Access to and use of long-lasting insecticidal nets and factors associated with non-use among communities in malaria-endemic areas of Al Hudaydah governorate in the Tihama region, west of Yemen

Abstract

BackgroundUniversal coverage of the targeted malaria-endemic areas with long-lasting insecticidal nets (LLINs) is implemented as one of the key interventions for malaria control and elimination in Yemen. In 2013, through a mass campaign, LLINs were distributed to the targeted communities in Al Hudaydah governorate. This study aimed to assess the ownership of, access to, and use of LLINs. It also aimed to identify factors associated with not using LLINs in malaria-endemic areas of Al Hudaydah in the Tihama region, west of Yemen.MethodsA cross-sectional survey was conducted in four districts (Ad Durayhimi, Al Marawi’ah, Al Mansuriyah and Bayt Al Faqiah) in Al Hudaydah during February 2016. A total of 701 households were included in this study. Data on socio-demographic characteristics and availability of LLINs were collected by interview and observation. Four indicators for malaria prevention using LLINs; proportion of households with at least one LLIN, proportion of households with at least one LLIN for every two people, proportion of population with access to LLINs in the surveyed households and proportion of population who slept under LLINs the previous night of the survey were calculated as indicated by Roll Back Malaria Monitoring and Evaluation Reference Group. Use to access ratio was assessed. Factors associated with not using LLINs among people with access were also investigated.ResultsOf 701 households with 4900 de facto population, ownership of at least one LLIN was 90.6%, while 24.1% owned at least one for every two people during the survey in 2016. The overall proportion of people with access to LLINs was 51.5% (95% CI 50.1–52.9). Only 19.0% (95% CI 17.9–20.1) slept under LLINs the night before the survey and the overall use to access ratio was 0.37. The proportions of children under 5 years of age with access to and use of LLINs were 13.7 and 42.5%, respectively. On the other hand, the proportions of pregnant women with access to and use of LLINs were 16.4 and 20.0%, respectively. Multivariable analysis identified that people living in Al Mansuriyah district [adjusted odds ratio (AOR) = 3.29, 95% confidence interval (CI) 1.35–8.01; P = 0.009)], having three or more damaged LLINs in the house (AOR = 2.76, 95% CI 1.79–4.25; P < 0.001), aged between 16 and 45 years old (AOR = 2.17, 95% CI 1.26–3.75; P = 0.005) or older (AOR = 2.17, 95% CI 1.09–4.29; P = 0.026) and living in huts (AOR = 1.59, 95% CI 1.09–2.32; P = 0.015) were significantly less likely to use LLINs.ConclusionsThis study shows a low LLIN access rate among local communities targeted for universal LLIN coverage in Al Hudaydah, a malaria-endemic area of high transmission. This finding necessitates additional distribution channels following mass campaigns to maintain the universal coverage. Reduced use of LLINs among people with access in these communities together with the identified risks of non-use highlight the importance of conducting behaviour change communication campaigns to enhance using LLINs in areas with universal coverage.

Long Lasting Insecticide-treated Bed Net Ownership, Utilization and Associated Factors Among School-age Children in Dara Mallo and Uba Debretsehay Districts, Southern Ethiopia

“…In similar with studies conducted in Adami Tulu, utilization of bed net among the study population was higher when the mother of children had higher level of education [36]. The same thing was true for study population in Equatorial Guinea (37). However, the educational status of caregiver of children aged bellow ve years was not in uenced by their educational status in Ghana (35) which could be related to differences in decision making capacity by the caregivers where non parental care givers might had low in uence in ordering the children to sleep under the bed net or low decision making power in the household.…”

“…From the socio demographic factors, being female and living in urban areas (36,37,44) were positively in uencing the utilization of bed net by the study population though this was not shown in the present study with respect to residence area. According to this study, the bed net utilization was higher among children in rural area as compared to those in urban area.…”

Uncomplicated falciparum malaria among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen: Association with anaemia and underweight

“…This nding is consistent with those reported for Ugandan and Cameroonian children [34,51] but inconsistent with that reported among Malawian schoolchildren [36]. The low utilisation of mosquito nets among schoolchildren is in agreement with that (19.0%) reported at the community level in Hodeidah in 2016 [52]. Low mosquito-net utilisation by children despite ownership is common in endemic countries.…”

Uncomplicated falciparum malaria among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen: Association with anaemia and underweight

“…This nding is consistent with those reported for Ugandan and Cameroonian children [34,50] but inconsistent with that reported among Malawian schoolchildren [36]. The low utilisation of mosquito nets among schoolchildren is in agreement with that (19.0%) reported at the community level in Hodeidah in 2016 [51]. Low mosquito-net utilisation by children despite ownership is common in endemic countries.…”