Factors that influence ownership and use of insectcide treated nets and the role of Community Health Workers in selected District of Southern Province

Abstract

Malaria remains a public health problem in Zambia and in the world as a whole. The use of Insecticide Treated Nets (ITNs), has been proven to be effective in the prevention against malaria. ITN use is the intended health behavior to affect the greatest impact on malaria burden, However, ITNs use lags behind ITN possession. . This study looked at some of the factors that affect the use of ITNs. Many factors have been previously associated with low ITN use including lack of knowledge on malaria, its cause, transmission, and prevention as well as the use of ITNs as malaria prevention method. Data stem from the cross-sectional, cluster randomized Malaria Indicator Survey specifically from four districts in Southern Province. The malaria indicator survey (MIS) took place between April and May 2013 as a follow-up evaluation survey for large-scale test and treat campaigns for malaria reduction. Bi-variate analysis using cross tabulations and graphs were used to determine the association between independent and dependent variables, P values <0.05 were considered significant. Descriptive analysis was used to determine frequencies using mean and standard deviation. Logistic regression was used to determine strength of associations between independent and dependent variables Education of head of household was found to have an association with ITN use OR= 0.67, p=0.001). Other factors that showed strong association with ITN use are; age p=0.001, number of sleeping spaces (OR = 0.88, P=0.002). Net characteristics such as condition of the net were associated with use (OR=0.56, p=0.001), Color of the net (OR= 1.01, p <0.001). Source of ITN and use OR= 0.99, p=0.001. Respondents who obtained ITNs from government hospital or clinic where more likely to use them as opposed to those who obtained ITNs from CHWs. Respondents in the wealthiest households were more likely to use ITNs (52.8%) as opposed to respondents in the poorest households (41%).Wealth quartile was found to be strongly associated with ITN use OR= 1.28 p=0.001. Logistic regression showed an association between ITN use and where ITN /malaria information was heard, OR= 1.2, p = 0.006. Respondents who obtained malaria messages or information from CHWs were more likely to use ITNs as opposed to those who got malaria information from sources such as TV, or family. Study suggests that there are a number of factors that influence ITN use. It is therefore important to identify these factors and address them if the battle against malaria is to be won. Behavioral change is a huge component in increasing ITN use. People may be knowledgeable about malaria prevention but if they don’t implement preventive measures the battle can never be won. Education to the communities should focus on ways in which people can be motivated or persuaded to use ITNs.