Abstract
BackgroundInsecticide-treated bed nets (ITNs) are highly effective in reducing malaria burden when used properly. However, factors related to individuals, households and community may influence how ITNs are used for malaria control. The study examined influences exerted at these levels to determine if they are associated with ITN non-use among children under 5 years of age in Rwanda.MethodsUsing data from the 2010 Rwanda Demographic Health Survey, the investigation was done on the factors associated with ITN non-use among children under 5 years. Descriptive statistics as well as univariate and multilevel logistic regression analyses were used to identify factors associated with ITN non-use.ResultsResponses from a total of 6173 women aged 15–49 years living in 492 villages were included in the analysis. Risk factors for children not utilizing ITNs (25 %) included: (Odds ratio [95 % confidence interval]) households with more than five members (1.42 [1.23–1.63]), employed mother (1.33 [1.06–1.66]), and lower household altitude (1.36 [1.14–1.61]). Protective risk factors for ITN use included households with more than three nets (0.39 [0.33–0.47]), mothers who attended one to four visits at antenatal clinics during pregnancy (0.45 [0.29–0.69]), more than four antenatal clinic visits during pregnancy (0.39 [0.21–0.70]), mothers married or living with partner (0.43 [0.36–0.52]), mothers with any education level (0.77 [0.65–0.91]), and households with higher community wealth quintile (0.71 [0.59–0.84]).ConclusionsRwanda has achieved high coverage of ITN use and proper use has contributed to a decline in malaria in Rwanda; however, maintaining universal ITN coverage is not enough to protect citizens from this disease. Risk factors related to ITN non-use at individual, household and community level include poverty, education, birth spacing, and antenatal clinic attendance. There is a need to address findings with strategies to mitigate the non-use of ITNs for effective malaria prevention in Rwanda.
Highlights
Insecticide-treated bed nets (ITNs) are highly effective in reducing malaria burden when used properly
In 2010, Rwanda distributed approximately 4.1 million ITNs during a universal coverage campaign with the goal of one ITN per two people, thereby covering all sleeping areas in each household. This campaign resulted in an increase of 25 % of children under 5 years (U5) sleeping under an ITN compared to 2007–2008 [3, 10, 15]
Two-thirds of the respondents had children aged more than 23 months (64.7 %), and the majority of respondents lived in rural areas (85.8 %)
Summary
Insecticide-treated bed nets (ITNs) are highly effective in reducing malaria burden when used properly. Following the scale-up of comprehensive malaria control interventions between 2007 and 2010, the prevalence of malaria parasitaemia measured by household surveys declined from 2.6 to 1.4 % in children between six and 59 months of age, Insecticide-treated bed nets (ITNs) are an important malaria prevention intervention in reducing childhood malaria morbidity and mortality. In 2010, Rwanda distributed approximately 4.1 million ITNs during a universal coverage campaign with the goal of one ITN per two people, thereby covering all sleeping areas in each household. This campaign resulted in an increase of 25 % of U5 sleeping under an ITN compared to 2007–2008 [3, 10, 15].
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