Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey

(2021) 20:200 Scott et al. Malar J https://doi.org/10.1186/s12936-021-03738-7 Malaria Journal Open Access RESEARCH Factors associated with use of insecticide‑treated net for malaria prevention in Manica District, Mozambique: a community‑based cross‑sectional survey Julia Scott1, Mufaro Kanyangarara1*, Abel Nhama2,3, Eusebio Macete2, William John Moss4 and Francisco Saute2 Abstract Background: Insecticide-treated net (ITN) use is crucial for preventing malaria infection. Despite significant improvements in ITN access and use over the past two decades, many malaria-endemic countries in sub-Saharan Africa have not yet reached global targets for universal coverage of ITNs. To reduce the gaps in ITN use, it is important to understand the factors associated with ITN use. The goal of this analysis was to determine the factors associated with ITN use in Manica District, Mozambique. Methods: A cross-sectional community-based survey was conducted from October to November 2019. Households were randomly selected, and all members of selected households were eligible to participate. Data on socio-demographic characteristics, housing construction and the ownership, use and characteristics of ITNs were collected using structured questionnaires. Factors independently associated with ITN use were identified using generalized estimating equations multivariate logistic regression. Results: Of the 302 households surveyed, 209 (69.2%) owned at least one ITN and 176 (58.3%) had one ITN for every two household members. The multivariate analysis indicated that the odds of ITN use was significantly lower among individuals in households with 3 or more members. However, the odds of ITN use was significantly higher among older age groups, poorer households, and as the number of ITNs in a household increased. Conclusions: The findings of this analysis highlight the need for behaviour change communication strategies targeting young people and ITN distribution campaigns targeting larger households to increase ITN ownership, thereby improving ITN use in Manica District. Keywords: Malaria, Prevention, Insecticide-treated nets, Sub-Saharan Africa, Mozambique Background Malaria exacts a heavy toll on public health across the world, as half of the world’s population is at risk of contracting malaria [1]. Sub-Saharan Africa bears a *Correspondence: 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29201, USA Full list of author information is available at the end of the article disproportionate burden of malaria morbidity and mortality, accounting for 94% of malaria cases and 94% of malaria deaths globally [1]. The region has been the focus of an intensive scale-up of interventions to prevent and control malaria, including insecticide-treated nets (ITNs), indoor residual spraying (IRS), intermittent preventative treatment during pregnancy (IPTp) and prompt diagnosis and treatment [2]. Vector control using ITNs represents the cornerstone of malaria prevention, © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativeco mmons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Scott et al. Malar J (2021) 20:200 as ITNs provide a physical barrier between the user and mosquito vectors, and repel or kill mosquito vectors upon contact with the insecticide [3]. It is estimated that 69% of the 663 million malaria cases averted in subSaharan Africa between 2000 and 2015 were attributable to ITNs [4]. In areas of stable malaria transmission, ITNs also have the potential to reduce severe malaria by up to 45% and malaria-related mortality in children under five years of age by up to 55% [5, 6]. Furthermore, when ITN usage is high, the protection of ITNs against malaria infection extends beyond the individual, affording the community indirect protection [7–9]. The World Health Organization (WHO) recommends mass campaigns for ITN distribution to the general population, and continuous distribution targeting pregnant women during antenatal care (ANC) visits and children under five years during immunizations, to ensure at least one ITN for every two people within a household [10]. Global targets for universal coverage with ITNs aim to achieve at least 80% coverage for ITN ownership and use [11]. Current estimates of ITN access and use demonstrate variable progress in achieving global targets for universal coverage, with most malaria endemic countries in sub-Saharan Africa falling well below these targets [1]. In 2018, an estimated 72% of households in sub-Saharan Africa owned at least one ITN [1]. Despite significant improvements in household ITN ownership in the past two decades, household ITN ownership rates have stagnated in recent years. Furthermore, only 50% of the population at risk in sub-Saharan Africa slept under an ITN the previous night indicating that gaps still exist between ITN ownership and use [12]. To maximize the direct (individual) and indirect (community) benefits of ITNs, an understanding of barriers and determinants of ITN use is crucial. The most significant barrier to ITN use is insufficient availability of ITNs within households [13]. However, while availability of ITNs within households is necessary, it is not a guarantee for effective use of ITNs. Lack of knowledge of malaria, community beliefs and misconceptions regarding malaria and its prevention contribute to the non-use of ITNs [13–15]. Other barriers to the use of ITNs include the physical discomfort of sleeping under a net, particularly during hot weather, challenges hanging nets over sleeping spaces, perceived lack of mosquitoes and perceived low risk of contracting malaria [13–15]. Several studies investigating the determinants of ITN use have previously identified age, sex, education level, socioeconomic status, rural/urban residence and number of nets in a household, among others as factors associated with ITN use [16–24]. The heterogeneity of determinants of ITN use in different settings is furt (...truncated)