The effect of long-lasting insecticidal nets (LLINs) physical integrity on utilization

• Published in: Malaria Journal
• Main Authors: Honelgn Nahusenay Hiruy, Ayele Zewde, Seth R. Irish, Semira Abdelmenan, Adugna Woyessa, Yonas Wuletaw, Hiwot Solomon, Mebrahtom Haile, Achamyelesh Sisay, Sheleme Chibsa, Alemayehu Worku, Josh Yukich, Yemane Berhane, Joseph Keating
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2021
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-021-03976-9; https://doaj.org/article/828ad929c249442a97e391f2b026cd63

Abstract Background In Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge. Different household-level factors have been identified as associated with LLIN use. However, the contribution of LLIN physical integrity to their utilization is not well investigated and documented. This study aimed to assess the association between the physical integrity of LLINs and their use. Methods This study employed a nested case-control design using secondary data from the Ethiopian LLIN durability monitoring study conducted from May 2015 to June 2018. LLINs not used the night before the survey were identified as cases, while those used the previous night were categorized as controls. The physical integrity of LLINs was classified as no holes, good, acceptable, and torn using the proportionate hole index (pHI). A Generalized Estimating Equation (GEE) model was used to assess and quantify the association between LLIN physical integrity and use. The model specifications included binomial probabilistic distribution, logit link, exchangeable correlation matrix structure, and robust standard errors. The factors included in the model were selected first by fitting binary regression, and then by including all factors that showed statistical significance at P-value less than 0.25 and conceptually relevant variables into the multivariate regression model. Results A total of 5277 observations fulfilled the inclusion criteria. Out of these 1767 observations were cases while the remaining 3510 were controls. LLINs that were in torn physical condition had higher odds (AOR [95% CI] = 1.76 [1.41, 2.19]) of not being used compared to LLINs with no holes. Other factors that showed significant association included the age of the LLIN, sleeping place type, washing status of LLINs, perceptions towards net care and repair, LLIN to people ratio, economic status, and study site. Conclusion and recommendation LLINs that have some level of physical damage have a relatively ...