Low ITN utilization among households in SWEPR Ethiopia: challenge for malaria elimination, a mixed design approach

To prevent malaria starting from 2005 more than 2 billion insecticide-treated nets (ITNs) have been distributed globally. Even though Ethiopia has been doing nationwide ITN distribution starting from 2016 with 64% ITN coverage, there is a significant gap in its utilization in different settings. Therefore, this study aimed to assess the utilization of ITN and associated factors among households in SWEPRS, 2023.

Community-based mixed study designs were applied in the present study. Firstly, the malaria area was selected purposively and the study participants were reached by using multi-stage stratified sampling techniques. Data was collected by using structured and pre-tested tools through an electronic data collection software, Kobo tool kit was analyzed by using STATA version 14. The multicollenearity between independent variables and model fitness were checked by using the variable inflation factor (VIF) and Hosmer Lemeshow model fitness test, respectively. A binary Logistic Regression model was fitted to identify the associated factors. In the multivariable analysis, an adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) was used to measure the strength of the association and the statistically significant association was declared at a P-value less than 5%. Focus group discussion (FGD) and in-depth interviews (IDI) were employed for the qualitative study and analyzed using Quirkos. The findings of qualitative data were presented in thematic analysis.

In this study, a total of 1,552 households participated. In all households, the ownership of at least one mosquito net per household was found to be 89% (95%: CI: 87.62-90.72%) whereas the proper use of ITNs was found to be 20.38% (95%: CI: 18.25-22.50%) in the region. From the multivariable logistic regression analysis, the urban residents, NGO employees, having a corrugated iron sheet house type, having good knowledge toward malaria, having good knowledge toward ITNs, having a favorable attitude towards malaria and having a favorable attitude towards ITNs had higher odds of the proper utilization of ITNs as compared to their counterparts. In addition to these, misconceptions about ITNs, unfair distribution of ITNs, lack of health education from health extention workers (HEWs), community resistance, improper use (use for other purposes) of ITNs and shortage of HEWs were explored barriers to ITNs use from the qualitative data.

This study showed relatively a high coverage of ITNS, but low proper ITN utilization among the households. Therefore, behavioral change communications (BCC) interventions and education and communication (IEC), interventions should be done in the region.