Low use of long-lasting insecticidal nets for malaria prevention in south-central Ethiopia: A community-based cohort study

Abstract

IntroductionA decline in malaria morbidity and mortality has been documented in Ethiopia since 2005 following a scale-up of the distribution of long-lasting insecticidal nets (LLINs). However, universal access to LLINs ownership and use has not yet been achieved. This study aimed to determine ownership and use of LLINs over time in south-central Ethiopia.MethodsA cohort of 17,142 individuals residing in 3,006 households was followed-up from October 2014 to January 2017 (121 weeks). New PermaNet2.0 LLINs were given to households in October 2014. Once per week, the LLIN use status was documented for each individual. A survey was conducted after 110 weeks of LLIN distribution to determine LLIN ownership. A multilevel negative binomial regression model was fitted to identify significant predictors of LLIN use.ResultsAt baseline, the LLIN ownership was 100%. After 110 weeks only 233 (8%) of the households owned at least one LLIN. The median proportion of LLIN use per individuals during the study period was only 14%. During the first year (week 1–52) the average LLIN use per individuals was 36% and during the second year (week 53–104) it was 4.6%. More frequent LLIN use was reported among age group [5–14 years (adjusted IRR = 1.13, 95% CI 1.04–1.22), 15–24 years (adjusted IRR = 1.33, 95% CI 1.23–1.45), ≥25 years (adjusted IRR = 1.99, 95% CI 1.83–2.17)] compared to <5 years, and household head educational status [read and write (adjusted IRR = 1.17, 95% CI 1.09–1.26), primary (adjusted IRR = 1.20, 95% CI 1.12–1.27), secondary or above (adjusted IRR = 1.20, 95% CI (1.11–1.30)] compared to illiterate. Having a family size of over five persons (adjusted IRR = 0.78, 95% CI 0.73–0.84) was associated with less frequent use of LLINs compared to a family size of ≤5 persons.ConclusionsThe study showed a low LLIN ownership after 110 weeks and a low LLIN use during 121 weeks of follow-up, despite 100% LLIN coverage at baseline. The study highlights the need to design strategies to increase LLIN ownership and use for setting similar to those studied here.

Bedbug Infestation Affects Utilization of Long-Lasting Insecticidal Nets in Kola Shara, South-West Ethiopia: A Longitudinal Study

“…However, this study employed strong methodological approach, longitudinal study, through engaging local health workers and managed to generate monthly household level information that has never been available. Therefore, the present nding is informative to partly answer questions like 'why net utilization has never been improved' in the last decade [4,5]; despite the blanket coverage of nets freely available to households in endemic kebeles through the support of global fund grants. So far, there was limited attention in exploring the household factors that compromise net utilization and high attrition rate on monthly basis [3][4][5].…”

“…In harmony with this study, although household reasons for attrition of nets was obscure, high rate of net loss was documented in central-Ethiopia. Only below one out of ten (90% lost) of the nets were available at the household after two years weekly follow up [5].…”

“…The absence of nets most frequently in a household is probably predisposing the family members, especially susceptible groups to malaria. Although a study mentioned that bedbug jeopardize persistent net utilization or barrier to net users [3][4][5]12], another study that focused on Bedbug containment practices [9,13], no detailed evidence available on the magnitude of the Bedbug versus net utilization.…”

“…However, no detailed information was presented its effect. Another previous study also con rmed that above three fourths of the nets were thrown away after two years as obtained from a weekly follow for two years (2014-2017), the reasons contributing for low rates of utilization not described to guide in tackling those factors accordingly [5].…”

Parents’ perception on cause of malaria and their malaria prevention experience among school-aged children in Kutcha district, Southern Ethiopia; qualitative study

“…The unintended use of bed nets were partly due to low socioeconomic status like using the bed nets for bed sheet, head scarf and curtains [27] while others are due to their bad attitude towards the bed nets [21,23,35]. Due to less awareness on the importance of bed nets, people give away their own bed nets to other people in Adami Tulu in Ethiopia [26,40,41].…”