Utilization Of Long-lasting Insecticidal Nets Research Articles

Long-Lasting Insecticidal Net Coverage and Utilization in Burla Town of Sambalpur District: A Cross-Sectional Study.

Background Vector-borne diseases continue to significantly contribute to mortality and morbidity, especially in developing nations. Vector management is a key pillar in combating these diseases, and long-lasting insecticidal nets (LLINs) are cost-effective tools. The Government of India, under the National Vector Borne Disease Control Programme (NVBDCP), has distributed LLINs for free to increase coverage and utilization. This study aims to estimate the coverage and utilization of LLINs in Burla town. Method This cross-sectional study was conducted from October to December 2022 in Burla town of Sambalpur in Odisha, India. The estimated sample size was 510 households, assuming 50% coverage. Multi-stage cluster sampling was adopted to select the Anganwadi centers and households. A pretested questionnaire was utilized for data collection by trained personnel through Epicollect5 (Centre for Genomic Pathogen Surveillance, Oxford, UK). Logistic regression was used to identify predictors for LLIN usage. Results The survey covered 516 households with 2,541 individuals and 1,165 nets. Household-level coverage was 94.2%, and regular utilization was 45.74%. Skin reactions (35.7%) were the most common reason for non-usage, followed by low mosquito density (12%). Logistic regression showed that the number of rooms (adjusted odds ratio (AOR) = 0.663, p = 0.012), number of bed nets (AOR = 2.757, p < 0.001), knowledge of malaria (AOR = 2.92, p = 0.04), adopting other measures for mosquito control (AOR = 0.295, p < 0.001), and washing the net (AOR =1.92, p = 0.028) significantly predicted sleeping under mosquito net. Conclusion Our study has depicted high coverage of LLINs in Burla town, but utilization needs further improvement. Counseling regarding proper use can decrease the skin reactions responsible for non-usage. Regular health education programs are required to emphasize the benefits of LLIN use, along with regular monitoring and supervision.

Assessment of Knowledge, Attitude, and Utilization of Long-Lasting Insecticidal Nets in Jigawa State: a cross-sectional study

Background: The sharing of long-lasting insecticide nets (LLINs), and utilization, alongside knowledge and attitude of the communities towards malaria, are vital to Malaria prevention, treatment, and control. This study intends to investigate the current state of knowledge, attitude, and usage of LLINs in Chamo town of Jigawa State, Nigeria. Methods: The study employed a cross-sectional survey with a semi-structured interview questionnaire. Results: Of the total 471 respondents interviewed, comprising males (39.7%) and females (60.3%). The respondents had a mean age of 35.2 (SD = 12.6), and more than half (n= 274; 58.5%) were between 20 and 40 years old. Most of the respondents (n = 390; 82.8 %) know LLINs. However, only 225 (47.8%) believed the role of LLINs in protecting one from a mosquito bite, and 353 (75.8%) of the respondents believed that malaria can be transmitted through a mosquito bite. Educational level, marital status, and occupation show a significant association with knowledge of LLIN use. Conclusion: We concluded that there was a general awareness of LLINs in the study area, and the majority had favorable knowledge regarding malaria transmission. However, nearly half of the participants have a favorable understanding of LLIN use.

Low long-lasting insecticidal net use in malaria elimination areas in Southern Ethiopia: results from community based cross-sectional study

BackgroundDespite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People’s Region (SNNPR) of Ethiopia.MethodsA community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI.ResultsFrom a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness.ConclusionLow LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country’s malaria elimination goal.

Under utilization of long-lasting insecticidal nets (LLINs) is challenging malaria elimination program in Ethiopia: a systematic review and meta-analysis

BackgroundMalaria is one of the most common causes of morbidity and mortality in developing countries including Ethiopia. Mass distribution of insecticide-treated nets and indoor residual spray for high malaria risk groups are the major prevention measures in different countries. Achievement of the malaria elimination plan is highly determined by the level of effective utilization of intervention measures. However, there is scarce information showing the national level of insecticide-treated nets utilization.ObjectiveTo estimate the pooled prevalence of insecticide-treated nets utilization in Ethiopia, 2023.MethodA Systematic Review and Meta-analysis employed to assess the utilization of long-lasting insecticidal nets in Ethiopia. Published articles were searched from Google Scholar, PubMed, Web Sciences, CINAHIL, EMBASE, and Scopus. The collected articles were screened for data extraction and further analysis using preferred reporting items for systematic review and meta-analysis (PRISMA) flow chart. The quality of each study was assessed using the Jonna Briggs Institute (JBI) checklist. The data were extracted using Microsoft Excel and exported to STATA version 17.0 for analysis. The overall pooled prevalence of long-lasting insecticidal nets utilization was determined using a random effects model.ResultOut of 1657 articles reviewed, only 21 of them were eligible for final analysis. All of the included studies were used to estimate the pooled prevalence of long-lasting insecticidal net utilization. The point prevalence of LLIN utilization ranged from 14.23 to 91.9%. The Meta-analysis estimated that the overall pooled prevalence of insecticidal nets utilization among all study participants in Ethiopia was 56.26% (95%CI: 44.04–68.48%). Subgroup analysis revealed that insecticidal nets utilization was relatively highest in the Amhara region [63.0, 95%CI (37.0–89.0%)] and during 2020–2023 [61, 95% CI (53.0–69.0%)].ConclusionLong-lasting insecticidal nets utilization in Ethiopia is lower than the national target plan. Hence, it needs extra follow-up and intervention to enhance its utilization.

Predictors of Daily Utilization of Long-Lasting Insecticidal Nets for Malaria Prevention in Pregnancy among Antenatal Care Recipients in Southern Nigeria

Malaria remains a significant public health concern, particularly among pregnant women in sub-Saharan Africa. Long Lasting Insecticidal Nets (LLINs) have been recognized as an effective preventive measure against malaria transmission. However, the utilization of LLINs among pregnant women remains suboptimal. This study aimed to assess the level of daily LLIN utilization and identify its predictors among pregnant women receiving antenatal care in a tertiary healthcare centre in Southern Nigeria. A cross-sectional study was conducted among antenatal recipients at the University of Uyo Teaching Hospital in Uyo, AkwaIbom State. A total of 323 respondents were recruited for the study. Data were collected using a pre-tested semi-structured questionnaire. Multivariable logistic regression analyses were performed to identify predictors of daily LLIN usage. One hundred and twenty seven (39.3%) of the respondents had ever slept inside a LLIN during the index pregnancy, while 22.6% reported daily usage. LLIN ownership was reported by 47.7% of the respondents, highlighting a discrepancy between ownership and consistent use. Predictors of daily LLIN usage included LLIN ownership (aOR 3.83, 95% CI 1.95-7.48), absence of discomfort during LLIN use (aOR 9.33,95%CI 4.32-20.17), non-use of other malaria preventive measures (aOR 3.7,95% CI 11.51-8.93) and presence of mosquitoes in home dwelling (aOR 3.56 95%CI 1.35-9.37). Health education campaigns should emphasize the benefits of daily LLIN usage during pregnancy. Policy interventions are warranted to increase LLIN distribution and availability to pregnant women through antenatal care clinics.

Utilization of long lasting insecticidal net among children aged less than five years in a tertiary health facility in south-west Nigeria

ABSTRACT Introduction Long-lasting insecticidal nets (LLINs) are the most widely used vector control interventions for preventing malaria transmission. The study sought to determine the regular use of LLIN, factors associated with the usage and the effect of regular LLIN utilization on the development of malaria among under-five children. Methods This was a hospital-based cross-sectional observation study. We enrolled consecutive caregivers with their children aged 6 to 59 months who presented with fever in the absence of a localizing sign. A structured questionnaire was used to obtain information about the level of utilization of LLIN. Malaria parasitemia was detected using the P. falciparum rapid diagnostic test kit and/or microscopic examination of blood. Results A total of 303 children/caregivers pair was studied. The mother’s mean (SD) age was 37.17 (6.75) years, while the children was 24.36 (16.63) months. The majority (183; 60.4%) of the children were male. Parental awareness of LLIN was high (96.7%), LLIN ownership was 72.3%, however, only 119 (39.3%) were regular user of LLIN. Factors significantly associated with regular LLIN use were younger age, parental awareness, ownership of LLIN, source of acquisition of LLIN and permanently hanging the LLIN on sleeping space (p = 0.031, 0.010, 0.000, 0.006 and 0.000 respectively). Using binary logistic regression, the child’s age, source of LLIN and hanging the LLIN permanently on the bed remained statistically significant to the regular use of LLIN (p = 0.046, 0.035 and 0.000 respectively). The frequency of malaria was significantly higher among the children who did not use and those who uses LLIN irregularly (97.1% versus 32.9%, p = 0.000). Conclusions Regular use of LLIN is low in the study area. Hanging the insecticidal bed-net permanently on the bed/sleeping space promotes its regular usage. The frequency of malaria was reduced among the children using the LLIN regularly.

Impact of malaria control interventions on malaria infection and anaemia in low malaria transmission settings: a cross-sectional population-based study in Sudan.

The past two decades were associated with innovation and strengthening of malaria control interventions, which have been increasingly adopted at large scale. Impact evaluations of these interventions were mostly performed in moderate or high malaria transmission areas. This study aimed to evaluate the use and performance of malaria interventions in low transmission areas on malaria infections and anaemia. Data from the 2016 Sudan malaria indicator survey was used. Multi-level logistic regression analysis was used to assess the strength of association between real-life community-level utilization of malaria interventions [diagnosis, artemisinin-based combination therapies (ACTs) and long-lasting insecticidal nets (LLINs)] and the study outcomes: malaria infections and anaemia (both overall and moderate-to-severe anaemia). The study analysis involved 26,469 individuals over 242 clusters. Malaria infection rate was 7.6%, overall anaemia prevalence was 47.5% and moderate-to-severe anaemia prevalence was 4.5%. The average community-level utilization was 31.5% for malaria diagnosis, 29.9% for ACTs and 35.7% for LLINs. The odds of malaria infection was significantly reduced by 14% for each 10% increase in the utilization of malaria diagnosis (adjusted odds ratio (aOR) per 10% utilization 0.86, 95% CI 0.78-0.95, p = 0.004). However, the odds of infection was positively associated with the utilization of LLINs at community-level (aOR per 10% utilization 1.20, 95% CI 1.11-1.29, p < 0.001). No association between malaria infection and utilization of ACTs was identified (aOR per 10% utilization 0.97, 95% CI 0.91-1.04, p = 0.413). None of the interventions was associated with overall anaemia nor moderate-to-severe anaemia. There was strong evidence that utilization of malaria diagnosis at the community level was highly protective against malaria infection. No protective effect was seen for community utilization of ACTs or LLINs. No association was established between any of the interventions and overall anaemia or moderate-to-severe anaemia. This lack of effectiveness could be due to the low utilization of interventions or the low level of malaria transmission in the study area. Identification and response to barriers of access and low utilization of malaria interventions are crucial. It is crucial to ensure that every suspected malaria case is tested in a timely way, notably in low transmission settings.

Effect of Health Education through Community Leaders on Increase Utilization of Households Regarding LLINs in Intervention and Control Villages of New Halfa Locality-Kassala State (2017-2020)

The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. . The current study aimed to assess the effect of Health Education through Community leaders on increased knowledge of Households Regarding malaria control, treatment and prevention in intervention and control villages of New Halfa Locality-Kassala State (2017-2020). Randomized community trials (Controlled intervention study) in New Halfa locality among two communities were randomly assigned to intervention group which receive health education messages regarding the use of LLINs and control group where there is no health education. Standard Questionnaire was use to collect data from the head of household at each village. The information collected should include the owner and using LLINs, distributed to household. The observation the conditions of LLINs. This Questionnaire was done with committee for integrated vector management - Federal Ministry of Health and WHO. The major source of information was TV in control (23.2%) and intervention villages (22.8%) with no significant difference, p&gt; 0.05. There was no significant difference between intervention and control regarding sleeping under net last night (p=.87). The proportion of households slept under nets was not significantly slightly increased in intervention villages (51.9%) compared to control villages (48.1%). The most reasons for not sleeping under nets in control and intervention villages was significantly were no mosquito, no need, hot weather, bad feeling, owner absence and other reasons not mentioned. The frequency distribution of number of bed nets per household. The number of bed nets per household in control villages was found to be 3.7(1.9%) during survey I , 3.1 (1.5%) during survey П and 3.2 (1.6%) during the survey Ш with mean of 3.2 (1.6%). However, the number of bed nets in intervention villages during surveyI , survey П, survey were found 3.7 (1.9%), 3.2 (1.4%) and 2.9 (1.4%) respectively with mean of 3.3 (1.7%). The number of households in control group during survey I was 2541 (44.8%), survey П 1838 (32.4%) and during survey Ш 1300 (22.9%). While the number of households in intervention villages during survey I 2526 (41.8%), survey П 1997 (33.1%) and during survey Ш was 1514 (25.1%). The ownership of bed nets was 100% in control village during surveyI, survey П and survey Ш, but the ownership was slightly decreased in intervention villages during survey I (99.4%) and during survey Ш (99.6%). Regarding use of nets, the use of bed nets during survey I in control villages was found high 70.8% compared to intervention villages (64.1%) while remarkable increased in bed nets use during survey П (82%) and survey Ш ( 55.8%) in intervention villages compared to control villages (74.8%), (47%) respectively. This may be due to health education packages. It can be concluded that the overall knowledge was fair in the present study. This could be attributed to the media campaign sessions during net distribution and to the role of community leaders in these campaigns. Also in other words this study has demonstrated the effectiveness of health education as vital tool for improving the knowledge of malaria and utilization of LLINs.

Effect of Health Education through Community Leaders on Increase Utilization of Households Regarding LLINs in Intervention and Control Villages of New Halfa Locality-Kassala State (2017-2020)

The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. . The current study aimed to assess the effect of Health Education through Community leaders on increased knowledge of Households Regarding malaria control, treatment and prevention in intervention and control villages of New Halfa Locality-Kassala State (2017-2020). Randomized community trials (Controlled intervention study) in New Halfa locality among two communities were randomly assigned to intervention group which receive health education messages regarding the use of LLINs and control group where there is no health education. Standard Questionnaire was use to collect data from the head of household at each village. The information collected should include the owner and using LLINs, distributed to household. The observation the conditions of LLINs. This Questionnaire was done with committee for integrated vector management - Federal Ministry of Health and WHO. The major source of information was TV in control (23.2%) and intervention villages (22.8%) with no significant difference, p&gt; 0.05. There was no significant difference between intervention and control regarding sleeping under net last night (p=.87). The proportion of households slept under nets was not significantly slightly increased in intervention villages (51.9%) compared to control villages (48.1%). The most reasons for not sleeping under nets in control and intervention villages was significantly were no mosquito, no need, hot weather, bad feeling, owner absence and other reasons not mentioned. The frequency distribution of number of bed nets per household. The number of bed nets per household in control villages was found to be 3.7(1.9%) during survey I , 3.1 (1.5%) during survey П and 3.2 (1.6%) during the survey Ш with mean of 3.2 (1.6%). However, the number of bed nets in intervention villages during surveyI , survey П, survey were found 3.7 (1.9%), 3.2 (1.4%) and 2.9 (1.4%) respectively with mean of 3.3 (1.7%). The number of households in control group during survey I was 2541 (44.8%), survey П 1838 (32.4%) and during survey Ш 1300 (22.9%). While the number of households in intervention villages during survey I 2526 (41.8%), survey П 1997 (33.1%) and during survey Ш was 1514 (25.1%). The ownership of bed nets was 100% in control village during surveyI, survey П and survey Ш, but the ownership was slightly decreased in intervention villages during survey I (99.4%) and during survey Ш (99.6%). Regarding use of nets, the use of bed nets during survey I in control villages was found high 70.8% compared to intervention villages (64.1%) while remarkable increased in bed nets use during survey П (82%) and survey Ш ( 55.8%) in intervention villages compared to control villages (74.8%), (47%) respectively. This may be due to health education packages. It can be concluded that the overall knowledge was fair in the present study. This could be attributed to the media campaign sessions during net distribution and to the role of community leaders in these campaigns. Also in other words this study has demonstrated the effectiveness of health education as vital tool for improving the knowledge of malaria and utilization of LLINs.

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

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.

Impact of malaria control interventions on malaria infection and anaemia in areas with irrigated schemes: a cross-sectional population-based study in Sudan

BackgroundWhile the overall burden of malaria is still high, the global technical strategy for malaria advocates for two sets of interventions: vector control-based prevention and diagnosis and prompt effective treatment of malaria cases. This study aimed to assess the performance of malaria interventions on malaria infection and anaemia in irrigated areas in Sudan.MethodsBased on the Sudan 2016 national malaria indicator survey, data for two states (Gezira and Sennar), characterized by large-irrigated schemes, were analysed. Four community-level malaria interventions were used as contextual variables: utilization of malaria diagnosis, utilization of Artemisinin-based combination therapy (ACT), utilization of long-lasting insecticidal nets (LLINs) and coverage with indoor residual spraying (IRS). Association between these interventions and two outcomes: malaria infection and anaemia, was assessed separately. Malaria infection was assessed in all age groups while anaemia was assessed in children under 5 years. Multilevel multiple logistic regression analysis were conducted.ResultsAmong 4478 individuals involved in this study distributed over 47 clusters, the overall malaria infection rate was 3.0% and 56.5% of the children under 5 years (total = 322) were anaemic. Except for IRS coverage (69.6%), the average utilization of interventions was relatively low: 52.3% for utilization of diagnosis, 33.0% for utilization of ACTs and 18.6% for LLINs utilization. The multi-level multiple logistic regression model showed that only IRS coverage was associated with malaria infection (Odds ratio 0.83 per 10% coverage, 95%Confidence Interval (95%CI) 0.74–0.94, p = 0.003) indicating that a higher level of IRS coverage was associated with less malaria infection. Anaemia was not associated with any intervention (all p values larger than 0.1).ConclusionsMalaria transmission in Gezira and Sennar areas is low. IRS, with insecticide to which vectors are susceptible, is an effective malaria control intervention in irrigated schemes. Community utilization of other interventions was not associated with malaria infection in this study. This may be due to the low utilization of these interventions. However, individual use of LLINs provide personal protection. This study failed to establish an association between anaemia and malaria control interventions in low transmission areas. The higher level of malaria infection in urban areas is a cause for concern.

Community knowledge, perceptions, and practices regarding malaria and its control in Jabi Tehnan district, Amhara Region, Northwest Ethiopia

BackgroundUse of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), community-based malaria education, prompt diagnosis and treatment are key programme components of malaria prevention and control in Ethiopia. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behaviour, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening).MethodsThe study was conducted in Jabi Tehnan district, Northwestern Ethiopia, from November 2019 to March 2020. A total of 3010 households from 38 villages were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters considering agro-ecological differences. A total of 1256 children under 10 years of age were screened for malaria parasites using microscopy to determine malaria prevalence. Furthermore, 5-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics.ResultsMalaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health-seeking behaviour remains a key behavioural challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average, households lost 2.53 working days per person-per malaria episode and they spent US$ 18 per person per episode. Out of the 1256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, with 50% of the total cases reported from households being from among individuals who were 15 years or older. The second most affected group was the age group between 5 and 14 years followed by children aged under 5, with 31% and 14% burden, respectively.ConclusionDespite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low. Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritized in the study area to bring about the desired behavioural changes.

Geopolitical zones differentials in intermittent preventive treatment in pregnancy (IPTp) and long lasting insecticidal nets (LLIN) utilization in Nigeria.

BackgroundThe coverage of long lasting insecticidal nets (LLIN) and intermittent preventive treatment of malaria in pregnancy (IPTp) uptake for the prevention of malaria commonly vary by geography. Many sub-Saharan Africa (SSA) countries, including Nigeria are adopting the use of LLIN and IPTp to fight malaria. Albeit, the coverage of these interventions to prevent malaria across geographical divisions have been understudied in many countries. In this study, we aimed to explore the differentials in LLIN and IPTp uptake across Nigerian geopolitical zones.MethodsWe analyzed data from Nigeria Multiple Indicator Cluster Survey (MICS) 2016–17. The outcome variables were IPTp and LLIN uptake among women of childbearing age (15–49 years). A total sample of 24,344 women who had given birth were examined for IPTp use and 36,176 women for LLIN use. Percentages, Chi-square test and multivariable logit models plots were used to examine the geopolitical zones differentials in IPTp and LLIN utilization. Data was analyzed at 5% level of significance.ResultsThe overall prevalence of IPTp was 76.0% in Nigeria. Moreover, there were differences across geopolitical zones: North Central (71.3%), North East (76.9%), North West (78.2%), South East (76.1%), South South (79.7%) and South West (72.4%) respectively. Furthermore, the prevalence of LLIN was 87.7%% in Nigeria. Also, there were differences across geopolitical zones: North Central (89.1%), North East (91.8%), North West (90.0%), South East (77.3%), South South (81.1%) and South West (69.8%) respectively. Women who have access to media use, married, educated and non-poor were more likely to uptake IPTp. On the other hand, rural dwellers and those with media use were more likely to use LLIN. Conversely, married, educated, non-poor and women aged 25–34 and 35+ were less likely to use LLIN.ConclusionThough the utilization of IPTp and LLIN was relatively high, full coverage are yet to be achieved. There was geopolitical zones differentials in the prevalence of IPTp and LLIN in Nigeria. Promoting the utilization of IPTp and LLINs across the six geopolitical zones through intensive health education and widespread mass media campaigns will help to achieve the full scale IPTp and LLIN utilization.

Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria

BackgroundThe long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria.MethodsA cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN.ResultsA total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3–4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5–0.9).ConclusionsThe knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).

Health system, socio-cultural, economic, environmental and individual factors influencing bed net use in the prevention of malaria in pregnancy in two Ghanaian regions

BackgroundImproving maternal health remains a priority to the Ghanaian government. Consequently, it has implemented the World Health Organization recommendation of distributing free long-lasting insecticidal nets (LLINs) to pregnant women—one of the effective strategies to combating malaria in pregnancy. However, the burden of negative outcomes of malaria in pregnancy such as low birth weight and miscarriages is still high. This may be related to the health system, socio-cultural and economic dynamics that influence LLIN use, but their role is not well understood. This ethnographic study sought to understand health system, socio-cultural, economic and environmental dynamics in utilization of LLINs among pregnant women in two Ghanaian regions.MethodsAn ethnographic study design was used. In-depth interviews and conversations were conducted among health workers, pregnant women and opinion leaders. Observations were conducted in 12 communities and eight health facilities. Ethical clearance was obtained from the University of Health and Allied Sciences’ Research Ethics Committee. Nvivo 11 was used to support data coding. Data were triangulated and analysed using a thematic approach.ResultsFindings suggest health system, socio-cultural, economic, environmental and individual factors influenced LLIN use. Health facility readiness in stocking LLINs influenced ownership and use. Receiving appropriate information from health providers and encouragement from public officials improved LLIN use. Women with a history of LLIN use prior to becoming pregnant and women who had young children remained consistent users. Experiencing irritating effects of LLINs and preference for traditional methods to wade off mosquitoes, reduced LLIN use. Pregnant women whose household and family members used LLINs were influenced positively to use them. Gender power relations between husbands and wives influenced women’s use of LLINs. The type of housing and weather conditions contributed to inconsistent use. Staying out late for business purposes and to converse, exposed pregnant women to mosquito bites.ConclusionGiving out LLINs at facility level should be accompanied with comprehensive information, which is relevant to the socio-cultural context that women live in. Mass distribution should factor in individual and public information to promote community acceptance and proper use of ITNs. Facilities should be encouraged to constantly maintain LLINs stock in order to ensure that ANC registrants receive LLINs for use.

Caregivers\u2019 knowledge and utilization of long-lasting insecticidal nets among under-five children in Osun State, Southwest, Nigeria

BackgroundUtilization of long-lasting insecticidal nets (LLIN) has been associated with reduction of malaria incidence, especially among children. The 2013 Nigeria Demographic and Health Survey revealed Osun State had the least proportion (5.7%) of under-five children (U5) who slept under LLIN the night before the survey. A study was conducted to assess caregivers’ knowledge about LLIN, utilization of LLIN and factors influencing LLIN use among U5 in Osun State, Nigeria.MethodsA cross-sectional study was carried out among 1020 mothers/caregivers of U5 selected from six communities in Osun State using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on socio-demographic characteristics, mothers’ knowledge about LLIN, ownership and utilization of LLIN and factors influencing use of LLIN in U5. Questions on knowledge about LLIN were scored and categorized into good (scored ≥ 5) and poor (score < 5) knowledge out of a maximum obtainable score of seven. Utilization of LLIN was defined as the proportion of U5 who slept under net the night before the survey. Data were analysed using descriptive statistics, Chi square test and logistic regression at α < 0.05. Transcripts from focus group discussions (FGD) were analysed for emerging themes related to caregivers’ perspectives on utilization and factors affecting use of LLIN among U5.ResultsMajority of the respondents 588 (58.3%) fall between age 25–34 years, with a mean age of 30.0 ± 6.3 years. All were aware of LLIN but only 76.1% had good knowledge and 59.0% reported use of LLIN among their U5. Reported barriers to utilizing LLIN were; heat (96.4%), reactions to the chemical (75.5%) and unpleasant odour (41.3%). These were corroborated at FGD. Those with formal education [adjusted odds ratio (aOR) = 1.4; 95% CI 1.0–2.1] and those with good knowledge of LLIN (aOR = 1.8; 95% CI 1.4–2.5) were more likely to use LLIN than their counterparts without formal education and those with poor knowledge of LLIN respectively.ConclusionsThe level of knowledge of respondents about LLIN was high and the utilization of LLIN among U5 was above average, however, it is still far below the 80% target. Efforts should be made to further improve utilization of LLIN through intensified promotion and health education.

Predictors of insecticidal net use among internally displaced persons aged 6-59 months in Abuja, Nigeria.

IntroductionMalaria is the commonest cause of morbidity and mortality among displaced populations especially children in endemic countries. Nigeria, an endemic country, has had increase in internally displaced persons (IDP) due to insurgency. utilization of long-lasting insecticidal nets (LLIN) is a key strategy employed to achieve global targets of malaria elimination and its effectiveness is determined by utilization, coverage and maintenance. We determined the coverage and utilization of LLIN among children aged 6-59 months at IDP camps and its predictors.MethodsA cross-sectional study was conducted among children aged 6-59 months at the three IDP camps in Abuja. We collected data on socio-demographic characteristics, LLIN ownership and utilization using computer-aided interview, complemented by direct observation of nets. We defined universal LLIN coverage as the proportion of households with one LLIN to two persons and utilization as an eligible child sleeping under the LLIN the night preceeding the survey. Bivariate analysis was done at p < 0.25 and logistic regression at 5% level of significance.ResultsOverall, 393 children were enrolled with mean age of 33.3 ± 17.4 months, 51.6% were female. Household LLIN ownership was 76.7.5%, universal coverage 11.2% and utilization 89.7%. Independent predictors of LLIN utilization were LLIN hung at sleeping area (adjusted OR: 99.9, CI: 22.7 – 438.8) and type of camp site (adjusted OR: 8.2, CI: 2.5 – 27.4).ConclusionLLIN utilization was high in these IDP camps despite low coverage. LLIN distribution and hanging campaigns are recommended to reduce malaria transmission in the IDP camps.

Replacement Campaign of Long Lasting Insecticide Treated Nets in Ondo State, Southwest Nigeria, Heartland of Africas Most Efficient Vector Species

Background: Ondo State in Southwest Nigeria, heartland of Africa’s most efficient malaria vector, conducted a Long- Lasting Insecticidal Nets (LLINs) replacement campaign at the last quarter of 2017 with the aim of achieving the recommended coverage of one LLIN per two persons, in line with the National Malaria Elimination Program (NMEP) strategy. The LLIN replacement campaign planned to reach 4,757,725 populations to achieve universal coverage, a proven intervention aimed at reducing malaria morbidity by increasing access to, as well as ownership and utilization of LLINs. The processes to achieve this goal are described in this paper. Methodology: This paper describes the modalities and scheme for LLIN distribution in one of the states in Southern Nigeria. The campaign took place in all the 18 Local Government Areas (LGAs) of the state between September 17 and November 15, 2017. Implementation trainings were held and advocacies were conducted at state level and to traditional and religious leaders followed by community mobilization in all the Local Government Authorities. Intense logistic activities included transportation and positioning of LLINs. The Implementation was endorsed by LLIN Ambassadors. End process evaluation and reverse logistics were carried out. The LLIN replacement was carried out at a time of high malaria transmission during the second rainy season of the year. Excel spreadsheet was used in data analysis. Outcome: The LLIN replacement campaign involved the training of 11,695 personnel in different cadres including teams, supervisors and monitors at state and at LGA levels, independent monitors, ward monitors and town announcers. Distribution point supervisors, health educators and crowd controllers as well as store keepers were also trained. In all 2,734,500 net cards were issued to LGAs of which 2,674,172 (98.0%) net cards were issued to beneficiaries to collect LLINs. In all, 2,444,036 (91.4%) LLINs were redeemed. Reasons for non-use of LLIN ranged from adverse reaction (11.0%) to “no mosquitoes” (1.0%). Majority (82.0%) of people heard about the LLIN campaign from town announcers and none was unaware of the campaign. Hanging rate was low at 55.0% while utilization by under-fives and by pregnant women was 67.0% and 76.0%, respectively. Conclusion: Despite the fact that replacement of LLINs in Ondo state of southwest Nigeria took place on a large scale, its utilization, especially among the at-risk groups, was still low. Aggressive follow-up campaigns to increase utilization should include more purposeful social and health advocacies to community and religious leaders. Use of local drama groups for behavioral change could be an advantage. Distribution of LLINs to school children should also be considered.

Factors influencing the ownership and utilization of long-lasting insecticidal nets for malaria prevention in Ethiopia

BackgroundUtilization of long-lasting insecticidal nets (LLINs) is regarded as key malaria prevention and control strategy. However, studies have reported a large gap in terms of both ownership and utilization particularly in the sub-Saharan Africa (SSA). With continual efforts to improve the use of LLIN and to progress malaria elimination, examining the factors influencing the ownership and usage of LLIN is of high importance. Therefore, the current study was conducted to examine the level of ownership and use of LLIN along with identification of associated factors at household level.MethodsA cross-sectional study was conducted in Mirab Abaya District, Southern Ethiopia in June and July 2014. A total of 540 households, with an estimated 2690 members, were selected in four kebeles of the district known to have high incidence of malaria. Trained data collectors interviewed household heads to collect information on the knowledge, ownership and utilization of LLINs, which was complemented by direct observation on the conditions and use of the nets through house-to-house visit. Bivariate and multivariable logistic regression analyses were used to determine factors associated to LLIN use.ResultsOf 540 households intended to be included in the survey, 507 responded to the study (94.24% response rate), covering the homes of 2759 people. More than 58% of the households had family size >5 (the regional average), and 60.2% of them had at least one child below the age of 5 years. The ownership of at least one LLIN among households surveyed was 89.9%, and using at least one LLIN during the night prior to the survey among net owners was 85.1% (n = 456). Only 36.7% (186) mentioned at least as the mean of correct scores of all participants for 14 possible malaria symptoms and 32.7% (166) knew at least as the mean of correct scores of all participants for possible preventive methods. Over 30% of nets owned by the households were out of use. After controlling for confounding factors, having two or more sleeping places (adjusted odds ratio [aOR] = 2.58, 95% CI 1.17, 5.73), knowledge that LLIN prevents malaria (aOR = 2.51, 95% CI 1.17, 5.37), the presence of hanging bed nets (aOR = 19.24, 95% CI 9.24, 40.07) and walls of the house plastered or painted >12 months ago (aOR = 0.09, 95% CI 0.01, 0.71) were important predictors of LLIN utilization.ConclusionsThis study found a higher proportion of LLIN ownership and utilization by households than had previously been found in similar studies in Ethiopia, and in many studies in SSA. However, poor knowledge of the transmission mechanisms and the symptoms of malaria, and vector control measures to prevent malaria were evident. Moderate proportions of nets were found to be out of use or in poor repair. Efforts should be in place to maintain the current rate of utilization of LLIN in the district and improve on the identified gaps in order to support the elimination of malaria.

Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study.

BackgroundMalaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas.MethodsA randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages.ResultsThe knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72–5.72)], (η2 = 0.64). The average of mothers’ knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages.ConclusionsThese results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1551-8) contains supplementary material, which is available to authorized users.