The present study made an attempt to draw attention of malaria program and public health authorities in addressing household barriers possibly threatening the effective utilization of LLINs in malaria endemic kebeles. This study unraveled that bedbugs, predominant public health pests, refuge themselves or trapped in the nets after feeding on human that subsequently forcing the users to discard even newly distributed nets within the first six months starting from the two months period. From the field observation held regularly, bedbugs mostly seclude themselves in certain sites of the nets particularly at each corner, i.e., where the sides of the nets join and sewed. Briefly, bedbug infestation of nets and subsequent multiplication in a certain period of time is known to provoke the community to discard their nets intended to serve longer.
The longitudinal field evaluation approach not only generated evidence on continuous declining of the proportion of nets hanging for proper utilization but also methods of estimating nets lost each month before a year. Nevertheless, an LLIN is supposed to serve for three years before it is replaced unless damaged. The present study demonstrated a need for comprehensive and integrated vector control approach that embrace pest control into account in malaria endemic kebeles like Kola Shara kebele. The present study faced some caveats similar to other observational studies. First, resistance patterns to the chemical; as performed elsewhere [22, 23], particularly for the dose recommended to impregnating LLINs was not determined for the bedbug species collected in the present study. This information would have helped us to comment on the simultaneous effect of nets in killing bedbugs to ensure community acceptance. From the field observation of the investigator, it appears that bedbugs require either another dose for effective pest control or improving housing conditions. Second, prevalence of malaria in the study kebele was not simultaneously estimated during the longitudinal study, particularly the infection status for those households that discarded the nets. Finally, the types and status of walls for the houses were recorded and comparison was done. Although the type and status of the walls were documented during the survey, it was not considered in the analysis almost all type of walls had similar pattern in their appearance and cracks that favored the hiding of the bedbug. However, this study employed strong methodological approach, longitudinal study, through engaging local health workers and managed to generate monthly household level information that has never been available. Therefore, the present finding is informative to partly answer questions like ‘why net utilization has never been improved’ in the last decade [4, 5]; despite the blanket coverage of nets freely available to households in endemic kebeles through the support of global fund grants. So far, there was limited attention in exploring the household factors that compromise net utilization and high attrition rate on monthly basis [3–5]. Thus, confidently, the present finding shade light on the effects of bedbug infestation on the proper utilization of nets.
The current study revealed that a certain proportion of the nets were discarded every month with an increasing trend, reaching three-folds during the last survey compared to the first one. In harmony with this study, although household reasons for attrition of nets was obscure, high rate of net loss was documented in central-Ethiopia. Only below one out of ten (90% lost) of the nets were available at the household after two years weekly follow up [5].
The present study also reported the proportion of nets absent during one round was 21% (69/330). The absence of nets most frequently in a household is probably predisposing the family members, especially susceptible groups to malaria. Although a study mentioned that bedbug jeopardize persistent net utilization or barrier to net users [3–5, 12], another study that focused on Bedbug containment practices [9, 13], no detailed evidence available on the magnitude of the Bedbug versus net utilization.
More interestingly, therefore, the finding of the present study might contribute as a base line data for improving malaria vector control through prioritizing household barriers like Bedbugs, which are pests of public health significance worth noting.
Studies revealed the benefit of proper utilization of LLINs apart from protecting malaria vectors has also additional relevance in avoiding bedbugs bite and infestation [9–11]. The present study found that between eight and nine out of ten (87.7%, 289/330) surveyed LLINs were infested by bedbugs. A certain proportion of LLINs were observed to be discarded every month with the perceptions that nuisance effects and blood sucking of the bedbugs is more pronounced than persistent use of nets for malaria vector control. This discrepancy may be due to the differences in geographical areas [9, 11].
The findings of the present study showed that the community considered application of LLINs can cause increase bedbugs infestation in their houses. Similarly, some community members perceived bedbugs infestation can be a result of mosquito nets that LLINs tends to cause an increase in frequency of bedbugs even if in different wall and floor structures. A previous study shows that as a bedbug can contribute on less utilization of LLINs [11, 22]. This most likely bedbug infestation makes a public health problem in the study kebele.
This study revealed that people are more bitten and annoyed by bedbugs rather than a mosquito. The present study found that bedbug infestation was not related with poor sanitation, but difference was observed between studies in Ethiopia [24]. Present study showed that most of the (62.20%, 205/330) invasions of bedbugs were observed in and around sleeping spaces. This finding is in agreement with a previous report from Iran [25]. On the other hand, sleeping under a bed net infested with bedbug was impeding the acceptability and use of malaria preventive measures [22, 26].
Infestations of the houses by bedbugs showed increased from (81.82%, 270/330) to (94.55%, 312/330) in this study. But it was in contrast to study in southern Ethiopia [9]. The findings of this study suggested that LLINs impregnated with Deltamethrin cannot contribute to the reduction of bedbugs in infested houses of Kola Shara Village. Similar reported were found elsewhere [22–24].