Challenges of Proper Disposal of Old Long-Lasting Insecticidal Nets and its Alternative Uses in Rural South-Eastern Tanzania

Introduction Insecticide-treated nets (ITNs) specifically long-lasting insecticidal nets (LLINs) are one of the most commonly used, scalable and cost-effective tools for controlling malaria transmission in sub-Saharan Africa. However, multiple alternative uses of retired LLINs have been observed and are associated with poor disposal practices. Nevertheless, the World Health Organisation (WHO) provided guidelines and recommendations for proper management of worn-out LLINs. This study assessed the existing alternative uses and disposal practices of old LLINs. Methods An explanatory sequential mixed-methods approach was used to assess LLINs existing alternative uses, disposal practices, knowledge and perceptions regarding WHO recommendations on proper disposal of old LLINs among stakeholders in Kilombero and Ulanga districts, southe-astern Tanzania. A survey questionnaire was administered to 384 respondents, Focus Group Discussions (FGD) and Key Informant Interviews (KII) were conducted to clarify responses regarding existing disposal practices with associated challenges and alternative uses of the LLINs. Findings from both study components were used to draw inferences. Results A total of 384 people surveyed, 97% were not aware of the WHO recommendation on proper disposal of old LLINs. The common methods used to dispose LLINs were burning 30.73%, disposing of into garbage pit 14.84% and alternative uses 12.24 %. Of respondents with LLINs (239); 41% had alternative uses while 59% had no alternative uses. The common alternative uses were ropes for tying or covering items 20.92%, garden fencing 7.53%, chicken coops 5.02% and 7.53% for other minor alternative uses. All key informants reported being unaware of the WHO guideline on the proper disposal of the old LLINs. Conclusion This study demonstrates that despite participant’s limited knowledge on WHO guidelines for proper disposal of old LLINs, after presenting these guidelines, majority are willing to comply. Comprehensive efforts are therefore needed to address challenges associated with poor disposal, alternative uses and awareness about WHO guidelines among key stakeholders. Collection strategies should be agreed upon within the community members prior to replacement. Since alternative uses sometimes referred to as repurposing of old nets, proper guidelines should be developed to ensure that repurposing of old LLINs do not cause harm to human health and the environment.