Insecticide-treated nets distribution campaign: Physical integrity, usage and sustainable disposal of end-of-life insecticide-treated nets under operational settings in Odisha, India.

Abstract

Objectives: Prior to 2017, Odisha accounted for 50% of all Plasmodium falciparum cases in India. The 'National Strategic Plan' for malaria elimination had distributed 11.3 million insecticidal treated nets (ITNs) to 23 million individuals in Odisha's 17 malaria-endemic districts by 2017. In 2021, the National Centre for Vector-Borne Disease Control replaced end-of-life ITNs. India needs official regulations on end-of-life ITNs collection and disposal mechanisms. A pilot study was undertaken to understand community practices and perceptions on end-of-life ITNs.

Methods: The 2021 study was conducted during mass ITN replenishment in a campaign mode at Koksara Community Health Centre in Odisha's Kalahandi region. ITN conditions were evaluated using structured questionnaires and household interviews. End-of-life ITNs were evaluated for chemical analyses. Door-to-door assessments of net conditions included noting their presence, attrition rates and fabric integrity. Officials from the Department of Health were consulted on eco-friendly disposal techniques.

Results: In the study region, 6022 ITNs were distributed, of which 5879 (97.6%) were available and 143 (2.4%) were reported as missing 43 months after the campaign (2017). One net per 2.1 persons was distributed. Of the 5879 ITNs, 84.2% were torn, 931 (15.8%) were in good condition and 3472 (59.1%) were serviceable. When combining the ITNs in good condition and those that were serviceable, 74.9% were deemed usable. A total of 3050 respondents were interviewed. Most respondents (98%, 2935/3050) were willing to exchange old ITNs for new ones (92.5%, 5437/5879) when replaced with new ones, highlighting the need for a disposal mechanism at both programme and household levels. Additionally, 61.6% of respondents chose to keep their ITNs, while others repurposed them (7.3% for covering items, 3.0% for fencing, 4.6% for nursery saplings, 5.6% for fishing, 0.4% for other uses). The end-of-life PermaNet 2.0 nets contained an average of 0.33 ± 0.35 g/kg (15.3 mg/m²), while the new nets contained an average of 1.4 g/kg ± 25% (55 mg/m²).

Conclusions: Community input on end-of-life ITN disposal contributes to the development of evidence-based decision support materials, facilitating the formulation of a strategy for the systematic collection and safe disposal of used nets. The lack of an operationally viable solution for the secure disposal of end-of-life ITNs within the National Programs underscores the urgent need for a comprehensive policy framework.