LLIN Evaluation in Uganda Project (LLINEUP): factors associated with ownership and use of long-lasting insecticidal nets in Uganda: a cross-sectional survey of 48 districts

• Published in: Malaria Journal
• Main Authors: Samuel Gonahasa, Catherine Maiteki-Sebuguzi, Sheila Rugnao, Grant Dorsey, Jimmy Opigo, Adoke Yeka, Agaba Katureebe, Mary Kyohere, Amy Lynd, Janet Hemingway, Martin Donnelly, Moses R. Kamya, Sarah G. Staedke
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2018
• Subjects: Malaria; Long-lasting insecticidal nets (LLINs); Uganda; Vector control; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-018-2571-3; https://doaj.org/article/213d8065295f47219b779a5806ae4d7b

Abstract Background Long-lasting insecticidal nets (LLINs) are a key malaria control intervention. To investigate factors associated with ownership and use of LLINs in Uganda, a cross-sectional community survey was conducted in March–June 2017, approximately 3 years after a national Universal Coverage Campaign (UCC). Methods Households from 104 clusters (health sub-districts) in 48 districts were randomly selected using two-staged cluster sampling; 50 households were enrolled per cluster. Outcomes were household ownership of LLINs (at least one LLIN), adequate LLIN coverage (at least one LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Associations between variables of interest and outcomes were made using multivariate logistic regression. Results In total, 5196 households, with 29,627 residents and 6980 bed-nets, were included in the analysis. Overall, 65.0% of households owned at least one LLIN (down from 94% in 2014). In the adjusted analysis, factors most strongly associated with LLIN ownership were living in a wealthier household (highest tercile vs lowest; adjusted odds ratio [aOR] 1.94, 95% CI 1.66–2.28, p < 0.001) and time since the last UCC (29–37 vs 42–53 months; aOR 1.91, 95% CI 1.60–2.28, p < 0.001). Only 17.9% of households had adequate LLIN coverage (down from 65% in 2014). Factors most strongly associated with adequate coverage were fewer residents (2–4 vs ≥ 7; aOR 6.52, 95% CI 5.13–8.29, p < 0.001), living in a wealthier household (highest tercile vs lowest; aOR: 2,32, 95% CI 1.88–2.85, p < 0.001) and time since the last UCC (29–37 vs 42–53 months; aOR 2.13, 95% CI 1.61–2.81, p < 0.001). Only 39.5% of residents used a LLIN the previous night. Age was strongly associated with LLIN use, as were household wealth and time since the last UCC. Children < 5 years (44.7%) and residents > 15 years (44.1%) were more likely to use nets than children aged 5–15 years (30.7%; < 5 years: aOR 1.71, 95% CI 1.62–1.81, p < 0.001; > 15 years: aOR ...