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

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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.

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