Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Macha Research Trust, Macha, Choma District, Zambia.
Malar J. 2018 Jan 19;17(1):41. doi: 10.1186/s12936-018-2178-8.
Insecticide-treated nets (ITNs) reduce malaria morbidity and mortality in endemic areas. Despite increasing availability, the use of ITNs remains limited in some settings. Poor malaria knowledge is a barrier to the widespread use of ITNs. The goal of this study was to assess the levels of malaria knowledge and evaluate factors associated with bed net use among individuals residing in three regions of southern Africa with different levels of malaria transmission and control.
A cross-sectional study was conducted on a sample of 7535 residents recruited from 2066 households in Mutasa District, Zimbabwe (seasonal malaria transmission), Choma District, Zambia (low transmission) and Nchelenge District, Zambia (high transmission), between March 2012 and March 2017. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge and use of preventive measures. Multivariate logistic regression analyses were used to assess determinants of bed net use.
Most of the 3836 adult participants correctly linked mosquito bites to malaria (85.0%), mentioned at least one malaria symptom (95.5%) and knew of the benefit of sleeping under an ITN. Bed net ownership and use were highest in Choma and Nchelenge Districts and lowest in Mutasa District. In multivariate analyses, knowledge of ITNs was associated with a 30-40% increased likelihood of bed net use after adjusting for potential confounders across all sites. Other factors significantly associated with bed net use were age, household size and socioeconomic status, although the direction, strength and size of association varied by study site. Importantly, participants aged 5-14 years had reduced odds of sleeping under a bed net compared to children younger than 5 years.
Relevant knowledge of ITNs translated into the expected preventive behaviour of sleeping under a bed net, underscoring the need for continued health messaging on malaria prevention. The implementation and delivery of malaria control and elimination interventions needs to consider socioeconomic equity gaps, and target school-age children to ensure access to and improve utilization of ITNs.
经杀虫剂处理的蚊帐（ITN）可降低流行地区疟疾的发病率和死亡率。尽管可用性不断提高，但在某些情况下，ITN 的使用仍然有限。疟疾知识不足是广泛使用 ITN 的障碍。本研究的目的是评估居住在南部非洲三个疟疾传播和控制程度不同地区的个体的疟疾知识水平，并评估与蚊帐使用相关的因素。
对津巴布韦穆塔萨区（季节性疟疾传播）、赞比亚乔马区（低传播）和恩切伦格区（高传播）的 2066 户家庭中招募的 7535 名居民进行了横断面研究。在 2012 年 3 月至 2017 年 3 月期间，使用标准化问卷收集了人口统计学、疟疾相关知识和预防措施使用情况的数据。采用多变量逻辑回归分析评估了蚊帐使用的决定因素。
大多数 3836 名成年参与者正确地将蚊虫叮咬与疟疾联系起来（85.0%），提到至少一种疟疾症状（95.5%），并知道使用 ITN 的好处。乔马区和恩切伦格区的蚊帐拥有率和使用率最高，穆塔萨区最低。在多变量分析中，在调整了所有地点的潜在混杂因素后，对 ITN 的了解与蚊帐使用增加 30-40%相关。其他与蚊帐使用显著相关的因素是年龄、家庭规模和社会经济地位，尽管关联的方向、强度和大小因研究地点而异。重要的是，与 5 岁以下的儿童相比，5-14 岁的儿童使用蚊帐的可能性降低。
对 ITN 的相关了解转化为预期的预防行为，即在蚊帐下睡觉，这突显了持续进行疟疾预防健康宣传的必要性。疟疾控制和消除干预措施的实施和提供需要考虑社会经济公平差距，并针对学龄儿童，以确保获得和改善 ITN 的利用。
