BackgroundMany countries across sub-Saharan Africa are rapidly increasing insecticide-treated net (ITN) coverage to combat malaria, but systematic data on the use of those ITNs and the factors affecting this use are scarce.MethodsA household survey was conducted during malaria season in 23 communities of Amhara and Oromia Regional States, Ethiopia, stratified by degree of urbanization (rural, peri-urban, or urban), whether or not they received indoor residual spraying (IRS), and whether or not free nets had been distributed. Descriptive statistics as well as univariate and multivariate logistic regression analyses were used to describe household net ownership and identify factors associated with use or non-use of nets already in the household. A qualitative component consisting of observations of ITNs in households and several open-ended questions provided further understanding of the reasons for ITN use and non-use.ResultsOf 857 surveyed households, 91% owned at least one ITN, but only 65% of ITNs owned had been used the prior night. The multivariate analysis found that the factors significantly associated with an ITN being used were regional state (Amhara) (Odds Ratio [OR] = 0.61; 95% Confidence Interval [C.I.] 0.43 - 0.86]; p < 0.01), residing in a house sprayed with IRS (OR = 1.89; 95% C.I. 1.36 - 2.63; p < 0.001), age of ITN (<12 months) (OR = 0.55; 95% C.I. 0.37 - 0.82; p < 0.01), shape (conical) (OR = 2.27; 95% C.I. 1.10 - 4.68; p < 0.05), and paying for the ITN rather than receiving it free (OR = 2.16; 95% C.I. 1.32 - 3.53; p < 0.01). The most common reasons for ITN non-use identified through the qualitative component of the study were: there are few mosquitoes around or malaria is not a serious problem; the ITN is no longer effective; ITN is in poor condition; the ITN is being saved. Observations showed many ITNs hanging incorrectly, and some being used for purposes other than as a bed net.ConclusionThe very high ITN ownership in the study areas suggests that a strategy targeting free nets to rural and poor households combined with support for the commercial sector is an effective means of achieving high coverage. The data suggests that use of ITNs owned could be increased by distribution of conical ITNs, continued development of the commercial sector, replacement schemes for worn-out ITNs, assistance with hanging of ITNs, and communication addressing misperceptions about ITNs.

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BackgroundDuring the past decade the malaria control community has been successful in dramatically increasing the number of households that own mosquito nets. However, as many as half of nets already in households go unused. This study examines the factors associated with use of nets owned in Ghana.MethodsThe data come from an August 2008 survey in Ghana of households with a pregnant woman or a guardian of a child under five, conducted during the rainy season. 1796 households were included in this analysis, which generated a sample of 1,852 mosquito nets. Using each net owned as the unit of analysis, multivariate logistic regression was used to examine the relationship of net used last night with 23 potentially explanatory variables having to do with characteristics of the household, of the respondent, and of the net. Odds Ratios, p-values, and confidence intervals were calculated for each variable to develop an explanatory model.ResultsThe final multivariate model consisted of 10 variables statistically associated with whether or not the net was used the prior night: rural location, lower SES, not using coils for mosquito control, fewer nets in the household, newer nets and those in better condition, light blue colour, higher level of education of the guardian of the child under five, knowing that mosquitoes transmit malaria, and paying for the net instead of obtaining it free of charge.ConclusionsThe results of this study suggest that net use would increase in Ghana if coloured nets were made available in mass distributions as well as in the commercial market; if programmes emphasize that malaria is caused only by night-biting mosquitoes, and that nets protect against mosquitoes better than coils and need to be used even if coils are burning; if donated nets are replaced more frequently so that households have nets that are in good condition; and if there were support for the commercial market so that those who can afford to purchase a net and want to choose their own nets can do so.

Mosquito net ownership is rising in sub-Saharan Africa but will substantially reduce malaria only if nets are used and the most vulnerable household members sleep under them. We used data from 9 large-scale household surveys conducted in 6 African countries from 2000 to 2004 that enumerated all household members and nets owned, analyzing only net-owning households. Across countries, women of reproductive age and children under 5 (without gender bias) were most likely to use the net; least likely were children of age 5-14 and adult males. Nets commonly covered 2-3 people. If a baby net was used, fewer people used the family net. Pregnant women were more likely to use a net in 2004 than in 2000. In several countries, a sizable minority of nets owned were not used. Understanding intra-household net-use patterns helps malaria control programs more effectively direct their efforts to increase their public health impact.

Background: In April 2000, the Roll Back Malaria (RBM) "Abuja Summit" set a target of having at least 60% of pregnant women and children under five use insecticide-treated nets (ITNs). Thereafter, programmes were implemented to create demand, reduce taxes and tariffs, spur the commercial market, and reach vulnerable populations with subsidized ITNs. Using national ITN monitoring data from the USAID-sponsored AED/NetMark project, this article examines the extent to which these activities were successful in increasing awareness, ownership, and use of nets and ITNs.