In Uganda, NetWorks is conducting cutting-edge research to test the effectiveness of behavior change communication (BCC) to promote net use and care. NetWorks is also conducting research to understand the “net culture” in different parts of the country to inform BCC and net distribution activities. Research activities in Uganda are described here and with other countries’ research on the Research page.

NetWorks’ activities in Uganda are aligned with Uganda’s Malaria Control Strategic Plan 2011-15, which places an increased focus on the cultural and social context of malaria-related behavior change. Specifically, the plan calls for strengthening the monitoring and evaluation of community SBCC activities and better understanding of the behavioral obstacles to malaria control interventions. In support of the Strategic Plan, NetWorks conducted research on hang-up visits, net care and repair campaigns, and the culture of net use in Uganda.

Hang Up Study

After net distributions, community volunteers often visit households to assist those who have difficulty hanging nets. NetWorks conducted a cluster-randomized control trial to determine the effect of these “hang-up visits” in increasing the hanging and use of LLINs.  The study will provide important information for the Uganda National Malaria Control Program and the global malaria community on the additional value of hang-up visits. 

In Kamuli District, which benefited from the Global Fund targeted distribution of LLINs to children under five and pregnant women, households who received two or one hang-up visits were compared to households who received none.  Preliminary results found that net use and hanging increased over time in all study arms, including among households who did not receive any hang-up visits. No statistically significant difference was found between the arms. It is theorized that individual and social norms around net use and hanging, also known as “net culture,” may influence the effectiveness and necessity of hang-up visits. The study is expected to be published in early 2014.

Net Care and Repair

Manufacturers state that long-lasting insecticidal nets should last 3-5 years, but household-level factors such as daily handling, pests, children, washing and housing materials can contribute to wear and tear on nets. Worn-out nets are less protective from malaria and the need to replace nets frequently can create massive costs for governments and for households.

NetWorks is piloting a behavior change communication campaign to help make nets last longer. The program will use community activities and radio to promote the household care of nets to prevent holes as well as prompt repair of any holes that develop. By supporting households’ ability to keep nets intact through their intended lifespan, households may also be more likely to use nets and seek new nets when needed.  A net care and repair BCC campaign is also being piloted in Nigeria; and both campaigns will be evaluated. BCC materials from the campaigns are available in the online Care and Repair of Mosquito Nets Toolkit.

Culture of Net Use Study

Despite significant increases from 2006 to 2011, net use in Uganda remains well below targets. Only 43% of children under 5 and 47% of pregnant women slept under an ITN the previous night (UDHS, 2011). In order to launch successful net use campaigns, it is important to know how the decision of whether to use the net is made, who sleeps in which sleeping spaces, who sleeps under the net, during which seasons the net is used, and how nets are cared for. 

NetWorks conducted a longitudinal qualitative study to better understand these factors. Data collection took place over several phases, alternating between dry and rainy seasons, and in four districts, one each from Central, Eastern, Northern, and Western Uganda. The study will inform more effective messaging to increase LLIN use and care and repair interventions. It will also provide insights related to net integrity and net-seeking behaviors. Results from Uganda will be compared with those from parallel studies in Senegal and Mali; they will also be used to inform net distribution activities and BCC campaigns. Link to an overview of net distribution approaches.