Malaria is a major cause of morbidity and mortality in Liberia. At the same time, insecticide-treated net (ITN) ownership and use remain low. Access is a key determinant of ITN use but it is not the only one; prior studies have identified factors that affect the use of ITNs in households with at least one ITN. These factors operate at the individual, household, and community levels. However, studies have generally not assessed the psychosocial or ideational determinants of ITN use. Using 2014 household survey data, this manuscript examines the socio-demographic, ideational, household, and community factors associated with household member use of ITNs in Liberia. Multilevel modeling was used to assess fixed effects at the individual, household, and community levels, and random effects at the household and cluster levels. The data showed significant residual clustering at the household level, indicating that there were unmeasured factors operating at this level that are associated with ITN use. The association of age with ITN use was moderated by sex such that men, older children, and teenagers were less likely to sleep under an ITN compared to women and children under five years old. Female caregivers’ perceived severity of malaria, perceived self-efficacy to detect a complicated case of malaria, and exposure to the “Take Cover” communication campaign were positively associated with ITN use by members of her household. The association with household size was negative, while the relationship with the number of ITNs was positive. Programs should seek to achieve universal coverage (that is, one ITN for every two household members) and promote the notion that everyone needs to sleep under an ITN every night. Programs should also seek to strengthen perceived severity of malaria and educate intended audience groups on the signs of malaria complications. Given the significance of residual clustering at the household level, interventions that engage men as heads of household and key decision-makers are relevant.

Malaria remains one of the leading causes of morbidity and mortality among children under five years old in many low- and middle-income countries. In this study, we examined how malaria-related ideational factors may influence care-seeking behavior among female caregivers of children under five with fever. Data came from population-based surveys conducted in 2014–2015 by U.S. Agency for International Development-funded surveys in Madagascar, Mali, and Nigeria. The outcome of interest was whether a child under five with fever within two weeks prior to the survey was brought to a formal health facility for care. Results show a wide variation in care-seeking practices for children under five with fever across countries. Seeking care for febrile children under five in the formal health sector is far from a norm in the study countries. Important ideational factors associated with care-seeking behavior included caregivers’ perceived social norms regarding treatment of fever among children under five in Nigeria and Madagascar, and caregiver’s knowledge of the cause of malaria in Mali. Findings indicate that messages aimed to increase malaria-related knowledge should be tailored to the specific country, and that interventions designed to influence social norms about care-seeking are likely to result in increased care-seeking behavior for fever in children under five.

During summer months, samples of marine beach water were tested weekly for human waterborne pathogens in association with high and low bather numbers during weekends and weekdays, respectively. The numbers of bathers on weekends were significantly higher than on weekdays (P < 0.001), and this was associated with a significant (P < 0.04) increase in water turbidity. The proportion of water samples containing Cryptosporidium parvum, Giardia duodenalis, and Enterocytozoon bieneusi was significantly higher (P < 0.03) on weekends than on weekdays, and significantly (P < 0.01) correlated with enterococci counts. The concentration of all three waterborne pathogens was significantly correlated with bather density (P < 0.01). The study demonstrated that: (a) human pathogens were present in beach water on days deemed acceptable for bathing according to fecal bacterial standards; (b) enterococci count was a good indicator for the presence of Cryptosporidium, Giardia, and microsporidian spores in recreational marine beach water; (c) water should be tested for enterococci during times when bather numbers are high; (d) re-suspension of bottom sediments by bathers caused elevated levels of enterococci and waterborne parasites, thus bathers themselves can create a non-point source for water contamination; and (e) exposure to recreational bathing waters can play a role in epidemiology of microsporidiosis. In order to protect public health, it is recommended to: (a) prevent diapered children from entering beach water; (b) introduce bather number limits to recreational areas; (c) advise people with gastroenteritis to avoid bathing; and (d) use showers prior to and after bathing.