difference in their habits. Families living in the town of Mankusa were much less likely to use nets compared to those in Finote Selam. Furthermore, the number of nets a family possessed mattered greatly. Households with only one net were significantly less likely to use it than those with three or more. In contrast, families with two nets were more likely to use them than those with just one. This suggests that having enough nets for everyone in the house, or for different sleeping areas, makes it easier for families to protect themselves consistently.

The researchers concluded that while ownership and reported use of these nets are high in these urban areas, there are still important gaps. The main barriers were a lack of nets in the household and the discomfort of using them. The study highlighted that simply having a net is not enough; ensuring that families have enough nets for all their members and addressing the specific reasons why people find them uncomfortable are necessary steps. By understanding these details, health programs can better support communities in maintaining protection against malaria, even during the dry season when the risk might seem low but remains real.