Abstract
BackgroundLong-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns.MethodsA cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest.ResultsOverall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p < .001). Only 64.7% (95% CI 64.0–65.5%) of children were reported to have slept under a LLIN the previous night. Compared to those living < 1 km from a health centre, households at ≥ 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% CI 0.83–0.89, p < .001). Households located farther from a health centre received a higher proportion of LLINs from government distributions compared to households living closer to health centres.ConclusionsLLIN use and sourcing was correlated with household elevation and estimated distance to the nearest health facility. The findings suggest that current facility-based distribution strategies are limited in their reach. More frequent mass distribution campaigns and complementary approaches are likely required to maintain universal LLIN coverage and high rates of use among children in rural Uganda.
Highlights
Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined
After removal of erroneous values, 99.2% (2173 of 2190) of entries had evaluable GPS coordinates, while malaria rapid diagnostic test results were available for 99.9% (2170 of 2173) of entries
Reported LLIN use declined among households living more than 2 km from the nearest level II or level III facility. Compared to those living less than 1 km from a health centre, households at more than 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% Confidence interval (CI) 0.83–0.89, p < 0.001) (Table 3)
Summary
Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. Much of the progress against malaria can be attributed to the development and widespread implementation of long-lasting insecticidal nets (LLINs) [2]. Recent reports suggest that global progress against malaria has stalled and may even be slipping backwards among high-burden countries in sub-Saharan Africa (SSA) [5]. Continued focus on the development of effective implementation strategies to achieve universal coverage, which the World Health Organization (WHO) defines as one LLIN for every two persons at risk of malaria, and high rates of use remains a critical undertaking [8]
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