Social and behavioural baseline for guiding implementation of an efficacy trial of insecticide impregnated bed nets for malaria control at nsukka, Nigeria.

Insecticide impregnated bed nets are being tested in many tropical areas as a major tool to control malaria. In a few African countries, there is a history of local bed net production and use, while in most others, ownership of commercially-produced nets is rare due to high costs relative to local income. Such variations in pre-existing bed net use behavior must be studied prior to designing new intervention trials. A "baseline" diagnostic study in Nsukka Local Government of Enugu State, Nigeria, found that local beliefs about malaria causation, which include heat from the sun and hard work, may reduce the perceived efficacy of bed nets as an appropriate malaria control action. While the belief that mosquitos can cause malaria increased with level of formal education, the study also documented that educated people simultaneously hold both indigenous and scientific perceptions about malaria. Although the project provided bed nets, curtains and residual house spray for free, long-term sustainability may be influenced by the main constraint to current ownership of a bed net, i.e., cost. Issues, such as concern about feeling hot under the nets, a tendency to sleep outside during the hot dry season, and variations in people's ideas about what constitutes a malaria episode, point to the need to monitor the bed net intervention. This is recommended as a means of learning how people perceive the efficacy of the nets, whether they use them correctly and whether the intervention can be sustained and integrated into local primary health care programs.