Determinants of Bed Net Use in Southeast Nigeria following Mass Distribution of LLINs: Implications for Social Behavior Change Interventions

• Type of Material: Article
• Authors: Cheryl L. Russell, Emory University; Adamu Sallau, The Carter Center; Emmanuel Emukah, The Carter Center; Patricia M. Graves, The Carter Center; Gregory S. Noland, The Carter Center; Jeremiah M. Ngondi, The Carter Center; Masayo Ozaki, The Carter Center; Lawrence Nwankwo, Ebonyi State Ministry of Health; Emmanuel Miri, The Carter Center; Deborah McFarland, Emory University; Frank O. Richards, The Carter Center; Amy E. Patterson, The Carter Center
• Language: English
• Date: 2015-10-02
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Russell et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0139447
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 10
• Issue: 10
• Start Page: e0139447
• End Page: e0139447
• Grant/Funding Information: This study was supported by a grant from the Bill and Melinda Gates Foundation.
• Research Categories: Health Sciences, Public Health; Health Sciences, General

Abstract

Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the global malaria control strategy. LLIN ownership, however, does not necessarily guarantee use. Thus, even in the ideal setting in which universal coverage with LLINs has been achieved, maximal malaria protection will only be achieved if LLINs are used both correctly and consistently. This study investigated the factors associated with net use, independent of net ownership. Data were collected during a household survey conducted in Ebonyi State in southeastern Nigeria in November 2011 following a statewide mass LLIN distribution campaign and, in select locations, a community-based social behavior change (SBC) intervention. Logistic regression analyses, controlling for household bed net ownership, were conducted to examine the association between individual net use and various demographic, environmental, behavioral and social factors. The odds of net use increased among individuals who were exposed to tailored SBC in the context of a home visit (OR = 17.11; 95% CI 4.45–65.79) or who received greater degrees of social support from friends and family (ptrend < 0.001). Factors associated with decreased odds of net use included: increasing education level (ptrend = 0.020), increasing malaria knowledge level (ptrend = 0.022), and reporting any disadvantage of bed nets (OR = 0.39; 95% CI 0.23–0.78). The findings suggest that LLIN use is significantly influenced by social support and exposure to a malaria-related SBC home visit. The malaria community should thus further consider the importance of community outreach, interpersonal communication and social support on adoption of net use behaviors when designing future research and interventions.