Factors associated with use of insecticide treated mosquito nets for Malaria prevention among school age children in Muntu Sub County, Amolatar District

Abstract

Introduction: Insecticide Treated Mosquito Nets (ITNs) are regarded as key tools for effective vector control, and hence the most widely used malaria prevention strategy in Sub Sahara Africa (SSA). In spite of this, the level of ITNs use among school age children (SAC) in Muntu Sub-County is low, yet the burden of malaria is estimated at 38% among this group, compared to 14.3% in children under five and the associated factors for this are not clear. Objective: To establish the level of ITNs use and associated factors among SAC in Muntu Sub-County, Amolatar District so as to inform stakeholders on appropriate interventions against malaria in this age group. Methods: A community based cross sectional study was conducted in the Sub County among 367 randomly selected households. Interviewer-administered structured questionnaires were used to collect quantitative data, while six key informants’ interviews were conducted to collect qualitative data. Data on ITNs condition and other observable environmental and household factors were collected using an observation check list. Data was then entered into EpiData 3.02, exported to STATA version 13.0, for editing and analysis. Descriptive statistics, bivariate and multivariate logistic regression analyses were performed to determine the factors associated with use of ITNs as binary outcome at 95% confidence interval. Qualitative data were analyzed using thematic analysis method and reported as quotations. Results: The majority of household heads, 243/367 (66.2%) were male and most, 277/367 (75.48%) were married. Half of the SAC, 186/367 (50.7%) were female, while the majority, 309/367 (84.2%) was attending school. The proportion of households with one ITN for every two people (ITN household coverage) was 177/367 (48.2%). The proportion of SAC using ITN was 201/367 (54.8%). The majority of SAC, 288/367 (78.5%) slept in separate rooms from that of their household heads while most children, 216/367 (58.9%) slept in rooms which had no beds. The independent factors associated with ITN use were: SAC in families with 1- 4 people and 5-7 people were more likely to use ITN [AOR: 3.7, (95% CI: 2.20-7.92)]; [AOR: 2.0, (95% CI: 1.05-3.86)] respectively; Children in households with 3 or more rooms for sleeping were more likely to use ITN [AOR: 3.1, (95% CI: 1.49-8.55)]; SAC were more likely to use ITNs if the household head had good knowledge of malaria [AOR: 4.3, (95% CI: 2.11-10.20)]; Children who were attending government schools were more likely to use ITNs compared to those who were attending private schools [AOR: 2.2, (95% CI: 1.39-3.60)] and children with perceived positive attitude to ITN use were more likely to use ITNs compared to their counterparts with perceived negative attitude to ITN use [AOR: 2.7, ( 95% CI: 1.51-4.86)]. In addition, SAC were perceived by the community as having negative attitude towards ITN use and that they were mature and immune to malaria infection hence given minimal priority in regards to malaria prevention. Mis-use of ITNs by the community was perceived to have contributed to its low use by SAC. Conclusions and recommendations: The household ITN coverage (i.e. proportion of households with one ITN for every two people) and the proportion of SAC using ITNs were both low compared to the UMRSP strategic objective of achieving and sustaining protection of at least 85% of the population at risk of malaria by 2017, using recommended malaria prevention measures (i.e. the national target). The individual, household and community factors were found to be associated with use of ITNs among SAC. The MoH and DHT should design behavioural change communication (BCC) messages as well as community health education programmes targeting SAC as well as the community to ensure positive behavioural change and improvement in household features so as to enhance optimal ITNs use among SAC, which in turn will lead to malaria prevention among this age group in the district.