The moderated mediation role of malaria knowledge and household income in the relationship between insecticidetreated mosquito nets and malaria prevalence

Abstract

Objectives: The study was premised on the notion that insecticidetreated mosquito nets are positively related to malaria prevalence, and that knowledge mediates the relationship between insecticide-treated mosquito nets and malaria. Furthermore, household income was hypothesized to have a moderating effect on the direct and indirect relationships (through malaria knowledge) between insecticide-treated mosquito nets and the prevalence of malaria. Methods: The hypothesized relationships were examined using panel data collected from ten regions of Ethiopia during 2011 – 2015. Structural equation modeling and the random effect model were used to test the hypotheses. Statistical analyses were performed using Stata version 13.0. Results: The results were consistent with our proposed hypotheses, showing a significant relationship between the research variables. The findings suggest that malaria knowledge contributes to improving the relationship between insecticide-treated mosquito nets and malaria prevalence. A positively significant indirect effect (β = 0.47, p = 0.003) as well as direct effect (β = 0.28, p = 0.001) was revealed in the study. Furthermore, a positive impact of household income in strengthening the relationship between insecticide-treated mosquito nets and malaria through knowledge reported, with a considerable value (β = 0.13, p = 0.000). The result also reveals differences in the outcome of malaria prevalence at different levels of household income category, where the indirect effect of insecticide-treated mosquito nets on malaria prevalence via malaria knowledge was positive and significant for households under the second-level income category (β = 0.15, p = 0.000). Conversely, the indirect effect of insecticide-treated mosquito nets on malaria prevalence via malaria knowledge was negative for the high level-income category (β = -0.14, p = 0.022). Besides, insignificant and negative relationships were reported for households under low-level income categories (β = 0.024, p = 0.539). Conclusion: The findings are potentially useful for the health sector to ensure success in infectious disease prevention and control, particularly malaria, and to explain how various factors contribute to the relationship. Keywords: malaria; insecticide-treated mosquito nets; malaria knowledge; household-income; structural equation modelling.