Abstract
Major efforts for malaria prevention programs have gone into scaling up ownership and use of insecticidal mosquito nets, particularly in sub-Saharan Africa where the malaria burden is high. Socioeconomic inequities in access to long lasting insecticidal nets (LLINs) are reduced with free distributions of nets. However, the relationship between social factors and retention of nets after a free distribution has been less studied, particularly using a longitudinal approach. Our research aimed to estimate the ownership and use of LLINs, and examine the determinants of LLIN retention, within an Indigenous Batwa population after a free LLIN distribution. Two LLINs were given free of charge to each Batwa household in Kanungu District, Uganda in November 2012. Surveyors collected data on LLIN ownership and use through six cross-sectional surveys pre- and post-distribution. Household retention, within household access, and individual use of LLINs were assessed over an 18-month period. Socioeconomic determinants of household retention of LLINs post-distribution were modelled longitudinally using logistic regression with random effects. Direct house-to-house distribution of free LLINs did not result in sustainable increases in the ownership and use of LLINs. Three months post-distribution, only 73% of households owned at least one LLIN and this period also saw the greatest reduction in ownership compared to other study periods. Eighteen-months post distribution, only a third of households still owned a LLIN. Self-reported age-specific use of LLINs was generally higher for children under five, declined for children aged 6–12, and was highest for older adults aged over 35. In the model, household wealth was a significant predictor of LLIN retention, controlling for time and other variables. This research highlights on-going socioeconomic inequities in access to malaria prevention measures among the Batwa in southwestern Uganda, even after free distribution of LLINs, and provides critical information to inform local malaria programs on possible intervention entry-points to increase access and use among this marginalized population.
Highlights
Insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are well recognized as cost-efficient and highly effective interventions for reducing the burden of malaria in endemic regions in sub-Saharan Africa [1]
This study found that redistribution of nets was more likely to occur in net-rich environments where access to LLINs was high
Direct house-to-house distribution of free LLINs did not result in sustainable increases in the ownership and use of LLINs among a population of Indigenous Batwa in Kanungu, Uganda
Summary
Insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are well recognized as cost-efficient and highly effective interventions for reducing the burden of malaria in endemic regions in sub-Saharan Africa [1]. Previous studies show that large-scale, free net distribution campaigns can reduce inequities in household net ownership across socio-economic gradients, relative to other forms of distribution [5,6,7,8,9,10]. Inequities in ownership and use may still persist, preventing those among the lowest socioeconomic strata from accessing and retaining malaria preventative measures [10,11]. Socioeconomic factors, such as household wealth and education, have been identified as consistent and important predictors of mosquito net acquisition in the absence of free-distribution campaigns [7,8,12]. Our understanding of the role that socioeconomic gradients play in influencing the retention of LLINs by households remains limited
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call