Ownership and use of long-lasting insecticidal nets three months after a mass distribution campaign in Uganda, 2021

Abstract

Background Uganda conducted its third mass long-lasting insecticidal net (LLIN) distribution campaign in 2021. The target of the campaign was to ensure that 100% of households own at least one LLIN per two persons and to achieve 85% use of distributed LLINs. LLIN ownership, use and associated factors were assessed 3 months after the campaign. Methods A cross-sectional household survey was conducted in 14 districts from 13 to 30 April, 2021. Households were selected using multistage sampling. Each was asked about LLIN ownership, use, duration since received to the time of interview, and the presence of LLINs was visually verified. Outcomes were having at least one LLIN per two household members, and individual LLIN use. Modified Poisson regression was used to assess associations between exposures and outcomes. Results In total, 5529 households with 27,585 residents and 15,426 LLINs were included in the analysis. Overall, 95% of households owned ≥ 1 LLIN, 92% of the households owned ≥ 1 LLIN < 3 months old, 64% of households owned ≥ 1 LLIN per two persons in the household. Eighty-seven per cent could sleep under an LLIN if every LLIN in the household were used by two people, but only 69% slept under an LLIN the night before the survey. Factors associated with LLIN ownership included believing that LLINs are protective against malaria (aPR = 1.13; 95% CI 1.04–1.24). Reported use of mosquito repellents was negatively associated with ownership of LLINs (aPR = 0.96; 95% CI 0.95–0.98). The prevalence of LLIN use was 9% higher among persons who had LLINs 3–12 months old (aPR = 1.09; 95% CI 1.06–1.11) and 10% higher among those who had LLINs 13–24 months old (aPR = 1.10; 95% CI 1.06–1.14) than those who had LLINs < 3 months old. Of 3,859 LLINs identified in the households but not used for sleeping the previous night, 3250 (84%) were < 3 months old. Among these 3250, 41% were not used because owners were using old LLINs; 16% were not used because of lack of space for hanging them; 11% were not used because of fear of chemicals in the net; 5% were not used because of dislike of the smell of the nets; and, 27% were not used for other reasons. Conclusion The substantial difference between the population that had access to LLINs and the population that slept under LLINs indicates that the National Malaria Control Programme (NMCP) may need to focus on addressing the main drivers or barriers to LLIN use. NMCP and/or other stakeholders could consider designing and conducting targeted behaviour change communication during subsequent mass distribution of LLINs after the mass distribution campaign to counter misconceptions about new LLINs.

Mass distribution campaign of long-lasting insecticidal nets (LLINs) during the COVID-19 pandemic in Uganda: lessons learned

“…The campaign’s objective was thus met despite the difficulties caused by COVID-19-related disruptions. The campaign’s coverage is consistent with a study conducted in 14 districts three months after the 2020/2021 campaign, which found that nearly all (96%) surveyed households owned at least one LLIN [ 24 ]. Another study conducted 1–5 months after distribution in 12 districts found that more than 93% of households had at least one LLIN obtained through the 2020/2021 campaign [ 17 ].…”

Knowledge and Practices of Women Regarding Malaria and Its Prevention: A Community-Based Study in an Area under Malaria Elimination Programme in Iran

“…Moreover, factors such as educational status of the mother of the household and the problems related to LLINs use such as discomfort due to heat and lack of airflow under LLINs were reported by the households to affect their LLINs usage. Similar observations from Tanzania, and Uganda have recognized that low use of bed nets in the tropical areas is related to the heat discomfort due to poor airflow caused by the bed nets ( 39 , 40 ). As a protective tool, LLINs are the most effective instruments for protection against mosquito bites and malaria transmission ( 41 ).…”

The challenge of improving long-lasting insecticidal nets coverage on Bioko Island: using data to adapt distribution strategies

“…In 2022, 44 countries planned such campaigns to distribute 241 million LLINs, which required spending very significant logistical and financial efforts [19]. While MDCs help improve ownership, population access and use of nets immediately after distribution [2,20,21,22,23,24,25], these endeavours often deteriorate into inefficient systems with nets unevenly distributed amongst households [6]. Furthermore, LLIN indicators frequently drop steeply relatively soon after distribution compromising use, as observed on Bioko [26,27].…”