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

Abstract

Background Use of insecticide-treated net (ITN) has been identified by the World Health Organization as an effective approach for malaria prevention. The government of Uganda has instituted measures to enhance ITN supply over the past decade, however, the country ranks third towards the global malaria burden. As a result, this study investigated how individual, community and region level factors affect ITN use among women of reproductive age in Uganda. Methods The 2018–2019 Malaria Indicator Survey of Uganda involving 7798 women aged 15–49 was utilized. The descriptive summaries of ITN use were analysed by individual, community and region level factors. Based on the hierarchical nature of the data, four distinct binomial multilevel logistic regression models were fitted using the MLwiN 3.05 module in Stata. The parameters were estimated using the Markov Chain Monte Carlo (MCMC) estimation procedure and Bayesian Deviance Information Criterion was used to identify the model with a better fit. Results The proportion of women who use ITN was 78.2% (n = 6097). Poor household wealth status [aOR = 1.66, Crl = 1.55–1.80], knowing that sleeping under ITN prevents malaria [aOR = 1.11, Crl = 1.05–1.24] and that destroying mosquito breeding sites can prevent malaria [aOR = 1.85, Crl = 1.75–1.98] were associated with higher odds of ITN use. ITN use attributable to regional and community level random effects was 39.1% and 45.2%, respectively. Conclusion The study has illustrated that ITN policies and interventions in Uganda need to be sensitive to community and region level factors that affect usage. Also, strategies to enhance women’s knowledge on malaria prevention is indispensable in improving ITN use.

Multilevel Modelling of Individual, Community and Regional Level Factors Associated with Insecticide-Treated Net Usage among Pregnant Women in Ethiopia

“…The study found that 58.37% of pregnant women slept under a net. This result is consistent with previous studies [ 28 , 29 , 30 , 31 , 32 ]. Women’s educational level was associated with ITNs usage among pregnant women; those with secondary or higher educational levels were more likely to sleep under a net than those who had no education.…”

“…This finding is similar to that of other studies in Ghana and Cameroon [ 41 , 42 ]. In contrast, Ameyaw et al [ 31 ] noted that rural residents in Uganda have a lower chance of using ITNs than urban residents following a national mass-distribution exercise.…”

Insecticide-Treated Nets Utilization and Associated Factors Among Pregnant Women in Miesso Woreda, Eastern Ethiopia: Observational Study

“…The odds of ITNs utilization was two times higher among urban resident pregnant women compared to the rural residents. This is consonant with the studies conducted in sub-Saharan Africa, 25 Tigray, 14 Northwest Ethiopia, 24 and Adama. 9 The reasons might be urban residents were near mass media, and health facilities/health professionals to get information and awareness regarding malaria prevention methods using ITNs, and they are near the market to buy ITNs.…”

“…Similarly, the odds of ITNs utilization was two times higher among pregnant women with monthly income >1050 Ethiopian total birr compared to their counterparts. This is supported by the findings of the studies conducted from sub-Saharan Africa 25 and North western Ethiopia 28 where pregnant women with income ≥151 dollar were more likely to utilize ITNs. This might be due to pregnant women with high income being able to access health services and having the ability to buy ITNs.…”

Utilization of insecticide-treated bed nets among pregnant women in Myanmar–analysis of the 2015–2016 Demographic and Health Survey

“…Many studies concluded that the individual’s economic status was associated with levels of malaria preventive practice in the community [ 10 , 26 – 28 ]. Mostly, ITNs are distributed free of charge directly to the hands of pregnant women.…”