South Ethiopia Regional Health Bureau, Hawassa, Ethiopia.
College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia.
Malar J. 2024 Apr 4;23(1):94. doi: 10.1186/s12936-024-04909-y.
Despite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People's Region (SNNPR) of Ethiopia.
A community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI.
From a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness.
Low LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country's malaria elimination goal.
尽管在减少疟疾负担方面取得了显著进展，但疟疾仍是全球主要的公共卫生问题。埃塞俄比亚一直在免费发放长效驱虫蚊帐（LLINs），并于 2016 年完成了全国范围内的发放。然而，有证据表明，由于不同的因素，LLINs 的利用情况因地点和时间而异，因此需要最新的证据来进行与 LLINs 相关的决策。因此，本研究旨在评估埃塞俄比亚南部地区（SNNPR）的 LLINs 使用情况及其决定因素。
本研究是一项 2019 年在埃塞俄比亚南部进行的基于社区的横断面研究。采用多阶段抽样方法，共纳入 2466 户家庭。该地区根据年度疟疾指数分为高、中、低和自由四个分层。然后采用聚类抽样从高、中、低分层中选择家庭。使用家庭问卷收集关于 LLIN 拥有、使用和不同决定因素的数据。使用 SurveyCTO 收集数据，并使用 Stata 15 进行数据管理。采用描述性统计和多水平混合效应逻辑回归来确定 LLIN 使用的决定因素。使用调整后的优势比（AOR）和 95%置信区间（CI）报告效应量。
在总共 2466 户家庭中，有 48.7%的家庭拥有至少一个 LLIN。按家庭规模计算，LLIN 的充足率为 23%，而按普遍获得和睡眠空间计算，充足率分别为 15.7%和 29.2%。在拥有 LLIN 的 1202 户家庭中，有 66.0%的家庭报告在前一天晚上调查时睡在 LLIN 下。然而，如果考虑到所有被调查家庭的总人口，只有 22.9%的家庭成员在前一天晚上调查时睡在 LLIN 下。疟疾流行程度、教育程度、财富状况和疟疾知识与 LLIN 的使用有关。此外，不使用 LLIN 的原因包括认为没有疟疾、LLIN 的副作用、LLIN 的状况、不方便的空间和低意识。
本研究发现 LLIN 的覆盖率和利用率都很低。低利用率与疟疾流行程度、财富状况和意识水平有关。LLIN 的分配和持续的社区意识创造活动的后续行动对于提高 LLIN 的覆盖率和利用率以及确保该国消除疟疾的目标至关重要。
