Prevalence and risk factors determinants of the non-use of insecticide-treated nets in an endemic area for malaria: analysis of data from Cameroon

Abstract

BackgroundMalaria is the main cause of morbidity and mortality in Cameroon. Insecticide-treated nets (ITNs) significantly reduce malaria transmission, but their use is not common among populations. This study aimed to estimate the prevalence of the non-use of ITNs and identify its major determinants.Methods A cross-sectional study was conducted on interview data collected in households selected across all the regions of Cameroon through a non-probabilistic, random, 2-stage stratified sampling process. Descriptive statistics were used to describe the distribution of baseline characteristics across the households, and statistical tests assessed if the distribution of these characteristics differed significantly based on the non-use of ITNs, with 0.05 serving as a threshold of the p-value for statistical significance. The prevalence of the non-use of ITNs was estimated, and logistic regression models were used to tally the odds ratios of the associations between various factors and the non-use of ITNs, along with their 95% confidence intervals. Sensitivity, specificity, and areas under the curves were also determined, and the Hosmer Lemeshow test was used to measure the goodness of fit of each statistical model. Results Of the 7593 households interviewed, 77% had at least one ITN and 59% of the population used ITNs. Only 72% of the population with at least one ITN actually used it. The logistic model of the Multivariate analysis was significant at 5%. The area under the receiver operating characteristic (ROC) curve was 0.7087 and the error rate was 18.01%. The sensitivity and specificity of the model were 97.56% and 13.70% respectively. The factors that were associated with ITN use were the presence of sufficient nets in the household ( p <0.0001), the region of residence (p< 0.0001), the level of education of the respondent (p < 0.0001) and the standard of living (p=0.0286). Sex, age, colour preferences, as well as the shape and size of the net were not associated with ITN use.ConclusionsThe use of ITNs was low and varied according to specific factors. These identified factors could be used as the foundations of effective sensitization campaigns on the importance of ITNs.

Gaps in long lasting insecticide-treated net coverage 2 years after a mass distribution campaign in central Côte d’Ivoire

“…Household and population LLIN access based on 1 net per 2 persons was 37.6% and 59.3% respectively. Household and population access in other countries 1 to 4 years after a mass distribution campaign were within range of those found in our study; Nigeria (25% and 43% respectively) [45], Benin (55.9% and 79.5% respectively) [48], Ethiopia (50.3% and 78.6% respectively) [22], Cameroon (41% and 59% respectively) [49] and Tanzania (41% household LLIN access) [53]. It is worth noting that during the 2021 DHS survey in Côte d'Ivoire, household LLIN access was 51% [3].…”

“…This difference was not unexpected as the DHS survey was done 6 months following the mass LLIN distribution campaign, while the present study was done 24 months after. Other studies done between 1 to 4 years post mass distribution campaigns had various household LLIN ownership; Tanzania (74.5%) [44], Nigeria (56%) [45], Burkina Faso (33%) [46] and Guinea (44%) [47], Benin (95.8%) [48], Ethiopia (92.6%) [22] and Cameroon (73%) [49]. These differences could be explained by differences in proximity of coverage surveys to mass distributions, the frequencies of and strategies used for mass net distribution across countries (central point versus door-to-door distribution), the use of school-based top-up campaigns (not implemented in Cote d'Ivoire), as well as differences in LLIN durability.…”