The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

Malaria Journal The effect of household heads training on long- lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia Amare Deribew 0 Zewdie Birhanu 2 Lelisa Sena 0 Tariku Dejene 0 Ayalu A Reda 1 Morankar Sudhakar 2 Fessehaye Alemseged 0 Fasil Tessema 0 Ahmed Zeynudin 4 Sibhatu Biadgilign 0 Kebede Deribe 3 0 Department of Epidemiology, Jimma University , Jimma , Ethiopia 1 Department of Public Health, College of Health Sciences, Haramaya University , Harar , Ethiopia 2 Department of Health Education and Behavioral Sciences, Jimma University , Jimma , Ethiopia 3 Faculty of public Health, Jimma University , Jimma , Ethiopia 4 Department of Medical Laboratory and Pathology, Jimma University , Jimma , Ethiopia Background: Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap. Methods: The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods. Results: A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.164.7) at the twelfth months of the project period. Conclusion: Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization. Trail registration: Australian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022). Malaria; LLITN; Effectiveness; Training on LLITN; Ethiopia - Background Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant impact in the reduction of malaria-related childhood morbidity and mortality [1-5]. However, the utilization of LLITN is greatly affected by behavioral factors in countries south of the Sahara. Previous studies had given much emphasis on the coverage and ownership of LLITN [5-7]. Nonetheless, all owned LLITN are not being used practically. A study conducted in the two biggest regions of Ethiopia showed that 91% of households owned at least one LLITN but only 65% of the LLITN had been utilized the night before the survey [6]. A more recent study in Ethiopia has documented a significant reduction of LLITN utilization [7], which indicates the need for sustainable mechanism of improving LLITN utilization. In Africa, the utilization of LLITN is affected by practical and technical difficulties related to fixing of the net above the mat and the design of the house [8,9]. Previous studies have also documented that people tend to use LLITN during the rainy season and peak malaria transmission periods [10]. To resolve the technical difficulties and improve LLITN utilization, the community should have access to information and skill-based trainings. Previous studies have not addressed behavioural aspect of LLITN utilization [6-8]. As far as could be ascertained, no other study has addressed the impact of household heads training on the proper utilization of LLITN. In this study, the hypothesis was that empowering household heads on the proper use of LLITN through training will increase its utilization by all age groups including under-five children. Methods Study area The study was conducted in a malaria endemic area in Gilgel Gibe Field Research Centre (GGFRC). The GGFRC, with a total population of 50,000, was (...truncated)