Factors associated with utilization of insecticide-treated nets in children seeking health care at a Ugandan hospital: perspective of child caregivers

Insecticide-Treated Bed Net Utilization and Associated Factors Among Households in Ilu Galan District, Oromia Region, Ethiopia

INTRODUCTION

Insecticide-treated mosquito nets are often used as a physical barrier to prevent infection of malaria. In sub-Saharan Africa, one of the most important ways of lowering malaria burden is the utilization of insecticide-treated nets (ITNs). However, there is no sufficient information on ITN utilization and its associated factors in Ethiopia. Therefore, this study aimed to assess the utilization of insecticide-treated bed nets and its associated factors among households in Ilu Galan district, Oromia Region, Ethiopia.

METHODS

A community-based cross-sectional study was conducted in the Ilu Galan district to select 550 households using systematic random sampling techniques. Interviewer-administered questionnaire and observational checklists were used to collect data. The collected data was entered into Epi data version 3.1 and exported to SPSS version 23 for analysis. The results were presented by texts, tables, and graphs. Both binary and multivariate logistic regressions were used to assess factors associated with ITN utilization.

RESULTS

A total of 532 study participants responded to the questionnaire making a response rate of 96.7%. About 72.2%, [95% CI: 68.4%, 75.8%] of the respondents utilized insecticide-treated nets in the night before the day data was collected. Being female [AOR = 0.55, 95% CI: 0.36, 0.81], age less than 25 years [AOR = 0.38, 95% CI: 0.23, 0.95], monthly income >1000 ETB [AOR = 2.24, 95% CI: 1.14, 4.69], and having more than 3 beds [AOR = 2.04, 95% CI: 1.29, 3.51] were significantly associated with ITN utilization.

CONCLUSIONS

Insecticide-treated nets utilization was found to be low in this study. There is a gap between the ownership and ITN utilization. Sex, age, monthly income, and number of beds were factors associated with ITN utilization. The provision of behavioral change communication to the community on the importance of ITN utilization is compulsory.

Perception and utilization of insecticide-treated mosquito net among caregivers of children in Abakaliki, Nigeria

Background:

Malaria contributes significantly to under-5 morbidity and mortality in Sub-Saharan African countries including Nigeria. The rollback malaria (RBM) initiative and millennium developmental goal 6 are the programs targeted at reduction in malaria burden. The target year here is 2015; it would be needful to determine the impact of these programs on lives of at-risk population.

Objectives:

To determine caregivers’ perception and utilization of insecticide-treated mosquito net (ITN) for their children/wards under 5 years of age.

Methods:

It was a cross-sectional, descriptive, hospital-based study conducted at Federal Teaching Hospital, Abakaliki, between April 1, 2014, and October 31, 2014. A structured questionnaire was used to assess caregivers’ perception and utilization of ITN. Relevant information collected from the respondents included awareness of what ITN is and its use, ownership, source and utilization of ITN, and frequency of antimalaria use for febrile episodes. Data were analyzed using Statistical Package for the Social Sciences (SPSS) Windows Program (SPSS Inc., Chicago, IL, USA) version 20.0 while the level of statistical significance was set at P < 0.05.

Results:

A total of 410 caregivers were interviewed; 362 (88.3%) were mothers. Three-hundred and eighty-four (93.7%) participants knew that ITN prevents mosquito bite that cause malaria infection, 81.2% (333/410) have at least one ITN in their homes, but only 215 (52.4%) use the ITN every night. Caregivers who used ITN regularly used antimalaria for their under-5 quarterly (34.9%) and rarely (33.9%). A significant relationship existed among socioeconomic class, knowledge of ITN, source of knowledge of ITN, frequency of anti-malaria use, and utilization of ITN.

Conclusion:

The study observed that awareness and ownership of ITN are high among study participants, but its utilization was suboptimal compared to RBM target for 2010 (80.0%). Health education and free distribution of ITNs should be further strengthened particularly among mothers of childbearing age and younger children.

Predictors of sleeping under cost-free mosquito bed nets among children under-five years in Mbarara, Uganda: a household survey

BACKGROUND

In 2010, Uganda Malaria Control Programme distributed cost-free mosquito bed nets to households with children under-five years and pregnant women in selected sub-counties. We assessed the factors associated with sleeping under costfree mosquito nets among children under-five years in Nyakayojo sub-county, Mbarara District, Uganda.

METHODS

381 households with at least a child under-five years and benefited from cost-free bed nets in Nyakayojo were randomly selected. Caregivers of children were interviewed using a questionnaire.

RESULTS

74% children slept under bed nets a night before the study. Children from households with ≥2 nets [aOR=1.75; 95% CI: 1.09-2.81, p=0.02], female caregiver [aOR=2.11; 95% CI: 1.16-3.79, p=0.01] and children from households that did not face problems (skin irritation, torn nets, suffocation, night sweating, nasal congestion and candle fire) when sleeping under bed nets [aOR=1.81; 95% CI: 1.10-2.98, p=0.02] were more likely to use nets. Main reason for not sleeping under a net was damage to the net (47.1%).

CONCLUSION

The proportion of children sleeping under nets was comparable to MDG target. Improvements in use of mosquito nets by children can be achieved through increasing number of nets in a household.

Utilization of insecticide treated bed net and associated factors among households of Kola Diba town, North Gondar, Amhara region, Ethiopia

OBJECTIVE

The primary aim of this study was to assess the utilization of an insecticide-treated bed net on the preceding night and associated factors among households of Kola Diba town in 2017.

RESULTS

Of the 260 households, 239 (91.9%) (95% CI = 88.5-95%) utilized insecticide-treated bed net on the night preceding the interview. 242 (93.1%) households didn't treat the bed net whereas 18 (6.9%) treat the bed net by chemical regularly. Household structure and knowledge about malaria transmission were found to be associated with insecticide-treated bed net utilization.

The Impact of Integrated Community Case Management of Childhood Diseases Interventions to Prevent Malaria Fever in Children Less than Five Years Old in Bauchi State of Nigeria

BACKGROUND

Malaria accounts for about 300,000 childhood deaths and 30% of under-five year old mortality in Nigeria annually. We assessed the impact of intervention strategies that integrated Patent Medicines Vendors into community case management of childhood-diseases, improved access to artemisinin combination therapy (ACT) and distributed bed nets to households. We explored the influence of household socioeconomic characteristics on the impact of the interventions on fever in the under-five year olds in Bauchi State Nigeria.

METHODS

A cross-sectional case-controlled, interventional study, which sampled 3077 and 2737 under-5 year olds from 1,588 and 1601 households in pre- and post-intervention periods respectively, was conducted from 2013 to 2015. Difference-in-differences and logistic regression analyses were performed to estimate the impact attributable to the interventions: integrated community case management of childhood illness which introduced trained public and private sector health providers and the possession of nets on the prevalence of fever.

RESULTS

Two-week prevalence of fever among under-fives declined from 56.6% at pre-intervention to 42.5% at post-intervention. Fever-prevention fraction attributable to nets was statistically significant (OR = 0.217, 95% CI: 0.08-0.33). Children in the intervention group had significantly fewer incidence of fever than children in the control group had (OR = 0.765, 95% CI: 0.67-0.87). Although being in the intervention group significantly provided 23.5% protection against fever (95% CI: 0.13-0.33), the post-intervention likelihood of fever was also significantly less than at pre-intervention (OR = 0.57, 95% CI: 0.50-0.65). The intervention protection fraction against fever was statistically significant at 43.4% (OR = 0.434, 95% CI: 0.36-0.50). Logistic regression showed that the odds of fever were lower in households with nets (OR = 0.72, 95% CI: 0.60-0.88), among children whose mothers had higher education, in the post-intervention period (OR = 0.39, 95% CI: 0.33-0.46) and in the intervention group (OR = 0.52, 95% CI: 0.48-0.66). The odds of fever increased with higher socio-economic status of households (17.9%-19.5%). Difference-in-differences showed that the interventions significantly reduced occurrence of fever in the intervention group (OR = 1.70, 95% CI: 1.36-2.14).

CONCLUSION

The interventions were effective in reducing the prevalence and the likelihood of childhood malaria fever. Taken to scale, these can significantly reduce the burden of malaria fever in the under-five year old children.

Comparing two approaches for estimating the causal effect of behaviour-change communication messages promoting insecticide-treated bed nets: an analysis of the 2010 Zambia malaria indicator survey

Over the past decade, efforts to increase the use of insecticide-treated bed nets (ITNs) have relied primarily on the routine distribution of bed nets to pregnant women attending antenatal services or on the mass distribution of bed nets to households. While these distributions have increased the proportion of households owning ITNs and the proportion of people sleeping under an ITN the night prior to the survey, the role that behaviour-change communication (BCC) plays in the use of ITNs remains unquantified.

This paper uses two analytic approaches, propensity score matching and treatment effect modelling, to examine the relationship between exposure to the BCC messages and the use of a bed net the previous night, using the 2010 Zambia Malaria Indicator Survey (MIS).

When matched on similar propensity scores, a statistically significant 29.5 percentage point difference in ITN use is observed between exposed and unexposed respondents. Fifty-nine per cent of unexposed respondents reported sleeping under an ITN the previous night, compared to 88% of the exposed respondents. A smaller but similarly significant difference between exposed and unexposed groups, 12.7 percentage points, is observed in the treatment effect model, which also controls for the number of bed nets owned by the household and exposure to malaria information from health workers.

Using either approach, a statistically significant effect of exposure to BCC messages on a woman’s use of an ITN was found. Propensity score matching has the advantage of using statistically-matched pairs and relying on the assumption that given the measured covariates, outcome is independent of treatment assignment (conditional independence assumption), thereby allowing us to mimic a randomized control trial. Results from propensity score matching indicate that BCC messages account for a 29-percentage point increase in the use of ITNs among Zambian households that already own at least one ITN.

These analyses serve to illustrate that BCC programmes can contribute to national programmes seeking to increase the use of ITNs inside the home. They also offer a viable approach for evaluating the effectiveness of other BCC programmes promoting behaviour that will reduce malaria transmission or mitigate the consequences of infection.

The effectiveness of student-run organizations within global health promotion initiatives

INTRODUCTION

This commentary describes a student-led project that distributed long-lasting insecticide-treated nets in Masaka, Uganda. The role of student-led initiatives in global health promotion projects is also discussed.

METHODS

A survey of 213 net recipients was conducted after a 12-month period to evaluate malaria prevention knowledge, and net use and maintenance.

RESULTS

Only 4.7% of recipients could not recall any malaria prevention methods. Seventy percent of pregnant women and 86.5% of children under five slept under a net the previous night. Only two households (0.9%) no longer possessed a net, and nets were not used in 2.3% of houses. Household observation revealed 17.4% of nets had at least one problem that would compromise effectiveness.

CONCLUSIONS

Student-led projects can play an important role in effectively preventing malaria. However coordination with existing programs, targeting hard-to-access groups, and training of students overcomes some common limitations of such student-led initiatives.