ReviewMalaria journal2025
Fabric integrity, net type and risk index predict attrition of insecticide-treated nets: evidence from a community durability trial of pyrethroid-piperonyl butoxide (PBO) nets in Tanzania.
Review in Malaria journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
12 authors.
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Abstract
backgroundThe fabric integrity of insecticide-treated nets (ITNs) deteriorates over time during household use, often leading households to discard or stop using damaged nets. This study quantified the extent to which net loss from households is attributable to declining fabric integrity, accounting for variation in user behaviour and environmental conditions.
methodsThis secondary analysis used data from an ITN durability trial in Bagamoyo, Tanzania. A total of 2,514 ITNs (three pyrethroid-PBO and one pyrethroid-only) distributed among 1,509 households were included because they had the outcome of interest (attrition). Fabric integrity was classified as good, damaged, or too-torn according to WHO ITN guidelines and assessed at 12-month intervals. The association between fabric integrity and net attrition over the subsequent 12 months was evaluated using an adjusted logistic regression model, accounting for net type, household risk index, household size, and age of the household head as fixed effects, with household as a random effect.
resultsAttrition increased over time, from 20% at one year to 53% at two years, and 83% at three years post-distribution, and it was associated with net type, household risk index, household size, and age of the household head. Damaged ITNs at one year were more likely to be lost by year two. Compared to nets in good condition, damaged nets had higher odds of attrition (OR: 1.73, 95% CI 1.06-2.82), and too-torn nets were at greater risk (OR: 9.82, 95% CI 5.87-16.4). Similar patterns were observed between years two and three (damaged: OR = 1.55, 95% CI 0.83-2.90; too-torn: OR = 11.7, 95% CI 6.16-22.3).
conclusionFabric integrity was the main driver of rapid ITN attrition and the strongest predictor of loss. Damaged nets were approximately twice as likely to be discarded after one year and at least ten times more likely to be lost in years two and three. These findings highlight the importance of promoting proper net care practices and procuring durable nets that withstand harsh household conditions, ensuring sustained population coverage.
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