Adherence to the Use of Insecticide-Treated Bed Nets by Nigerian Children.

Abstract

Background: As access to insecticide-treated bed nets (ITNs) increases, it becomes important to understand factors associated with regular and proper use of ITNs (here termed as "adherence"). This research was undertaken to fill the gap in knowledge and has four main objectives: 1. Evaluate malaria knowledge of caregivers and its association with adherence to children's ITN use; 2. Determine the associations between use of other mosquito avoidance methods and adherence to ITN use; 3. Evaluate the relationships between people's perceptions of ITNs and adherence to their use; and 4. Determine how the characteristics of ITNs and the areas where children sleep are associated with adherence to ITN use.

Methods: Caregivers (N=1,939) of young children were recruited through a random school-based survey in two states (Lagos and Oyo) in Nigeria. There were 927 ITN owners in the sample. Data were collected from caregivers using a pre-piloted, self-administered questionnaire. Logistic regression models were used to estimate the relationships between the cofactors, confounding variables, and adherence to ITN use by children.

Results: Level of malaria knowledge had no significant relationship with adherence to ITN use. Furthermore, a majority (60%) of participants reported using other methods for avoiding mosquitoes. Children of caregivers who used insecticide sprays and window screens were less likely to adhere to ITN use. While negative perceptions of ITNs were not predictors of consistent use, positive perceptions were. Characteristics of nets such as color, shape, size, age, deployment method, and how they were obtained were not associated with adherence to ITN use. However, ownership of more than one ITN, regular sharing of ITN, education on hanging the net, and sleeping on a bed with a frame were positively associated with use.

Conclusions: Educational activities around the hanging and use of nets should be incorporated into ITN distribution activities. Locally appropriate educational messages should be developed to discredit misinformation and encourage integration of other mosquito avoidance methods to complement ITN use. This study suggests that positive messages may help promote consistent ITN use, and if reinforced, could become an important component of the efforts to reduce the malaria burden in African countries.