Why using bed nets is a challenge among minority populations in Central Vietnam

• Published in: Malaria Journal
• Main Authors: Thuan Thi Nguyen, Xa Xuan Nguyen, Marta Wilson-Barthes, Ikumi Sawada, Joan Muela, Susanna Hausmann-Muela, Thanh Vinh Pham, Hong Van Nguyen, Van Van Nguyen, Duong Thanh Tran, Charlotte Gryseels, Umberto D’Alessandro, Koen Peeters Grietens, Annette Erhart
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: Vietnam; Forest malaria; Ethnic minorities; Insecticide-treated nets; Bed net use; Social determinants; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-022-04114-9; https://doaj.org/article/c58195c1f30b46a0b8bd3df9213f2e86

Abstract Background Despite freely distributed insecticide-treated nets (ITNs) and health information campaigns to increase their use among populations at risk, malaria transmission persists in forested areas in Vietnam, especially among ethnic minority communities. A mixed-methods study was conducted in four villages of Ca Dong and M’nong ethnicity in Central Vietnam between 2009 and 2011 to assess factors limiting the uptake of ITNs. Methods The mixed-methods research design consisted of a qualitative study to explore the context and barriers to ITN use, and a cross-sectional household survey (n = 141) to quantify factors for limited and appropriate net use. Results The Ca Dong and M’nong’s livelihood was dependent on swidden farming in the forest. Poverty-related factors, including the lack of beds, blankets, the practice of sleeping around the kitchen fire and deteriorated ITNs due to open housing structures, were reasons for alternative and non-use of ITNs. When household members stayed overnight in plot huts at fields, ITNs were even more unavailable and easily deteriorated. 72.5% of households reported having received one net for every two persons, and 82.2% of participants reported to have used ITNs the night before the survey. However, only 18.4% of participants were estimated to be effectively protected by ITNs after accounting for the availability of torn ITNs and the way ITNs were used, for example as blankets, at both village and fields. Multi-variable logistic regression showed the effect of four significant factors for appropriate ITN use: i) being female (AOR = 8.08; p = 0.009); ii) aware of mosquito bites as the sole cause of malaria (AOR = 7.43; p = 0.008); iii) not sleeping around the kitchen fire (AOR = 24.57; p = 0.001); and iv) having sufficient number of ITNs in the household (AOR = 21.69; p = 0.001). Conclusion This study showed how social factors rooted in poverty and swidden agriculture limited the effective use of ITNs, despite high coverage, among ethnic minority populations in ...