Okiring Jaffer, Katamba Paul, Kamya Carol, Namugaya Faith, Lavoy Geoff, de Broucker Gatien, Ssebagereka Anthony, Kiracho Elizabeth Ekirapa, Mak Joshua, Patenaude Bryan N
Infectious Diseases Research Collaboration, PO Box 7475, Kampala, Uganda.
International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Public Health. 2025 Jul 2;25(1):2269. doi: 10.1186/s12889-025-23386-9.
Long-lasting insecticidal nets (LLINs) form a physical and chemical barrier against mosquitoes and have been shown to reduce malaria burden and mortality. Many countries, Uganda inclusive have distributed LLINs free of charge, drastically increasing LLIN ownership. However, ownership does not directly translate in to LLIN use.
Data from serial cross-sectional surveys were obtained from LLIN Evaluation in Uganda Project (LLINEUP); a cluster-randomized trial conducted in eastern and western Uganda. We apply the Vaccine Economics Research for Sustainability and Equity (VERSE) Toolkit to analyze LLIN usage and equity among household members before and after a nationwide mass distribution campaign in 48 districts.
Overall, the proportion of household members who slept under a bed net a night prior to survey reduced from 85.4% (6 months), to 78.8% (12 months), and to 73.0% (at 18 months) following LLIN mass distribution campaign). The Wagstaff concentration indices were 0.131 at baseline and ranged between 0.023 to 0.051 between 6 and 18 months following the national LLIN campaign. This indicates that LLIN use is more prevalent amongst the more privileged people. At baseline, the Absolute Equity Gap (AEG) of 0.260 implied that the 20% most disadvantaged households would need to increase LLIN use by 26.0 percentage points to have similar levels as the top 20% most privileged households. Overall, inequity decomposition showed that relationship to household head was the major contributor to whether a household member slept under LLIN the previous night for their age in most timepoint with the exception at baseline.
LLIN use level significantly increased following a nationwide distribution campaign. It appears that respondent's relationship with the household head explains most of the variation in LLIN use, while the least wealthy households seem to be dropping off at a faster rate in the use of LLINs following a nationwide distribution campaign. Strategies targeting LLIN use among the most disadvantaged households following a mass distribution campaigns are recommended.
长效驱虫蚊帐（LLINs）形成了一道抵御蚊子的物理和化学屏障，并已证明可减轻疟疾负担和降低死亡率。包括乌干达在内的许多国家都免费分发了长效驱虫蚊帐，大幅提高了长效驱虫蚊帐的拥有率。然而，拥有率并不直接等同于长效驱虫蚊帐的使用。
数据来自乌干达长效驱虫蚊帐评估项目（LLINEUP）的系列横断面调查；这是一项在乌干达东部和西部进行的整群随机试验。我们应用疫苗经济可持续性与公平性研究（VERSE）工具包，分析在全国48个地区开展大规模分发运动前后家庭成员中长效驱虫蚊帐的使用情况和公平性。
总体而言，在长效驱虫蚊帐大规模分发运动后，调查前一晚睡在蚊帐下的家庭成员比例从85.4%（6个月时）降至78.8%（12个月时），并降至73.0%（18个月时）。基线时的瓦格斯塔夫集中指数为0.131，在全国长效驱虫蚊帐运动后的6至18个月期间，该指数在0.023至0.051之间。这表明长效驱虫蚊帐的使用在较富裕人群中更为普遍。在基线时，绝对公平差距（AEG）为0.260，这意味着最贫困的20%家庭需要将长效驱虫蚊帐的使用率提高26.0个百分点，才能与最富裕的20%家庭达到相似水平。总体而言，不公平分解表明，在大多数时间点，与户主的关系是决定家庭成员前一晚是否睡在长效驱虫蚊帐下的主要因素，但基线时除外。
在全国范围内开展分发运动后，长效驱虫蚊帐的使用率显著提高。受访者与户主的关系似乎解释了长效驱虫蚊帐使用情况的大部分差异，而最贫困家庭在全国分发运动后长效驱虫蚊帐的使用率似乎下降得更快。建议在大规模分发运动后，针对最贫困家庭开展提高长效驱虫蚊帐使用率的策略。
