Osuorah D Chidiebere, Ezeudu Chijioke Elias, Onah Stanley Kenechi, Anyabolu Obinna Tochukwu
Child Survival Unit, Medical Research Council UK, The Gambia Unit, Banjul, The Gambia,
Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria,
Res Rep Trop Med. 2013 Jul 24;4:15-27. doi: 10.2147/RRTM.S45586. eCollection 2013.
Malaria remains the leading cause of morbidity and mortality in sub-Saharan Africa, with children under 5 years accounting for 86% of all malaria deaths. For effective control of malaria, WHO recommends rapid diagnosis and effective treatment, insecticide-treated bed nets, and indoor residual spraying. The use of insecticide-treated bed nets has been shown to be the most cost-effective strategy in preventing this infection. However, despite the Roll Back Malaria subsidized and free bed net distribution initiatives in some Africa countries, bed net uptake and usage still remains low in many households.
This study aimed to investigate household characteristics and child factors that determine bed net ownership and use amongst under-5 children and the effect of its usage on malaria parasitemia in under-5 children in Nigeria.
Data from a nationally representative sample of 5895 households was obtained from the 36 states and the Federal Capital Territory in the 2010 Nigeria demographic and health survey, with a minimum of 67 households enrolled per state. Appropriate statistical tools were used to identify the characteristics of households that owned a bed net and to examine the association between the households and child-level factors that predict the use of bed net and malaria prevalence among under-5 children within these households.
The rate of households bed net ownership in Nigeria is about 45.5%. About 48.5% of under-5 children in 33.9% of households surveyed, use a bed net during sleep. There was a strong correlation between households ownership and child sleeping under a bed net ( = 0.706, < 0.001). Acquisition of these bed nets at no cost significantly determined ownership ( < 0.001) but not usage ( = 0.450). Ownership of a bed net was significantly higher in households in rural areas ( = 0.001), poorer households ( = 0.001), households with an under-5 child ( = 0.001), households whose heads were male ( = 0.001), and of lower educational attainment ( = 0.010). There was a greater likelihood of under-5 children sleeping under a bed net in households with two or more under-5 children (odds ratio [OR] 1.26; CI: 1.05-1.66), two or more bed nets (OR 2.03; CI: 1.56-2.66), and in households whose heads were younger ([OR 2.79; CI: 1.65-4.70] for household heads younger than 29 years and [OR 1.6; CI: 1.17-2.19] for those 30-49 years of age), female (OR 1.61; CI: 1.00-2.61), and poorer (OR 1.77; CI: 1.03-3.04), and less likely in households with more than three other (aside from the under-5 children) household members ([OR 0.23; CI: 0.08-0.69] for household with 4-6 family members and [OR 0.20; CI: 0.07-0.61] for households with 7 or more family members). Malaria parasitemia in under-5 children was higher in: households without a bed net (41.9% versus [vs] 34.2%) ( = 0.016), in children who did not sleep under a bed net (39.7% vs 35.0%) ( = 0.292), in poor households compared to middle and rich households (50.5% vs 44.9% vs 25.9%; = 0.001), and households in rural settlements (42.6% vs 19.6%) ( = 0.001).
Bed net ownership in households in Nigeria is poor and does not translate to usage. Governments and organizations should not just distribute these nets free of charge to households, but also follow up with regular visits and provision of household education to ensure consistent and correct use, especially amongst under-5 children and pregnant women, who are the most vulnerable to infections and complications from malaria.
疟疾仍然是撒哈拉以南非洲地区发病和死亡的主要原因，5岁以下儿童占所有疟疾死亡人数的86%。为有效控制疟疾，世界卫生组织建议进行快速诊断和有效治疗、使用经杀虫剂处理的蚊帐以及室内滞留喷洒。使用经杀虫剂处理的蚊帐已被证明是预防这种感染最具成本效益的策略。然而，尽管在一些非洲国家开展了减疟倡议资助的免费蚊帐分发活动，但许多家庭的蚊帐使用率仍然很低。
本研究旨在调查决定尼日利亚5岁以下儿童家庭蚊帐拥有情况和使用情况的家庭特征及儿童因素，以及使用蚊帐对5岁以下儿童疟疾寄生虫血症的影响。
从2010年尼日利亚人口与健康调查中36个州和联邦首都地区具有全国代表性的5895户家庭样本中获取数据，每个州至少登记67户家庭。使用适当的统计工具来确定拥有蚊帐的家庭特征，并研究家庭与儿童层面因素之间的关联，这些因素预测了这些家庭中5岁以下儿童的蚊帐使用情况和疟疾患病率。
尼日利亚家庭蚊帐拥有率约为45.5%。在接受调查的33.9%的家庭中，约48.5%的5岁以下儿童在睡眠时使用蚊帐。家庭拥有蚊帐与儿童在蚊帐下睡眠之间存在很强的相关性（r = 0.706，P < 0.001）。免费获得这些蚊帐显著决定了拥有率（P < 0.001），但对使用率没有影响（P = 0.450）。农村地区家庭（P = 0.001）、贫困家庭（P = 0.001）、有5岁以下儿童的家庭（P = 0.001）、户主为男性的家庭（P = 0.001）以及教育程度较低的家庭（P = 0.010）蚊帐拥有率显著更高。在有两个或更多5岁以下儿童的家庭（优势比[OR] 1.26；置信区间：1.05 - 1.66）、有两个或更多蚊帐的家庭（OR 2.03；置信区间：1.56 - 2.66）以及户主较年轻的家庭（户主年龄小于29岁的家庭[OR 2.79；置信区间：1.65 - 4.70]，30 - 49岁的家庭[OR 1.6；置信区间：1.17 - 2.19]）、女性户主家庭（OR 1.61；置信区间：1.00 - 2.61）和贫困家庭（OR 1.77；置信区间：1.03 - 3.04）中，5岁以下儿童在蚊帐下睡眠的可能性更大；而在有三个以上其他家庭成员（不包括5岁以下儿童）的家庭中可能性较小（有4 - 6名家庭成员的家庭[OR 0.23；置信区间：0.08 - 0.69]，有7名或更多家庭成员的家庭[OR 0.20；置信区间：0.07 - 0.61]）。5岁以下儿童疟疾寄生虫血症在以下情况中更高：没有蚊帐的家庭（41.9% 对 [vs] 34.2%）（P = 0.016）、不在蚊帐下睡眠的儿童（39.7% vs 35.0%）（P = 0.292）、贫困家庭相比于中高收入家庭（50.5% vs 44.9% vs 25.9%；P = 0.001）以及农村定居点的家庭（42.6% vs 19.6%）（P = 0.001）。
尼日利亚家庭蚊帐拥有情况不佳，且拥有并不意味着使用。政府和组织不仅应向家庭免费分发这些蚊帐，还应定期随访并提供家庭教育，以确保持续正确使用，特别是在5岁以下儿童和孕妇中，他们最易感染疟疾并出现并发症。
