Ernst Kacey C, Hayden Mary H, Olsen Heather, Cavanaugh Jamie L, Ruberto Irene, Agawo Maurice, Munga Stephen
Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
National Center for Atmospheric Research, 3450 Mitchell Lane, Boulder, CO, 80301, USA.
Malar J. 2016 Apr 14;15:217. doi: 10.1186/s12936-016-1262-1.
Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use.
Community forums and a household, cross-sectional survey were used to collect information on factors related to bed net ownership and use in western Kenya. Sites with disparate levels of transmission were selected, including an endemic lowland area, Miwani, and a highland epidemic-prone area, Kapkangani. Analysis of ownership was stratified by site. A combined site analysis was conducted to examine factors associated with use of all available bed nets. Logistic regression modelling was used to determine factors associated with ownership and use of owned bed nets.
Access to bed nets as the leading barrier to their use was identified in community forums and cross-sectional surveys. While disuse of available bed nets was discussed in the forums, it was a relatively rare occurrence in both sites. Factors associated with ownership varied by site. Education, perceived risk of malaria and knowledge of individuals who had died of malaria were associated with higher bed net ownership in the highlands, while in the lowlands individuals reporting it was easy to get a bed net were more likely to own one. A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria. In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season.
Variations in factors associated with ownership should be acknowledged when constructing messaging and distribution campaigns. Despite reports of bed nets being used for other purposes, those in the home were rarely unused in these communities. Disuse seemed to be related to beliefs that can be addressed through education programmes. As mass distributions continue to take place, additional research is needed to determine if factors associated with LLIN ownership and use change with increasing availability of LLIN.
在确保长效驱虫蚊帐（LLINs）的可及性和优化使用方面，挑战依然存在。与蚊帐拥有和使用相关的因素可能因特定地区的疟疾流行史和预防控制措施而异。在确定提高蚊帐使用率和正确使用的解决方案时，了解高风险和低风险地区蚊帐使用的文化和社会环境背景差异很重要。
通过社区论坛和家庭横断面调查，收集肯尼亚西部与蚊帐拥有和使用相关因素的信息。选择了传播水平不同的地点，包括一个地方性低地地区米瓦尼和一个易发生疟疾流行的高地地区卡普坎加尼。按地点对蚊帐拥有情况进行分层分析。进行综合地点分析，以研究与所有可用蚊帐使用相关的因素。使用逻辑回归模型确定与自有蚊帐的拥有和使用相关的因素。
在社区论坛和横断面调查中，蚊帐获取困难被确定为蚊帐使用的主要障碍。虽然论坛中讨论了现有蚊帐的闲置问题，但在两个地点这种情况都相对少见。与蚊帐拥有相关的因素因地点而异。在高地，教育程度、对疟疾风险的认知以及对死于疟疾者情况的了解与更高的蚊帐拥有率相关；而在低地，报告称容易获得蚊帐的个人更有可能拥有蚊帐。综合地点分析表明，不使用现有蚊帐与认为服用疟疾药物比使用蚊帐更容易以及使用蚊帐不能预防疟疾的态度有关。此外，家中有闲置蚊帐的个人更有可能表示蚊帐难以使用、购买的蚊帐比免费分发的更好，以及蚊帐只应在雨季使用。
在制定宣传和分发活动时，应认识到与蚊帐拥有相关因素的差异。尽管有报道称蚊帐被用于其他目的，但在这些社区中，家中的蚊帐很少闲置。闲置似乎与一些观念有关，这些观念可通过教育项目加以解决。随着大规模分发的继续，需要进一步研究以确定与长效驱虫蚊帐拥有和使用相关的因素是否会随着长效驱虫蚊帐供应量的增加而发生变化。
