Assessment of the coverage, use rate and physical integrity of long-lasting insecticide nets after scaling up of their distribution in Gujarat, India

Abstract

Long-Lasting Insecticidal Nets (LLINs) are a key tool for control and elimination of malaria, by providing protection from the bite of infected mosquitoes. To support its malaria elimination goal by 2030, Gujarat distributed LLINs across 33 districts in 2019. However, sustained effectiveness depends on consistent use and proper maintenance. A household-based cross-sectional survey was conducted in the Anand, Kutch, Panchmahal, and Surendranagar districts of the state of Gujarat in India. A Standard WHO questionnaire was used to assess LLIN coverage, usage, and maintenance. A total of 4719 households were surveyed. Net ownership, usage patterns, physical integrity (Hole size, washing and dry pattern), and maintenance practices were evaluated. LLIN ownership was high (93.8%), but consistent usage was lower (51.9%). Seasonal variation in adherence was observed, with 86.5% of households using LLINs year-round and 91.8% using them while sleeping outdoors. Maintenance practices varied: 76.5% of households washed their nets regularly, but 51.6% dried them in direct sunlight, which may reduce their efficacy. Physical durability was compromised, with 27.3% of nets developing holes due to wear and misuse. Additionally, 23.6% of households repurposed LLINs for activities such as fishing or livestock protection. Despite high coverage, gaps in consistent usage, proper care, and net durability remain challenges. Addressing these through community education, discouraging alternative net use, and improving sleeping conditions is essential to maximize the impact of LLINs. Strengthening behavioral interventions and maintenance practices will enhance LLIN effectiveness and contribute to Gujarat’s malaria elimination efforts.