A total of 255 bednets were collected 38 months after distribution in Lawra District of northwest Ghana to examine their physical condition and residual insecticide levels. Physical condition varied from nearly pristine to highly damaged. In 50 selected nets, 2023 holes > or = 0.5 cm and 31 holes > or = 10 cm were counted. The incidence of holes increases toward the bottom edge of the net. Seam failures were found in 50% of the nets. Repairs, mostly sewn, were evident in 64% of the nets. Using a combination of bromine x-ray fluorescence (XRF) spectrometry, high-pressure liquid chromatography, and cone bioassays, it was determined that 14.9% of the nets had retained full insecticidal strength. These results highlight the value of real-world data on bednet longevity to guide decisions regarding mosquito control strategies, bednet purchasing, frequency of bednet replacement, and product development.