Table 5 Barriers against LLIN use as identified through focus group discussions, in-depth interviews, and key informants interviews

Insufficient access to LLINs within households: Some participants complained they do not have sufficient number of LLINs for all household members

“I have four beds in my household but got only one LLIN, how will we prevent ourselves from having malaria” (FGD, Netrokona)

Shape of the net: Given the rectangular nature of the nets, it is not comfortable to hang over sleeping area, ‘incompatibility with sleeping arrangements and house style’

Sleeping outdoor: Many FGD and key informants mentioned that the family members who slept outdoors for work (especially woodcutter, zoom cultivator) cannot always use LLINs

Migration: The study documented some people who migrated in Bandarban district and those who are facing a shortage of LLINs. So that they mostly use normal mosquito nets or coils to avoid mosquito bites at night. SK of Bandarban told us that there are some families and also single individuals who regularly migrate from rural to urban areas. Some of the families came before survey and some not, but only the families who come before survey can get LLINs. Individuals living in mess/shared rooms for the purpose of education or service were not usually counted as a programme beneficiary

Perceived low efficacy of LLINs: Some participants argued that mosquito net is not of good quality as before. One of the participants mentioned

“The LLINs we received previously from BRAC was of very good quality indeed; once we hanged those nets there we couldn’t find any mosquito in that whole room but now using this LLINs we found poor quality from our experiences. This net is more or less similar with an ordinary mosquito net because we found mosquito with it even after hanging before sleeping.” [FGD participant]

Fear of physical problems: Some may have faced various physical problems while using LLINs: burning inside eye, body itching and dyspnea were major physical problems quoted by participants in FGD sessions. According to the statements of those who had faced such problems never used LLIN in their household for a long time. One also reported a household who received LLINs in 2014. During the first time they were not very aware of usage procedure of LLINs and found a burning sensation inside eye as a side effect of LLINs. So they moved the mosquito net and started using coil instead. Another example might show the problem of body itching and dyspnea during LLIN use. They also moved the mosquito net but they never tried nor understood to look for a solution

“Some people complained that they suffered from burning eyes, swelling of the eye after using LLINs. Some people complained that it has bad smell” (SS, Kolmakanda)

Saving LLIN for another time: People mentioned that they saved the nets for someone

“A mother kept her LLIN for her son. Her son works in India and often comes home. So she and her daughter are using the normal bed nets, saving the LLIN for her son”

Lack of knowledge. Some people do not use LLINs because of their lack of knowledge regarding the importance of LLINs

“Some people do understand. I have seen some family that pregnant mothers or under five children are sleeping under normal bed nets, whereas other family members are using LLINs. Because they do not understand the difference between LLINs and normal bed nets” (SS, Kolmakanda)

Uncomfortable: another reason for not using LLINs

“I am pregnant and I feel a sense of breathlessness whenever I use LLIN. Every time I hang LLIN I feel sick. So I use mosquito coil for safety.” (IDI, pregnant women)

Presence of a guest: LLINs are distributed according to family members, so, if the family has a guest, some members have to sleep without LLINs

“We have four members in our family but we have only one mosquito net. In this situation my father-in-law might come someday and we only have one mosquito net. How would it be possible to manage the situation with one net? Though we received 1 mosquito net almost 3 years ago and after that we received another one. But day after day those nets became quite obsolete to use so we put them underground.” (IDI, Netrokona)