Azanaw Jember, Worede Eshetu Abera
Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2025 Sep 10;20(9):e0330431. doi: 10.1371/journal.pone.0330431. eCollection 2025.
Having access to Insecticide-Treated Nets (ITNs) is crucial for avoiding malaria in Sub-Saharan Africa (SSA), where the disease burden is disproportionately high. Despite their efficacy, socioeconomic, demographic, and geographic factors continue to cause notable differences in ITN access within and between nations. By employing a multilevel analysis of data from 29 Demographic and Health Surveys (DHS) throughout SSA, this study seeks to fill knowledge gaps about the factors that influence access at the individual and community levels.
The study utilized data from 29 DHS surveys in SSA, which encompassed 214,181 households. Factors affecting access to ITN at the individual and community levels were examined using multilevel logistic regression models. Household head characteristics (sex, marital status, education, wealth index, television access, and family size) were among the individual-level factors. On the other hand, community-level characteristics included geography, kind of home, poverty, media exposure, and education. The Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and deviance were used to evaluate the model's fitness. Measures of variation, including the Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and Intraclass Correlation Coefficient (ICC), were used to assess the effects at the community level.
ITNs were reported by just 32.11% of households, with notable differences across socioeconomic classes and geographical areas. Higher ITN access was substantially correlated with married household heads, wealthier families, larger family sizes, and higher educational attainment. Access was also greatly enhanced by community-level factors such as urban residency, media exposure, and higher education. The best fit was Model 3, which explained 15.24% of the variance in ITN access by combining characteristics at the person and community levels. There were clear regional differences, with West Africa having higher probabilities of access than East Africa (AOR = 4.48).
The study highlights the multifaceted determinants of ITN access in SSA, emphasizing the need for targeted interventions addressing both individual and community-level barriers. Strengthening distribution networks, increasing funding for subsidized ITN programs and enhancing public health education is essential for achieving universal coverage and reducing the malaria burden in the region.
在撒哈拉以南非洲（SSA），获得经杀虫剂处理的蚊帐（ITN）对于预防疟疾至关重要，该地区疾病负担极高。尽管其有效，但社会经济、人口和地理因素继续在国家内部和国家之间导致ITN获取方面的显著差异。通过对整个SSA的29项人口与健康调查（DHS）数据进行多层次分析，本研究旨在填补关于影响个人和社区层面获取因素的知识空白。
该研究利用了SSA的29项DHS调查数据，涵盖214,181户家庭。使用多层次逻辑回归模型研究影响个人和社区层面获取ITN的因素。户主特征（性别、婚姻状况、教育程度、财富指数、是否有电视以及家庭规模）属于个人层面因素。另一方面，社区层面特征包括地理位置、房屋类型、贫困程度、媒体曝光度和教育程度。使用赤池信息准则（AIC）、贝叶斯信息准则（BIC）和偏差来评估模型的拟合度。变异度量，包括中位数优势比（MOR）、方差比例变化（PCV）和组内相关系数（ICC），用于评估社区层面的影响。
仅32.11%的家庭报告拥有ITN，社会经济阶层和地理区域之间存在显著差异。ITN获取率较高与已婚户主、较富裕家庭、较大家庭规模和较高教育程度密切相关。城市居住、媒体曝光和高等教育等社区层面因素也极大地提高了获取率。最佳拟合模型是模型3，通过结合个人和社区层面的特征，该模型解释了ITN获取差异的15.24%。存在明显的区域差异，西非获取ITN的概率高于东非（调整后优势比 = 4.48）。
该研究突出了SSA地区ITN获取的多方面决定因素，强调需要针对个人和社区层面的障碍采取有针对性的干预措施。加强分销网络、增加对补贴ITN项目的资金投入以及加强公共健康教育对于实现普遍覆盖和减轻该地区疟疾负担至关重要。
