Abstract

BackgroundUniversal long-lasting insecticidal net (LLIN) coverage (ULC) has reduced malaria morbidity and mortality across Africa. Although information is available on bed net use in specific groups, such as pregnant women and children under 5 years, there is paucity of data on their use among the general population. Bed net source, ownership and determinants of use among individuals from households in an eastern Rwanda community 8 months after a ULC were characterized.MethodsUsing household-based, interviewer-administered questionnaires and interviewer-direct observations, data on bed net source, ownership and key determinants of net use, including demographics, socio-economic status indicators, house structure characteristics, as well as of bed net quantity, type and integrity, were collected from 1400 randomly selected households. Univariate and mixed effects logistic regression modelling was done to assess for determinants of bed net use.ResultsA total of 1410 households and 6598 individuals were included in the study. Overall, the proportion of households with at least one net was 92 % while bed net usage was reported among 72 % of household members. Of the households surveyed, a total ownership of 2768 nets was reported, of which about 96 % were reportedly LLINs received from the ULC. By interviewer-physical observation, 88 % of the nets owned were of the LLIN type with the remaining 12 % did not carry any mark to enable type recognition. The odds of bed net use were significantly lower among males and individuals: from households of low socio-economic status, from households with <two bed nets, from households reporting use of ≥two sleeping spaces, and those reporting to have not slept on a bed.ConclusionIn this study, despite high a bed net coverage, over 25 % of members reported not to have slept under a bed net the night before the survey. Males were particularly less likely to use bed nets even where nets were available. Household socio-economic status, number of bed nets and type and number of sleeping spaces were key determinants of bed net use. To maximize impact of ULC, strategies that target males as well as those that ensure ITN coverage for all, address barriers to feasible and convenient bed net use including covering over all sleeping space types, and provide net hanging supports, are needed.

Highlights

  • Universal long-lasting insecticidal net (LLIN) coverage (ULC) has reduced malaria morbidity and mortality across Africa

  • To achieve and maintain ULC, Rwanda adopted the World Health Organization (WHO)’s recommendations for high malaria burden countries of using multiple distribution channels, including free ULCs that are supplemented by continuous LLIN distributions through programmes such as antenatal care (ANC) and immunization services for pregnant women and infants, respectively [3, 9]

  • A sample of 1400 households was randomly selected from a sampling frame of 4522 sector households generated 2 months prior to the survey as part of an enumeration exercise conducted while planning for indoor residual spraying (IRS) exercise for the sector

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Summary

Introduction

Universal long-lasting insecticidal net (LLIN) coverage (ULC) has reduced malaria morbidity and mortality across Africa. The World Health Organization (WHO) recommends universal access to, and use of long-lasting insecticidal nets (LLINs) for all individuals at risk of malaria so as to optimize ITN effectiveness [3]. With ITNs shown to be the most cost-effective intervention in reducing malaria transmission [6], universal long-lasting insecticidal net coverage (ULC) has been recommended and is widely implemented as a key intervention in malaria control efforts [7]. Despite the observed initial decline in health facility-recorded malaria cases and deaths following LLIN scale-up in Rwanda, increases in malaria burden continue to be reported [8, 10, 11]. To achieve and maintain ULC, Rwanda adopted the WHO’s recommendations for high malaria burden countries of using multiple distribution channels, including free ULCs that are supplemented by continuous LLIN distributions through programmes such as antenatal care (ANC) and immunization services for pregnant women and infants, respectively [3, 9]

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