Insecticide-treated net (ITN) use, factors associated with non-use of ITNs, and occurrence of sand flies in three communities with reported cases of cutaneous leishmaniasis in Ghana

PLOS ONE RESEARCH ARTICLE Insecticide-treated net (ITN) use, factors associated with non-use of ITNs, and occurrence of sand flies in three communities with reported cases of cutaneous leishmaniasis in Ghana Richard Akuffo ID1,2,3☯*, Michael Wilson1☯, Bismark Sarfo2☯, Phyllis Dako-Gyeke2☯, Richard Adanu2☯, Francis Anto2☯ a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana, 2 School of Public Health, University of Ghana, Accra, Ghana, 3 University of Ghana Medical Centre, University of Ghana, Accra, Ghana ☯ These authors contributed equally to this work. * , Abstract OPEN ACCESS Citation: Akuffo R, Wilson M, Sarfo B, Dako-Gyeke P, Adanu R, Anto F (2021) Insecticide-treated net (ITN) use, factors associated with non-use of ITNs, and occurrence of sand flies in three communities with reported cases of cutaneous leishmaniasis in Ghana. PLoS ONE 16(12): e0261192. https://doi. org/10.1371/journal.pone.0261192 Editor: Alireza Badirzadeh, School of Medicine, Iran University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN Background The insecticide treated bed net (ITN) has been proven for malaria control. Evidence from systematic review also suggests benefits of ITN roll out in reducing the incidence of cutaneous leishmaniasis (CL) and other vector borne diseases. Methods Using a community-based cross-sectional study design, ITN use, factors associated with non-use of ITNs, and occurrence of sand flies were investigated in three communities with reported cases of CL in the Oti region of Ghana. Received: August 6, 2021 Accepted: November 24, 2021 Results Published: December 16, 2021 A total of 587 households comprising 189 (32.2%), 200 (34.1%), and 198 (33.7%) households from Ashiabre, Keri, and Sibi Hilltop communities with de facto population of 3639 participated in this study. The proportion of households that owned at least one ITN was 97.1%. The number of households having at least one ITN for every two members was 386 (65.8%) and 3159 (86.8%) household population had access to ITN. The household population that slept in ITN the night before this survey was 2370 (65.1%). Lack of household access to ITN (AOR = 1.80; CI: 1.31, 2.47), having a family size of more than 10 members (AOR = 2.53; CI: 1.20, 4.24), having more than 10 rooms for sleeping in a household (AOR = 10.18; CI: 1.28, 81.00), having 2–4 screened windows (AOR = 1.49; CI: 1.00, 2.20), and having 8–10 screened windows (AOR = 3.57; CI: 1.25, 10.17) were significantly associated with increased odds of not sleeping in ITN the night before the survey. A total of 193 female sand flies were trapped from various locations within the study communities. Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0261192 Copyright: © 2021 Akuffo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PLOS ONE | https://doi.org/10.1371/journal.pone.0261192 December 16, 2021 1 / 22 PLOS ONE Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This project was funded by the post graduate training scheme fellowship in implementation science program of the Special Program for Research and Training in Tropical Diseases (WHO/TDR) at the School of Public Health, University of Ghana. The funder had no role in the study design, data collection, data analysis, data interpretation, and in writing the manuscript. Competing interests: The authors have declared that no competing interests exist. ITN use, ITN non-use factors, and sand flies in Ghana Conclusions Factors associated with ITN non-use such as lack of household access to ITN should be incorporated into future efforts to improve ITN use. Species of sand flies and their potential vectorial role in the study communities should also be investigated. Introduction Insecticide-treated nets (ITNs) are proven for malaria control and have played a significant role in reducing the global malaria burden by about two-thirds between 2000 and 2015 [1, 2]. Over the years, investments have been made into improving access to the ITNs and more people now own and use them than a few decades ago, especially in Africa. This may have contributed to the significant gains observed in the reduction of the global malaria burden. Some of the investments include free mass ITN distribution campaigns, ITN distribution at antenatal clinics and schools, among other measures [3–7]. The World Health Organization (WHO) defines universal coverage of ITN as “universal access to, and use of, ITNs by populations at risk of malaria” [2]. The minimum target for universal coverage to be considered achieved is usually 80% for both ITN access and use [8] To measure ITN access and use, the Roll Back Malaria Monitoring and Evaluation Reference Group recommends the following four indicators: (i) the proportion of households that own at least one ITN, (ii) the proportion of households that own at least one ITN for two people, (iii) the proportion of the population with access to an ITN within the household, and (iv) the proportion of the population that used an ITN the previous night [8, 9]. Although improvements have been made over the years with these indicators, particularly ownership of at least one ITN by households, progress has been unequal across countries and communities, thereby requiring consistent monitoring of the indicators within various contexts [9, 10] The Ghana national malaria control program actively promotes the use of ITNs for malaria control and aimed at reducing the malaria morbidity and mortality by 75.0% in its 2015–2020 Ghana malaria strategic plan. Some specific objectives in line with achieving the proposed reduction in malaria burden in Ghana include the following: 100% of households will own at least one ITN and 80% of the general population will sleep under ITNs [11, 12]. Vector control is also a key component of many anti-leishmaniasis programs and is likely to remain so until an effective vaccine against Leishmania infection becomes available. Some of the vector control methods used in the control of leishmaniasis include the ITN, insecticide impregnated durable wall lining (DWL), and indoor residual spraying [13–16]. Leishmaniasis is a neglected vector borne disease caused by parasites of the genus Leishmania and is endemic in over 98 countries with 350 million people estimated to be at risk of contracting the disease globally [17, 18]. Depending on the area of localization of (...truncated)