Use of Bed Nets and Factors That Influence Bed Net Use among Jinuo Ethnic Minority in Southern China
Havumaki J (2014) Use of Bed Nets and Factors That Influence Bed Net Use among Jinuo Ethnic Minority in Southern
China. PLoS ONE 9(7): e103780. doi:10.1371/journal.pone.0103780
Use of Bed Nets and Factors That Influence Bed Net Use among Jinuo Ethnic Minority in Southern China
Jian-wei Xu 0
Yuan-mei Liao 0
Hui Liu 0
Ren-hua Nie 0
Joshua Havumaki 0
Roly D. Gosling, University of California, San Francisco, United States of America
0 1 Yunnan Institute of Parasitic Diseases , Puer , China , 2 Health School of Ganzhou , Jiangxi Province, Ganzhou, China, 3 Foundation for Innovative New Diagnostics, Cointrin/Geneva , Switzerland
Background: Insecticide-treated nets (ITNs) are an integral part of vector control recommendations for malaria elimination in China. This study investigated the extent to which bed nets were used and which factors influence bed net use among Jinuo Ethnic Minority in China-Myanmar-Laos border areas. Methods and Findings: This study combined a quantitative household questionnaire survey and qualitative semi-structured in-depth interviews (SDI). Questionnaires were administered to 352 heads of households. SDIs were given to 20 key informants. The bed net to person ratio was 1:2.1 (i.e., nearly one net for every two people), however only 169 (48.0%) households owned at least one net and 623 (47.2%) residents slept under bed nets the prior night. The percentages of residents who regularly slept under nets (RSUN) and slept under nets the prior night (SUNPN) were similar (48.0% vs. 47.2%, P.0.05), however the percentage correct use of nets (CUN) was significantly lower (34.5%, P,0.0001). The annual cash income per person (ACIP) was an independent factor that influenced bed net use (P,0.0001), where families with an ACIP of CNY10000 or more were much more likely to use nets. House type was strongly associated with bed net use (OR: 4.71, 95% CI: 2.81, 7.91; P,0.0001), where those with traditional wood walls and terracotta roofs were significantly more likely to use nets, and the head of household's knowledge was an independent factor (OR: 5.04, 95% CI: 2.72, 9.35; P,0.0001), where those who knew bed nets prevent malaria were significantly more likely to use nets too. Conclusions: High bed net availability does not necessarily mean higher coverage or bed net use. Household income, house type and knowledge of the ability of bed nets to prevent malaria are all independent factors that influence bed net use among Jinuo Ethnic Minority.
Funding: The authors thank the fifth grant to China of the Global Fund to fight AIDS, Tuberculosis and Malaria for financial sponsorship. The funder had no role
in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Malaria is a global disease. The World Health Organization
(WHO) estimated that between 2000 and 2010, global malaria
incidence decreased by 17% and malaria-specific mortality rates
decreased by 26%. Reported malaria cases have reduced by more
than 50% in 34 of the 99 malaria endemic countries .
Currently, malaria prevalence is decreasing and 32 of the 99
countries have either declared a national policy for malaria
elimination or are pursuing spatially progressive elimination within
their borders [2,3]. Countries in the Asia Pacific region are making
substantial progress towards eliminating malaria . China has
seen a great reduction in malaria burden, and is aiming to
eliminate malaria by 2020 . Vector control is one strategy that
China is employing to eliminate malaria. This method requires
that more than 90% of the population in ongoing transmission
areas has at least one method of protection against mosquitoes.
Therefore insecticide-treated nets (ITNs) are an integral
component of the recommendations for vector control .
In China, Yunnan province has the heaviest burden of malaria
among the countrys 31 Provinces/Municipalities/Autonomous
Regions, 1522 (34.0%) of 4479 malaria cases reported in the
country in 2011 were from Yunnan . Chinas border areas
originally belonged to hyper-endemic malaria zones. The Jinuo
People, whose language belongs to the Tibetan-Burman group of
the Sino-Tibetan family , are an ethnic minority living in the
China-Myanmar-Laos border area of the Yunnan Province in
southern China. The burden of malaria is substantial amongst
Jinuo People . The Jinuo people used slash-and-burn
agriculture for rice and maize before 1958. They then started small-scale
rice cultivation in irrigated paddy fields. Rubber growing was
introduced into the Jinuo Mountain Area in the 1990s. Currently,
rubber typping is the main source of economic income in the
region. Rubber tappers may bring malaria into the community.
Workers go into the forest at 3:004:00 am to tap rubber. They
may contract malaria in the forest and bring it into the
community. The results of a survey conducted in 56 villages of
Jinuo Mountain Township showed that 153 (10.3%) of 1500
residents had a malaria episode between March to November
1993. There was a 5.8% (30/513) parasite rate amongst febrile
patients in Jinuo Mountain Township in 1993 . This was
significantly higher (x2 = 11.48, P = 0.0007) when compared with
the 3.1% (19489/620778) rate in Yunnan province  in 1993.
The WHO Global Malaria Program has recommended full
coverage of long lasting insecticidal nets (LLINs) in areas targeted
for malaria prevention . However, the use of bed nets among
ethnic minorities is not well researched. This study investigated the
extent bed nets including untreated nets, ITNs and LLINs are
used and also which factors influence bed net use among the Jinuo
Ethnic Minority from July to September, the high risk season of
Study site and population
This study was conducted on China-Myanmar-Laos border,
Xishuangbanna prefecture in southern Yunnan, China (Figure 1).
Jinuo tribe was recognized as an ethnic minority by the Chinese
government in June 1979. It was the last of the 55 ethnic minority
groups to be recognized in China. There are about 20,000
members of the Jinuo ethnic minority and they live in 56 villages
on the Jinuo Mountain. The Jinuo Mountain has a tropical rain
forest climate. Therefore, malaria is a substantial public health
problem among the Jinuo people. Both Plasmodium falciparum
and P. vivax are prevalent . Malaria vectors are complex, and
the primary vector is Anopheles minimusis. Peak malaria
transmission occurs during the rainy seasons from May to
November each year [13,14].
The study combined a quantitative household questionnaire
and qualitative semi-structured in-depth interviews (SDIs). The
data collection tools (questionnaires and SDI guidelines) were
developed in Chinese because the Jinuo language is only a spoken
language and most heads of households understand Chinese.
When a respondent did not understand Chinese, a researcher
from Jinuo Township Hospital who understands both Jinuo and
Chinese conducted the interview in the Jinuo language and then
filled the questionnaire in Chinese. Households were the units of
sampling. The list of households for sampling was obtained
through the three Villager Committee Offices in Jinuo Mountain.
Ten out of the 56 villages were sampled by a simple computer
randomization, and then every household in each selected village
was surveyed. A sample size of 350 households was required for
the 5% precision around a 35% point estimate for the proportion
of community residents sleeping under nets the prior night and
95% of confidence limits. A household was defined as all those
eating from the same cooking pot. The interviewers first
introduced the purpose of the project, the topic and type of
questions. Then an oral informed consent was obtained, and
finally the questionnaire was administered to heads of households.
When permission was obtained, all bed nets in each household
were checked to determine how much they had been used and
their textile integrity.
Semi-structured in-depth interviews
Structure in-depth Interviews (SDIs) were administered to 20
key informants to explore potential factors which influenced bed
net use. The key informants consisted of two staff members that
were responsible for control of communicable diseases in the Jinuo
Township Hospital, seven health workers who worked for the ten
selected villages, six village leaders who were appointed by the
local government and five representatives of the villagers who were
selected by recommendations from their fellow villagers during the
household survey. The key informants discussed local health
problems, malaria incidence, perception of the villagers, symptoms
and treatment seeking behavior, transmission and prevention of
malaria, and finally factors which influence the use of bed nets.
The use of bed nets was categorized as regularly sleeping under
bed nets (RSUN), sleeping under bed nets the prior night
(SUNPN) and correct use of bed nets (CUN). RSUN was defined
as a person who reported habitually using nets on a daily basis.
CUN was defined as an individual who closes the net and puts the
hemline under the mattress before sleeping. Annual cash income
per person (ACIP) was used as a surrogate for socioeconomic
status because ACIP is more easily obtained. Every household
owns a rubber plantation, and rubber tapping is the main source
of income in the region. Nets were classified in three ways;
untreated nets, ITNs and LLINs. An untreated net was either
never treated or had been treated with insecticide 12 or more
months prior to the survey. An ITN was treated less than 12
months prior to the survey. There is a gradual loss of insecticide
over time in LLINs, reducing their protective effect. LLINs
therefore expire three or more years after their production;
however the dates of LLIN production could not be identified in
the survey, so the LLIN were therefore defined as having been
owned for three years or less. Personal characteristics of family
members (PCFM) and characteristics of households and household
heads (CHHH) were examined separately to determine factors
that influence bed net use. PCFM are characteristics of a person in
each household. CHHH are characteristics of a household and
head of household who responded during the interview survey.
Double data entry and cleaning of quantitative data was done in
Epidata 3.1. The dataset was then analyzed in EpiInfo 7.
Household ownership, coverage and use of untreated nets, ITNs
and LLINs were all analyzed. Chi-squared test compared the
percentage of the bed net use across different demographic groups.
Sleeping under nets the prior night (SUNPN) was used as the
outcome variable to decrease recall bias. Personal characteristics of
family members were independent variables; a multivariate logistic
model was used to assess the association of personal variables and
the use of bed nets. Meanwhile, SUNPN for at least one family
member was the outcome variable and the characteristics of
households and their heads of households (respondents) were
independent variables. The multivariate logistic analysis was
conducted to analyze these difference factors and their impact
on the use of nets. Qualitative data analysis was carried out to
explore potential factors which influence the use of bed nets.
Qualitative data analysis was conducted with support of TAMS
3.0 software. The data were encoded on the basis of emerging
themes and a codebook was created. Trends in the data were
identified by producing matrices which combined and compared
information from the different key informants.
According to the Helsinki Declaration, ethical approval for the
study was granted by the Ethics Committee of Yunnan Institute of
Parasitic Diseases, China. The Ethics Committee approved a
verbal consent procedure as sufficient because the study was
interview-based, and did not include any human specimens. The
purpose and procedures of the study were explained and disclosed
to all participants before obtaining informed consent. They could
choose whether or not to participate in the study, and could also
refuse a response to any question at any time. The participants
were for oral consent at the start of the survey and were advised
that they could skip questions or end the interview at any time.
Their consent was assumed if they did not refuse to answer
questions. No one was coerced into participation in the study and
if individuals wanted to withdraw from the study, they were
allowed to do so without any issue.
Characteristics of respondents
The total number of households was 482 across the ten sampled
villages. 370 households were available at the time of sampling and
18 of them chose not to participate in the study. Three hundred
and fifty two households with a total 1319 individuals participated
in the questionnaire survey. The median of annual cash income
per person (ACIP) of 352 households was CNY6667 (range
CNY37537500) or about US$1092 (range US$ 626148).
Questionnaires were administered to 287 (81.5%) male and 65
(18.5%) female heads of households. The mean age of the 352
respondents was 41.3 (95% CI, 40.0, 42.5) years old. Three
hundred and twenty one (91.2%) of the respondents were married.
One hundred and eighty two (51.7%) of the respondents
completed secondary school or higher, 154 (43.8%) had completed
primary school and 16 (4.5%) were illiterate. The median number
of family members was four (range 19) persons. The twenty key
informants who were interviewed were composed of 10 males and
10 females ranging from 26 to 52 years old.
Ownership and types of the bed nets
Ownership of bed nets was low among the Jinuo ethnic
minority. One hundred and sixty nine (48.0%) households owned
at least one net, reporting a total of 633 nets amongst all
households. Three hundred and fifty eight (56.6%) nets were
untreated nets s, 126(19.9%) were ITNs and 149 (23.5%) were
LLINs. The net to person ratio was 1:2.1(nearly one net for every
two people). According to villager-self report in the survey, 482
(76.1%) of the nets were obtained by the villagers themselves
commercially. Based on records of LLIN distribution in Jinuo
Township Hospital, only 149 (23.5%) of free LLINs were delivered
by the national malaria elimination program. One hundred and
forty five (41.2%) of households owned at least one ITN or one
LLIN. Eighty four (13.3%) nets were cotton textile and 549
(86.7%) were polyester-based. One hundred and thirty three
(21.0%) nets had at least one hole (Figure 2).
Use of the bed nets
The rate of bed net use was low; the key informants estimated
that only half of residents consistently slept under the nets. Results
from the survey revealed that 686 (52.0%) residents had never
slept under nets, 633 (48.0%) residents regularly slept under the
nets (RSUN), and 623(47.2%) residents slept under the nets the
prior night (SUNPN). The SUNPN group included 353 (26.8%)
residents who used untreated nets, 124 (9.4%) used ITNs and 146
(11.1%) used LLINs. Total RSUN and SUNPN use was similar
(P.0.05), however the proportion (34.5%)of correct use of the nets
(CUN) was significantly lower (P,0.0001) than RSUN and
SUNPN (table 1).
Bed net use was then categorized by age, educational status and
annual cash income per person (ACIP). The percentage of CUN
was significantly lower than RSUN and SUNPN for all categories
except for those who had completed senior middle or higher
education. Rates of bed net use including RSUN, SUNPN and
CUN were approximately equal between males and females (P.
0.05). All five villager representatives said that The oldest and the
ill residents commonly slept under the nets more. Additionally,
children under five years old had a slightly higher rate of use than
other age categories (P,0.05). It was observed that children under
five years old slept under the nets more correctly than those aged
50 years or older, older people usually paid less attention to CUN
and the maintenance of bed nets. Education status did not
significantly predict differences in the bed net use (P.0.05).
However, bed net use rates were significantly different in the four
categories of economic status. Families with an ACIP of
CNY10000 or more were much more likely to use nets, their
rates of RSUN, SUNPN and CUN were 88.89%, 87.58% and
72.55% respectively (table 1).
Influence factors on use of the bed nets
In summary of the qualitative study, only people of Balaxia
Village considered it important to use nets; however people in nine
out of the ten selected villages did not feel it was important to sleep
under bed nets. Reasons include that they felt it was too hot to
sleep under bed nets, they did not feel at risk for malaria infection,
they could burn mosquito coils and spray insecticides instead of
bed net use, they found hanging bed nets to be troublesome, and
others said that they didnt have enough money to buy bed nets.
The results of the multivariate logistic regression analysis
(MVLRA) showed that economic status was strongly associated
with bed net use. The three poorest categories were significantly
less likely to use nets than those with more than CNY10000 ACIP
(P,0.0001). Residents who slept outside at night were slightly less
likely to use nets than those that didnt (OR: 0.58, 95% CI: 0.32,
0.94; P = 0.047) in the hot season (table 2).
The qualitative information from the SDIs and household visits
indicated that people living in modern houses used nets less
because there are fewer holes reducing vector entry in modern
houses. Additionally, they tended to use other measures such as
window screens and mosquito coils. MVLRA of household
variables and respondents identified that house type was strongly
associated with use of the bed nets (OR: 4.71, 95% CI: 2.81, 7.91;
P,0.0001), where those with traditional wood walls and terracotta
roofs were significantly more likely to sleep under nets the prior
night. Additionally, respondents living in houses with windows and
screen doors were less likely to use nets (OR: 0.54, 95% CI: 0.29,
0.99; P = 0.045) (table 3).
One villager head commented, Providing information on the
risk of mosquitoes such as transmission of malaria and other
communicable diseases, communicating on the benefits of the bed
nets, especially ITNs and LLINs and providing free bed nets will
promote the use of nets. Results of MVLRA showed that bed net
use was not associated with head of households knowledge about
malaria transmission, however it was closely related to the
knowledge that the bed nets prevent malaria infection (OR:
5.04, 95% CI: 2.72, 9.35; P,0.0001), where those who knew bed
nets preventing malaria were significantly more likely to use nets
Figure 2. Percentage for categories of bed nets in Jinuo Ethnical Minority, Yunnan Province, China.
Male (n = 671)
Female (n = 648)
#5 (n = 98)
$50(n = 279)
Illiterate (n = 266)
Primary (n = 425)
Junior mid (n = 514)
#6000 (n = 241)
60018000 (n = 453)
800110000 (n = 472)
.10000 (n = 153)
Total (n = 1319)
Senior mid or higher (n = 114)
Annual cash income per person (CNY)
(table 3). A village health worker in Balaxia, the site of a malaria
outbreak in 2000, said, In the malaria outbreak, many people
contracted malaria. The outbreak improved awareness and
knowledge of malaria among the villagers. They know bed nets
are effective in preventing malaria. Currently, in our village, bed
nets are available in every house and most people use them.
Furthermore, bed net use has become part of our normal living
habits. Most of the villagers, including those living in modern
houses, always sleep under the nets. The village head of Balaxia
commented Not only do nets prevent mosquito bites, but they
also prevent nuisances caused by other pests such as cockroaches,
bedbugs and fleas. Additionally, the nets are dustproof, windproof
and preserve warmth in the winter.
Yunnan province has one of greatest burdens of malaria in
China, and Jinuo Mountain is one of the highest endemic areas in
China. Of 352 households visited, 169 of them had any nets.
Together these 169 houses owned 633 nets. Only 47.2% of 1319
residents surveyed had slept under them the previous night. Two
hundred and fifty (19.0%) of the nets were ITNs or LLINs. One
hundred and forty five (41.2%) households owned at least one
LLIN or ITN. The results of a survey for the Fifth Round of China
Global Fund Malaria Project in 2007 showed that 65.8% (25797/
39234) of households owned at least one net and 8.68%(3404/
39234) owned at least one ITN in Yunnan province . With the
implementation of The National Malaria Control Program,
coverage and use of ITNs and LLINs increased in Yunnan.
89.7% (278/310) of households owned at least one LLIN or ITN
and 30.6% (789/2582) had slept under LLINs or ITNs the
previous night by 2010 . This shows that the ownership of
general nets, ITNs and LLINs, and the use of ITNs and LLINs
among Jinuo ethnic minority are lower than the mean in the rest
of Yunnan. The results of the study also indicated that Jinuo
people did not have equal to access bed nets because 482 (76.1%)
of the nets used were procured by villagers themselves
commercially, and only 149 (23.5%) of LLINs were free from the national
malaria elimination program.
More than 80% of the residents in Tanzanian households which
have a net to person ratio better than 1:4 reported using a net the
previous night . While a net to person ratio of 1:2.1 among the
Jinuo people only ensured that 47.2% of people slept under bed
nets the previous night. MVLRA identified that annual cash
income per person (ACIP) was significantly associated with the bed
net use (p,0.0001). Overall, free distribution of bed nets can
increase their coverage and equity. When commercial sectors are
responsible for bed net availability, the ownership and use of nets
is concentrated among the richest families . For instance, the
Univariate OR (95% CI)
Adjusted OR (95% CI)
Male (n = 671)
Female (n = 648)
,15 (n = 189)
1549 (n = 851)
$50 (n = 279)
Illiterate & prim (n = 691)
Mid or higher (n = 628)
#6000 (n = 241)
60018000 (n = 453)
800110000 (n = 472)
.10000 (n = 153)
Yes (n = 307)
No (n = 1012)
Annual cash income per person (CNY)
Rest outdoor at night of hot season
*SUNPN = sleeping under a net the prior night.
Wa people in a focus group discussion in Yunnan said if nets
were provided bed nets freely, we would use them . On other
hand, more than other vector control methods, ITN programs
largely depend on the acceptance and active involvement of
communities. Involvement of communities in promoting use of
bed nets also depends on their knowledge, perception, attitude and
behavior towards nets [20,21]. Knowledge, information and
distribution of free bed nets are established as the first step
towards encouraging the use of nets . The MVLRA did not
identify the association between the net use and head of
households knowledge of the cause of malaria and its
transmission. However, the knowledge that bed nets prevent malaria was
an independent factor for bed net use. This indicated that among
the Jinuo ethnic minority, direct knowledge worked better than
more technical knowledge such as the cause of malaria and the life
cycle of parasites. When considering strategies to encourage
behavioral changes among the Jinuo people, special attention
should be given to what points should be communicated. On other
hand, knowledge itself was not sufficient to guarantee bed net use.
This is because knowledge does not always confer a certain
behavior or action. Individual perception, awareness, the
availability of nets and an environment which enables net use are
necessary for behavioral change . House type and
availability of windows and screen doors was strongly associated
with bed net use among the Jinuo Ethnical Minority. Additionally,
residents who slept outdoors at night during the hot season were
less likely to use nets than others. They said sleeping under nets is
uncomfortable and hanging a net is a burden during the SDIs.
The Wa people also said sleeping under a net is too hot, so
villagers prefer not to use it . These results indicate that
human, socio-economic and the environmental factors can all
affect the use of bed nets. Additionally, the nuisance of mosquitoes
and perceived threat of malaria were the main determinants of bed
net use . In Balaxia village, most people have been sleeping
under bed nets since the outbreak of malaria in 2000. Whereas in
other nine villages, people did not sleep under bed nets because
they felt like the risk of malaria was very low. The villager
representatives commented, Malaria was common ten years ago,
but now it is difficult to find or has disappeared entirely.
The epidemiological trends of malaria have changed in
countries where it is targeted for elimination which are often
predominantly adult men, with shared social, behavioral, and
geographical risk characteristics . Most Jinuo families earn
their income from rubber tapping. Adults go the forest at 3:00
4:00 am to tap rubber. Therefore bed nets are unlikely to prevent
malaria transmission for these rubber tappers since they are
exposed at night. They might then bring malaria from the forest
into the community. Bed net use within this community can
prevent malaria transmission from the malaria infected workers to
others. Therefore, bed net use within this community is very
important for both these workers and other villagers. On the other
hand, other measures, such as topical and spatial repellents for
rubber tappers are needed. Additionally, among villagers,
longlasting insecticidal hammocks and mosquito traps should be used
before sleeping and throughout the night for those that sleep
The study had several limitations. Firstly, considering the low
prevalence of pregnant women and low malaria incidence in
general, information on pregnant women was not specifically
gathered. Therefore, the study has not identified whether pregnant
women were more likely to sleep under nets. Secondly, if
demographic groups are not similar, bias might be introduced
. Selection bias and information bias may have influenced the
study results. One hundred and twelve (23.2%) households were
not available at the time of sampling, and 18 (3.7%) households
chose not to participate in the study. However it is not known why
residents were away from their homes or why they opted out of
participating in the study. This might have led to selection bias.
Univariate OR (95% CI)
Adjusted OR (95% CI)
Sex of respondents
Male (n = 287)
,35 (n = 101)
$35 (n = 251)
Age (years) of respondents
Marriage status of respondents
Married (n = 321)
Single (n = 31)
#5 (n = 197)
.6 (n = 155)
Husband (n = 175)
Wife or co-decision (n = 177)
Traditional (n = 173)
Modern (n = 104)
Window and door screen
Yes (n = 91)
No (n = 261)
Yes (n = 185)
No (n = 167)
Yes (n = 202)
No (n = 150)
Yes (n = 244)
No (n = 108)
Household heads knew malaria cause
Household heads knew malaria transmission
Household heads knew bed nets against malaria infection
*SUNPN1 = sleeping under a net the prior night at least one family member.
However, the selection bias would be limited because 73.1% of
households were involved in the study. Despite the analysis
adjusting for sex and age to identify independent influence factors,
a higher proportion (81.5%) of male respondents might have also
caused selection bias. Data on relatively sensitive topics, such as
annual cash income per person (ACIP) was obtained by
selfreporting. This is a potential source information bias. In the
interviews, the validity of ACIP was confirmed through the
number of rubber trees owned by each household.
In Conclusion, high bed net availability does not necessarily
mean higher coverage or bed net use. The household income,
house type and knowledge of the ability of bed nets to prevent
malaria are independent influence factors which influence bed net
use among Jinuo Ethnic Minority.
We are grateful to Dr Kang Zhu from Jinuo Township Hospital for his
interviewing the respondents who could not understand Chinese; and Dr
Qiang Huang from Jinghong Center for Disease Control and Prevention
for his coordination of the field survey. The study would not have been
possible without the generous and willing cooperation of the study
Conceived and designed the experiments: JWX YML HL. Performed the
experiments: JWX YML HL RHN. Analyzed the data: JWX YML JH HL.
Wrote the paper: JWX YML JH HL RHN.
1. WHO ( 2011 ) World malaria report 2011 . Geneva: World Health Organization.
2. Feachem RG , Phillips AA , Hwang J , Cotter C , Wielgosz B , et al. ( 2010 ) Shrinking the malaria map: progress and prospects . Lancet 376 : 1566 - 1578 .
3. Tatem AJ , Smith DL , Gething PW , Kabaria CW , Snow RW , et al. ( 2010 ) Ranking of elimination feasibility between malaria-endemic countries . Lancet published online Oct 29. DOI: 10.1016/S0140-6736(10)61301-3.
4. Gosling RD , Whittaker M , Gueye CS , Fullman N , Baquilod M , et al. ( 2012 ) Malaria elimination gaining ground in the Asia Pacific . Malaria Journal 11 : 346 .
5. Ministry of Health , People's Republic of China ( 2010 ) Malaria elimination action plan 2010-2020 (in Chinese) . Beijing: The Ministry of Health.
6. China Centre for Diseases Control and Prevention ( 2011 ) Technical guidelines for malaria elimination (in Chinese) . Beijing: China Centre for Diseases Control and Prevention.
7. Xia ZG , Yang MN , Zhou SE ( 2012 ) Malaria Situation in the People's Republic of China in 2011 . Chin J Parasitol Parasit Dis (abstract in English) 30 : 419 - 422 .
8. Gai X ( 1986 ) Jinuo-yu Jianzhi (Introduction of the Jinuo Language) . Kunming: Minzu Press.
9. Xu JW , Liu H ( 1997 ) Border malaria in Yunnan , China. Southeast Asian J Trop Med Public Health 28 : 456 - 459 .
10. Zhou HN , Dong LM ( 1994 ) An epidemiological survey on malaria in Jinuo Mountain . J practical parasit dis (in Chinese) 2: 44 - 45
11. Zhu DF ( 1997 ) The implementation of the eighth malaria control program and situation analysis in Yunnan Province . J practical parasit dis (in Chinese) 5: 45 - 46
12. WHO ( 2007 ) WHO Global Malaria Programme: Position Statement on ITNs . Geneva: World Health Organization.
13. Dong XS ( 2000 ) The malaria vectors and their ecology in Yunnan Province (abstract in English) . Chin J Parasit Dis 13 : 144 - 147 .
14. Dong XS ( 2010 ) The mosquito fauna of Yunnan Province . Kunming: Yunnan Science and Technology Press (abstract in English): 49 - 84 .
15. Zhou S , Yang R , Lv Q , Yang ZH , Du LF et al. ( 2009 ) Situation analysis of insecticide treatment bed net in Yunnan malaria endemic areas and its generalization strategy . Chin J Vector Bio & Control (abstract in English) 20 : 326 - 328 .
16. Li BF , Yang YM , Xu JW , Chen GW , Zhou S et al. ( 2013 ) Baseline investigation of the national malaria elimination program and projects funded by the Global Malaria Fund in Yunnan Province . J Pathogen Bio (abstract in English) 8 : 448 - 472 .
17. Tsuang A , Lines J , Hanson K ( 2010 ) Which family members use the best nets? An analysis of the condition of mosquito nets and their distribution within households in Tanzania . Malaria Journal 9:211
18. Noor A M , Amin AA , Akhwale WS , Snow WS ( 2007 ) Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children . PLoS Medicine 4 ( 8 /e255): 1341 - 1348 .
19. Xu JW , Xia M , Tao H , Zhong YC , Wu XH et al. ( 2004 ) Current situation, attitudes and scaling up obstacles toward usage of bednets in Wa ethnic . China Trop Med 4 : 319 - 332 .
20. Stewart T and Marchand RP ( 2002 ) Factors that affect the success and failure of insecticide treated net programs for malaria control in SE Asia and the Western Pacific . Manila: WHO/WPRO.
21. Xu JW , Wu XH , Zhong YC ( 2004 ) Bednet use and influential factors of two ethnical minorities at China-Myanmar border (abstract in English) . Chin J Schisto Control 16 : 51 - 53 .
22. Mishra RN , Singh SP , Vanlerberghe V , Sundar S , Boelaert M , et al. ( 2010 ) Lay perceptions of kala-azar, mosquitoes and bed nets in Bihar India . Trop Med Int Health 15 (suppl. 2): 36 - 41 .
23. Atkinson AJ , BobogareA, Fitzgerald L , Boaz L , Appleyard B , et al. ( 2009 ) A qualitative study on the acceptability and preference of three types of long-lasting insecticide-treated bed nets in Solomon Islands: implications for malaria elimination . Malaria Journal 8 : 119 .
24. Xu JW , Wu XH , WEI C , Petlueng P , Tao H , et al. ( 2010 ) A pilot study on strengthening malaria control for ethnic minorities (abstract in English) . Chin J Vector Biol Control 21 : 527 - 530 .
25. Xu JW , Liu H ( 2012 ) The Challenges of malaria elimination in Yunnan Province , People's Republic of China. Southeast Asian J Trop Med Public Health 43 : 819 - 824 .
26. Cotter C , Sturrock HJW , Hsiang MS , Liu J , Phillips AA , et al. ( 2013 ) The changing epidemiology of malaria elimination: new strategies for new challenges . Lancet, published online Apr 15. http://dx.doi.org/10.1016/S0140- 6736(13)60310- 4 .
27. Sochantha T , Van Bortel W , Savonnaroth S , Marcotty T , Speybroeck N , et al. ( 2010 ) Personal protection by long-lasting insecticidal hammocks against the bites of forest malaria vectors . Trop Med Int Health 15 : 336 - 341 .
28. Thang ND , Erhart A , Speybroeck N , Xa NX , Thanh NN , et al. ( 2009 ) Longlasting insecticidal hammocks for controlling forest malaria: a community-based trial in a rural area of Central Vietnam . PLoS One 4 : e7369 .
29. Ward KA , Spokes PJ , McAnulty JM ( 2011 ) Case-control study of risk factors for hospitalization caused by pandemic (HIN1) 2009 . Emerging Infectious Diseases 17 : 1409 - 1416 .