Age and gender trends in insecticide-treated net use in sub-Saharan Africa: a multi-country analysis

Abstract

BackgroundThe degree to which insecticide-treated net (ITN) supply accounts for age and gender disparities in ITN use among household members is unknown. This study explores the role of household ITN supply in the variation in ITN use among household members in sub-Saharan Africa.MethodsData was from Malaria Indicator Surveys or Demographic and Health Surveys collected between 2011 and 2016 from 29 countries in sub-Saharan Africa. The main outcome was ITN use the previous night. Other key variables included ITN supply (nets/household members), age and gender of household members. Analytical methods included logistic regressions and meta-regression.ResultsAcross countries, the median (range) of the percentage of households with enough ITNs was 30.7% (8.5–62.0%). Crude analysis showed a sinusoidal pattern in ITN use across age groups of household members, peaking at 0–4 years and again around 30–40 years and dipping among people between 5–14 and 50+ years. This sinusoidal pattern was more pronounced in households with not enough ITNs compared to those with enough ITNs. ITN use tended to be higher in females than males in households with not enough ITNs while use was comparable among females and males in households with enough ITNs. After adjusting for wealth quintile, residence and region, among households with not enough ITNs in all countries, the odds of ITN use were consistently higher among children under 5 years and non-pregnant women 15–49 years. Meta-regressions showed that across all countries, the mean adjusted odds ratio (aOR) of ITN use among children under 5 years, pregnant and non-pregnant women aged 15–49 years and people 50 years and above was significantly higher than among men aged 15–49 years. Among these household members, the relationship was attenuated when there were enough ITNs in the household (dropping 0.26–0.59 points) after adjusting for geographical zone, household ITN supply, population ITN access, and ITN use:access ratio. There was no significant difference in mean aOR of ITN use among school-aged children compared to men aged 15–49 years, regardless of household ITN supply.ConclusionsThis study demonstrated that having enough ITNs in the household increases level of use and decreases existing disparities between age and gender groups. ITN distribution via mass campaigns and continuous distribution channels should be enhanced as needed to ensure that households have enough ITNs for all members, including men and school-aged children.

“We have this, with my husband, we live in harmony”: exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique

“…Most of the malaria interventions at community or facility levels in Mozambique have been designed to reach women, often through multiple ANC visits, and children under 5 and pregnant women are consistently most likely users of ITNs [23]. A recent qualitative study in Zambézia Province found that barriers to ANC included gender inequality in decision-making, and the responsibility for pregnancy being seen to have to be largely shouldered by the woman [24].…”

Factors Associated with the Use of Insecticide-Treated Nets: Analysis of the 2018 Burkina Faso Malaria Indicator Survey

“…Studies have shown that the major driver of ITN use is access to an ITN, because a person cannot use an ITN unless one is available [9][10][11]. However, individual, household, and community-level factors also in uence ITN usage.…”

“…Household-level determinants of ITN include household size, household composition, number of sleeping rooms, and intrahousehold sleeping arrangements [11,14,[18][19][20][21]. At the community level, factors such as residence, environmental conditions, and malaria seasonality have also been shown to in uence ITN usage [9,21,22].…”

“…This corroborates previous research that found that most households in SSA prioritize ITN use in young children (children under age 5) and pregnant women of reproductive age. In these households, children share sleeping spaces with their mothers or with other female siblings[11,20]. Older children are not priorities for nets, especially when a household does not have enough nets for all members in the household.At the household level, the number of rooms for sleeping and wealth quintile were signi cantly associated with ITN use.…”

The Consequences of Declining Population Access to Insecticide Treated Nets (ITNs) on Net Use Patterns and Physical Degradation of Nets after 22 Months of Ownership

“…There are several factors that affect ITN access and use, including household size [23], user characteristics: age, gender, pregnancy status [24][25][26], and socio-economic status (SES) [27]. So, as nets wear out and access to nets declines, it is likely that households will prioritize who will use the remaining net(s) based on the number of net(s) currently available in the household and their condition [28][29][30]. Potential consequences of prioritization could be 1) crowding, i.e.…”