Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland.
University of Basel, Petersplatz 1, P.O. Box CH-4001, Basel, Switzerland.
Malar J. 2019 Mar 8;18(1):63. doi: 10.1186/s12936-019-2700-7.
Insecticide-treated nets (ITNs) are one of the most effective and widely available methods for preventing malaria, and there is interest in understanding the complexities of behavioural drivers of non-use among those with access. This analysis evaluated net use behaviour in Ghana by exploring how several household and environmental variables relate to use among Ghanaians with access to a net.
Survey data from the Ghana 2014 Demographic and Health Survey and the 2016 Malaria Indicator Survey were used to calculate household members' access to space under a net as well as the proportion of net use conditional on access (NUCA). Geospatial information on cluster location was obtained, as well as average humidex, a measure of how hot it feels, for the month each cluster was surveyed. The relationship between independent variables and net use was assessed via beta-binomial regression models that controlled for spatially correlated random effects using non-Gaussian kriging.
In both surveys, increasing wealth was associated with decreased net use among those with access in households when compared to the poorest category. In 2014, exposure to messages about bed net use for malaria prevention was associated with increased net use (OR 2.5, 95% CrI 1.5-4.2), as was living in a rural area in both 2014 (OR 2.5, 95% CrI 1.5-4.3) and 2016 (OR 1.6, 95% CrI 1.1-2.3). The number of nets per person was not associated with net use in either survey. Model fit was improved for both surveys by including a spatial random effect for cluster, demonstrating some spatial autocorrelation in the proportion of people using a net. Humidex, electricity in the household and IRS were not associated with NUCA.
Net use conditional on access is affected by household characteristics and is also spatially-dependent in Ghana. Setting (whether the household was urban or rural) plays a role, with wealthier and more urban households less likely to use nets when they are available. It will likely be necessary in the future to focus on rural settings, urban settings, and wealth status independently, both to better understand predictors of household net use in these areas and to design more targeted interventions to ensure consistent use of vector control interventions that meet specific needs of the population.
经杀虫剂处理的蚊帐（ITN）是预防疟疾最有效且广泛可用的方法之一，人们对了解获得 ITN 的人群中非使用的行为驱动因素的复杂性很感兴趣。本分析通过探索几个家庭和环境变量与加纳获得 ITN 人群中的使用情况之间的关系，评估了加纳的蚊帐使用行为。
使用加纳 2014 年人口与健康调查和 2016 年疟疾指标调查的数据，计算了家庭中每个成员在蚊帐下的空间使用情况，以及在获得 ITN 的情况下使用蚊帐的比例（NUCA）。获得了集群位置的地理空间信息，以及每个集群调查月份的平均湿热指数，这是衡量体感热度的指标。使用非高斯克里金对空间相关随机效应进行控制，通过贝塔二项式回归模型评估独立变量与蚊帐使用之间的关系。
在两次调查中，与最贫穷的类别相比，在获得 ITN 的家庭中，财富的增加与使用蚊帐的人数减少有关。2014 年，接受关于预防疟疾使用蚊帐的信息宣传与增加蚊帐使用有关（OR 2.5，95% CrI 1.5-4.2），2014 年和 2016 年生活在农村地区也是如此（OR 2.5，95% CrI 1.5-4.3 和 OR 1.6，95% CrI 1.1-2.3）。两次调查中，人均蚊帐数量与蚊帐使用情况无关。两次调查的模型拟合都通过包含集群的空间随机效应得到了改善，表明了人们使用蚊帐的比例存在一定的空间自相关。湿热指数、家庭用电和 IRS 与 NUCA 无关。
在加纳，获得 ITN 情况下的蚊帐使用情况受到家庭特征的影响，并且具有空间依赖性。（家庭）所处环境（城市或农村）起着作用，较富裕和更城市化的家庭在获得 ITN 时不太可能使用蚊帐。未来可能需要独立关注农村、城市和财富状况，以便更好地了解这些地区家庭蚊帐使用的预测因素，并设计更有针对性的干预措施，以确保符合人口特定需求的病媒控制干预措施的持续使用。
