LLIN Evaluation in Uganda Project (LLINEUP2)—Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020–21 national mass distribution campaign: a cross-sectional survey of 12 districts

• Published in: Malaria Journal
• Main Authors: Jaffer Okiring, Samuel Gonahasa, Martha Nassali, Jane F. Namuganga, Irene Bagala, Catherine Maiteki‑Sebuguzi, Jimmy Opigo, Isaiah Nabende, Joanita Nangendo, Jane Kabami, Isaac Ssewanyana, Steven M. Kiwuwa, Joaniter I. Nankabirwa, Grant Dorsey, Jessica Briggs, Moses R. Kamya, Sarah G. Staedke
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: Malaria; Long-lasting insecticidal nets (LLINs); Uganda; Mass distribution campaign; Ownership; Coverage; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-022-04302-7; https://doaj.org/article/69ce3027140842f4aec64fc26c3a2eaa

Abstract Background In 2020–2021, long-lasting insecticidal nets (LLINs) were distributed nationwide in Uganda during the COVID-19 pandemic. A cross-sectional survey was conducted in 12 districts to evaluate the impact of the campaign 1–5 months after LLIN distribution. Methods During April–May 2021, households were randomly selected from target areas (1–7 villages) surrounding 12 government-run health facilities established as Malaria Reference Centres; at least 50 households were enrolled per cluster. Outcomes included household ownership of LLINs distributed through the universal coverage campaign (UCC) (at least one UCC LLIN), adequate coverage of UCC LLINs (at least one UCC LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Multivariate logistic regression models were used to identify household- and individual-level factors associated with outcomes, controlling for clustering around health facilities. Results In total, 634 households, with 3342 residents and 1631 bed-nets, were included. Most households (93.4%) owned at least 1 UCC LLIN, but only 56.8% were adequately covered by UCC LLINs. In an adjusted analysis, the factor most strongly associated with adequate coverage by UCC LLINs was fewer household residents (1–4 vs 7–14; adjusted odds ratio [aOR] 12.96, 95% CI 4.76–35.26, p < 0.001; 5–6 vs 7–14 residents; aOR 2.99, 95% CI 1.21–7.42, p = 0.018). Of the 3166 residents of households that owned at least one UCC LLIN, only 1684 (53.2%) lived in adequately covered households; 89.9% of these used an LLIN the previous night, compared to 1034 (69.8%) of 1482 residents living in inadequately covered households. In an adjusted analysis, restricted to residents of inadequately covered households, LLIN use was higher in children under-five than those aged 5–15 years (aOR 3.04, 95% CI 2.08–4.46, p < 0.001), and higher in household heads than distantly-related residents (aOR 3.94, 95% CI 2.38–6.51, p < 0.001). Conclusions Uganda’s 2021–21 campaign was successful, ...