The effect of long-lasting insecticidal nets (LLINs) physical integrity on utilization

Honelgn Nahusenay Hiruy,Joseph Keating,Alemayehu Worku,Josh Yukich,Sheleme Chibsa,Semira Abdelmenan,Yemane Berhane,Ayele Zewde,Seth R. Irish,Adugna Woyessa,Mebrahtom Haile,Hiwot Solomon,Yonas Wuletaw,Achamyelesh Sisay

doi:10.1186/s12936-021-03976-9

Abstract

BackgroundIn Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge. Different household-level factors have been identified as associated with LLIN use. However, the contribution of LLIN physical integrity to their utilization is not well investigated and documented. This study aimed to assess the association between the physical integrity of LLINs and their use.MethodsThis study employed a nested case-control design using secondary data from the Ethiopian LLIN durability monitoring study conducted from May 2015 to June 2018. LLINs not used the night before the survey were identified as cases, while those used the previous night were categorized as controls. The physical integrity of LLINs was classified as no holes, good, acceptable, and torn using the proportionate hole index (pHI). A Generalized Estimating Equation (GEE) model was used to assess and quantify the association between LLIN physical integrity and use. The model specifications included binomial probabilistic distribution, logit link, exchangeable correlation matrix structure, and robust standard errors. The factors included in the model were selected first by fitting binary regression, and then by including all factors that showed statistical significance at P-value less than 0.25 and conceptually relevant variables into the multivariate regression model.ResultsA total of 5277 observations fulfilled the inclusion criteria. Out of these 1767 observations were cases while the remaining 3510 were controls. LLINs that were in torn physical condition had higher odds (AOR [95% CI] = 1.76 [1.41, 2.19]) of not being used compared to LLINs with no holes. Other factors that showed significant association included the age of the LLIN, sleeping place type, washing status of LLINs, perceptions towards net care and repair, LLIN to people ratio, economic status, and study site.Conclusion and recommendationLLINs that have some level of physical damage have a relatively higher likelihood of not being used. Community members need to be educated about proper care and prevention of LLIN damage to delay the development of holes as long as possible and use available LLINs regularly.

Highlights

In Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge
In Ethiopia knowledge of malaria and LLINs [10, 11], erroneous perception about LLINs [12], and exposure to malaria-related messages [13] were associated with utilization of available LLINs
The proportion of LLINs owned by households whose heads had very positive attitudes towards bed net care and repair was slightly lower among cases (24.8%) compared to controls (26.9%) (Table 1)

Summary

Introduction

In Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge. Hiruy et al Malaria Journal (2021) 20:468 settings, residence being urban or rural), behavioural factors (i.e., knowledge and attitudes), housing conditions (i.e., numbers and types of sleeping spaces, number of people in the house), and net level factors (i.e., physical integrity, shape, colour, cleanness, age) which are discussed below. Other studies have identified other external factors, such as distance from mosquito breeding sites [6], proximity to a health facility [7], altitude, availability of other interventions, such as indoor residual spraying (IRS) [8], and being an urban or rural residence [9] to be associated with the use of available LLINs. Behavioural factors are important predictors for the utilization of available LLINs. In Ethiopia knowledge of malaria and LLINs [10, 11], erroneous perception about LLINs (including evaluating insecticidal efficacy of LLINs based on their ability to kill bed bugs, and tending not to use LLINs that do not kill bed bugs and other arthropods) [12], and exposure to malaria-related messages [13] were associated with utilization of available LLINs. Risk perception about malaria was associated with use of LLINs in other places [14]. In 2015, a study by Birhanu et al in southwestern Ethiopia revealed that about a third (30%) of respondents did not sleep under a LLIN the night preceding the survey due to behaviourdriven factors such as low risk perception and perception of low efficacy of LLINs [9]

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