Determinants of bed net use conditional on access in population surveys in Ghana

Abstract

Background Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net. Methods Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members’ access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging. Results In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5–4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5–4.3) and 2016 (OR 1.6, 95% CrI 1.1–2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA. Conclusion Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population. Electronic supplementary material The online version of this article (10.1186/s12936-019-2700-7) contains supplementary material, which is available to authorized users.

Individual, community and region level predictors of insecticide-treated net use among women in Uganda: a multilevel analysis

“…Poor women were more likely to use ITN. This outcome resonates with evidence from Rwanda and Ghana [22,23]. Through the National Malaria Control Programme, the President's Malaria Initiative and other anti-malaria interventions, the government of Uganda and other stakeholders have ensured easy access to ITN and other malaria control measures [3,4].…”

“…In contrast, Bennett et al [34] noted that rural residents in Cameroon stand a higher chance of using ITN compared with urban residents following a national mass distribution exercise. Another study from Ghana revealed that rural residents are more likely to use ITN [22]. Contextual variations between Uganda and settings for the other studies may account for the inconsistent findings.…”

“…For instance, over 7.2 million LLINs were distributed in 2010 under the National Malaria Control Programme and as of 2013/2014, about 12 million LLINs had been distributed through mass campaigns where 60% administrative coverage was achieved with the aim of achieving the "Malaria free Uganda" vision [4]. These interventions are predominantly pro-poor because the rich are more likely to reside in less malaria prone environments unlike the poor who may be in environments with poor drainage system and unkempt environments where mosquito breeding sites are immanent [22,24]. On the account of these, the poor are likely to embrace and effectively use ITNs.…”

Attrition, physical integrity and insecticidal activity of long-lasting insecticidal nets in sub-Saharan Africa and modelling of their impact on vectorial capacity

“…Only LLINs that are being used can contribute to malaria transmission control, and LLINs that are present in households but are stored away and remain in good condition are useless until used. LLIN use, in addition to depending on presence, physical and chemical status of LLINs, depends on a plethora of factors including product quality, geographically specific use practices, knowledge about their benefits, and seasonally varying factors such as mosquito nuisance levels, temperature and humidity which impact the comfort level inside a LLIN [25][26][27][28][29]. Also, LLINs may be temporarily unavailable due to washing or travel.…”

Individual and contextual correlates of mosquito net use among women in Nigeria

“…This study has demonstrated that the use of mosquito nets among women of reproductive age in Nigeria is influenced by both individual and contextual factors. It is revealed that women who are from poor households used mosquito nets more than their counterparts who are from rich households [24,25]. This may be attributed to the fact that women from rich households may have devised other means of protecting themselves from [18].…”