Table 2.

Current challenges to using insecticide-treated bed nets as reported in community-forums

Key themes	Sub-themes	Focus groups reporting theme	Representative quote
Access	Distance	H2, H3, L10	“The health clinic is far from the community members, up to 7 km, therefore going to buy a net is far and it leads to impulse buying of other items needed.” H3
	Cost	H1, H2, H3, H5, L9	“Once distributed to the people on warranty no chances of getting replacement unless you dig deep into your pockets.” L9
	Age-restrictions	H1, H2, H3, H4, H5, H6, L10	“There are problems getting a bed net because they are only given at the health facility on the condition that they belong to pregnant women and children under 5 years” H5
	Stock-outs	H1, H3, L7	“The greatest problem is that statistics taken for bed net supply doesn’t correspond to the actual nets brought for distribution hence most people don’t get the bed nets.” L7
	Replacement	H1, H6	“In some region the bed nets are sold and others given freely.it therefore kill the morale of others to acquire the nets.” H6
Effectiveness	Wears out too soon	H1, H2, H4, H5, L7, L8, L9, L10	“After the washing of the nets the effectiveness of the mosquito repellant fade away and that make it not effective.” L7
	Difficult to maintain/damage easily	H1, H2, H3, H6	“Most nets get burned with tin lamps creating a hole making the net not effective to use” H3
	Quality of distributed nets	H2, L8, L9	“Some of the nets have less effective chemical repellent since they are not retreated and are [ineffective] even though not in bad condition” L9
Side effects	Suffocation	H2, L7, L8, L10	“It also suffocates small children and leads to difficulty in breathing.” L7
	Heat	H4, L8, L10	“We don’t always use a bed net because during the dry spell season it is hot and people do not use the bed net.” H4
	Rash/allergy	H1, H2, H3, H4, H5, H6, L7, L8, L9, L10	“Once one gets into contact with the net which the repellant is still strong, the skin rashes are developed causing discomfort to the skin.” L7
	Family planning	H2	“The belief that the chemical in the bed net is for family planning [keeps them from using it]” H2
	Bad dreams	H4	“Sleeping under a bed net gives one to dream bad dreams.” H4
Lack of knowledge	Don’t understand transmission or importance of using bed net	H1, H2, H4, H6	“[In our] culture [we] believe that we used to sleep without nets why use it now?” H2
	Not aware of how to maintain bed net	H1, H2, H3, H4, H6, L7, L8	“Those who distributed them never taught us how to use them.” L8
	Use for other purposes	H1, H2, H4, H5, H6	“A bed net is a multi-purpose item. Some use it for decoration and curtains, fishing, rope to tie animals.” H4
Logistical/convenience	Hanging	H1, H2, H3, H4, H5, H6, L7, L8, L9, L10	“Hanging a bed net is a problem especially one without a ring. It is difficult because at night when you are tired you simply sleep.” L10
	Not attractive	H1, H2	“Some people are attractive to certain colours when a bed net is dull they don’t go for it.” H1
	Difficult to keep clean	L8, L10	“They become dirty very easily and they are difficult to [re]hang” L10
	Sleeping space too small	H1, L8	“Squared bed net consume space therefore some rooms are not enough.” H1
	Believe only for use with bed	H3, H4	“Some believe that bed net is used only on bed net on sleeping on the floor.” H3

Key themes were identified a priori and sub-themes were determined during the analysis phase. H/L# refers to the community forum site (H highland, L lowland and the community-forum number)