Effect of exposure to malaria messages on insecticide-treated net use among women and under-five children in Uganda: a propensity score matched analysis

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BACKGROUND: Malaria remains a global public health issue, with almost 2.5 million cases and more than 0.6 million deaths each year, of which women and children remain disproportionately affected. Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention in endemic malaria regions. Malaria messages (MM) are intended for positive and measurable social, attitude, and behavioural change towards malaria prevention uptake. However, their impact on insecticide-treated nets (ITNs) use has not been sufficiently investigated through rigorous statistical approaches. This study investigated the effect of MM on ITN use among women and children under five years in Uganda using Propensity Score Matched Analysis (PSMA). METHODS: The study utilized the Uganda Malaria Indicator Survey (UMIS) 2018 -19 data. Women (n = 8868) and children (n = 6915) datasets were extracted from Individual Women's and Children's Data, respectively. The children's dataset included data on interviewed women (caregivers), household indicators and under-five children's data, while the women's dataset contains records of every eligible woman in selected households. Propensity score-matched analysis (PSMA) was utilized to identify the effect of the MM (intervention) on ITN use (outcome) among women of reproductive age and children under five in Uganda. RESULTS: The results revealed that 69.3 [95% CI: 67.2, 71.2] of the women and 71.8 [95% CI: 69.1, 74.4] of the children under five years slept under a mosquito bed net the night preceding the survey. The results further revealed a significant and positive effect of exposure to malaria messages on ITN use among exposed women [Average Treatment Effect of the Treated (ATT) = 5.1%, 95% CI: 1.5-8.9%] and under-five children of exposed women [ATT = 4.3%, 95% CI: 1.0-7.6%]. CONCLUSION: Effective and relevant behavioural change communications, such as malaria messages, are an effective way of influencing the use of ITN. Such an intervention may reduce malaria endemicity, morbidity, and mortality in Uganda.

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