Key Findings

Ongoing malaria transmission is the malaria transmission that remains after universal coverage of long-lasting insecticidal nets (LLINs) has been achieved. This study showed that universal coverage of LLINs has not been achieved in the study sites, and therefore not all of the malaria cases seen could be attributed to ongoing malaria transmission.

• Not enough LLINs had been distributed to cover each family member, and the LLINs provided were not sized for family beds.

• LLINs were unavailable in the village markets, and concerns existed about the impregnation of nets with insecticides.

• Substandard net maintenance and treatment was prevalent, and villagers used damaged nets.

• There was limited to no use of mosquito nets in farm and forest sites. This was because families did not have spare nets to take to their farm huts, nets were cumbersome to carry, or it was not possible to use nets in the farm and forest environments.

This study also showed that even if every individual in the study site were to use an LLIN when asleep, malaria transmission could still occur. This was due to a number of reasons, most notably:

• Mosquitoes fed before people went to bed in the evenings and after they woke up in the mornings.

• Mosquitoes displayed preference for outdoor feeding (exophagy) and animal feeding (zoophily). By remaining outdoors and feeding on animals, mosquitoes escaped contact with IRS and LLINs.

• Higher mosquito abundance existed in forested areas, which is also where LLINs were used less frequently or could not be used.