Individual, community and region level predictors of insecticide-treated net use among women in Uganda: a multilevel analysis

Edward Kwabena Ameyaw,Yusuf Olushola Kareem,Sanni Yaya

doi:10.1186/s12936-020-03412-4

Abstract

BackgroundUse of insecticide-treated net (ITN) has been identified by the World Health Organization as an effective approach for malaria prevention. The government of Uganda has instituted measures to enhance ITN supply over the past decade, however, the country ranks third towards the global malaria burden. As a result, this study investigated how individual, community and region level factors affect ITN use among women of reproductive age in Uganda.MethodsThe 2018–2019 Malaria Indicator Survey of Uganda involving 7798 women aged 15–49 was utilized. The descriptive summaries of ITN use were analysed by individual, community and region level factors. Based on the hierarchical nature of the data, four distinct binomial multilevel logistic regression models were fitted using the MLwiN 3.05 module in Stata. The parameters were estimated using the Markov Chain Monte Carlo (MCMC) estimation procedure and Bayesian Deviance Information Criterion was used to identify the model with a better fit.ResultsThe proportion of women who use ITN was 78.2% (n = 6097). Poor household wealth status [aOR = 1.66, Crl = 1.55–1.80], knowing that sleeping under ITN prevents malaria [aOR = 1.11, Crl = 1.05–1.24] and that destroying mosquito breeding sites can prevent malaria [aOR = 1.85, Crl = 1.75–1.98] were associated with higher odds of ITN use. ITN use attributable to regional and community level random effects was 39.1% and 45.2%, respectively.ConclusionThe study has illustrated that ITN policies and interventions in Uganda need to be sensitive to community and region level factors that affect usage. Also, strategies to enhance women’s knowledge on malaria prevention is indispensable in improving ITN use.

Highlights

Use of insecticide-treated net (ITN) has been identified by the World Health Organization as an effective approach for malaria prevention
Most women who knew that mosquito bite causes malaria reported ITN use (79.6%)
A higher proportion of those who indicated that sleeping under mosquito net prevents malaria utilized ITN (78.6%) and among women who indicated that destroying mosquito breeding sites can prevent malaria (79.5%)

Summary

Introduction

Use of insecticide-treated net (ITN) has been identified by the World Health Organization as an effective approach for malaria prevention. The government of Uganda has instituted measures to enhance ITN supply over the past decade, the country ranks third towards the global malaria burden. Malaria among women in the reproductive age has become a public health priority due to the enormous adverse implications it poses to their reproductive wellbeing [1]. Six countries account for more than half of the global malaria burden. All these countries are located in Ameyaw et al Malar J (2020) 19:337 revenue. Insecticide-treated net (ITN) has been identified by the World Health Organization (WHO) and the global community as an effective approach for malaria prevention. Women and children constitute the priority group of these interventions due to reduced immunity during pregnancy and immature immune system of children [1, 4]

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