Win Kyawt Mon, Show Kyaw Lwin, Sattabongkot Jetsumon, Cui Liwang, Nguitragool Wang, Parker Daniel M, Aung Pyae Linn
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Independent Expert, Yangon, Myanmar.
Malar J. 2025 Aug 28;24(1):278. doi: 10.1186/s12936-025-05535-y.
Vector control has played a pivotal role in malaria control and elimination efforts, with insecticide-treated nets (ITNs) recognized as one of the most effective and widely accepted strategies. This study assessed ITN use and identified factors associated with non-use among individuals with access to ITNs in Myanmar.
Data were drawn from the nationally representative 2015-2016 Myanmar Demographic and Health Survey. Access to ITNs was defined as having at least one ITN per two household members, and ITN use as having slept under an ITN the night before the survey. Descriptive statistics and multivariable logistic regression models were conducted using the "svyset" command in STATA to account for the two-stage stratified cluster sampling design.
Among 6,140 individuals with access to ITNs, approximately one-third (31.6%, 95% CI 28.3%-35.0%) reported not using them. Factors associated with higher odds of ITN non-use were age 15-34 years (adjusted odds ratio [aOR]: 1.31; 95% CI 1.07-1.61) and ≥ 50 years (aOR: 1.33; 95% CI 1.07-1.67), rural residence (aOR: 1.82; 95% CI 1.10-3.01), and belonging to the fourth wealth quintile, representing higher socioeconomic status (aOR: 1.74; 95% CI 1.06-2.85).
Despite having access to ITNs at that time, a substantial proportion of individuals in Myanmar did not use them. These historical findings highlight behavioural and contextual barriers that existed before recent health system disruptions due to political unrest and COVID-19. Although present-day challenges differ, understanding past determinants of ITN non-use remains valuable for designing behaviour change communication (BCC) strategies, especially in regions where ITN distribution remains feasible.
病媒控制在疟疾控制和消除工作中发挥了关键作用，经杀虫剂处理的蚊帐（ITN）被认为是最有效且被广泛接受的策略之一。本研究评估了缅甸有机会使用ITN的人群中ITN的使用情况，并确定了与不使用ITN相关的因素。
数据来自具有全国代表性的2015 - 2016年缅甸人口与健康调查。获得ITN的定义为每两名家庭成员至少拥有一顶ITN，ITN的使用定义为在调查前一晚睡在ITN下。使用STATA中的“svyset”命令进行描述性统计和多变量逻辑回归模型，以考虑两阶段分层整群抽样设计。
在6140名有机会使用ITN的个体中，约三分之一（31.6%，95%置信区间28.3% - 35.0%）报告未使用ITN。与ITN不使用几率较高相关的因素包括15 - 34岁（调整后的优势比[aOR]：1.31；95%置信区间1.07 - 1.61）和≥50岁（aOR：1.33；95%置信区间1.07 - 1.67）、农村居住（aOR：1.82；95%置信区间1.10 - 3.01）以及属于第四财富五分位数，代表较高的社会经济地位（aOR：1.74；95%置信区间1.06 - 2.85）。
尽管当时有机会使用ITN，但缅甸仍有很大一部分人未使用。这些历史研究结果凸显了在近期因政治动荡和新冠疫情导致卫生系统中断之前就存在的行为和环境障碍。尽管当今面临的挑战不同，但了解过去ITN不使用的决定因素对于设计行为改变沟通（BCC）策略仍然很有价值，特别是在ITN分发仍然可行的地区。
