Ownership, coverage, and determinants of utilization of long-lasting insecticidal nets in a high malaria transmission setting in Uganda: a cross-sectional study

Le résumé fourni par la source

Malaria remains highly endemic in many parts of Uganda despite repeated rounds of universal coverage campaigns distributing free Long-Lasting Insecticidal Nets (LLINs) to strengthen control efforts. While household-level LLIN ownership has reached near-universal levels nationally, utilization is still low. This study assessed ownership, coverage, and determinants of utilization of LLINs in a high malaria transmission setting in Eastern Uganda. A cross-sectional survey was conducted among 441 households selected from four sub-counties with the highest malaria burden in Bugiri District. Structured questionnaires adapted from the Roll Back Malaria Monitoring and Evaluation Reference Group indicators were administered to collect data on LLIN ownership, coverage, and use. Modified Poisson regression analysis was performed to determine factors associated with LLIN use among household heads. Prevalence ratios (PR) were reported with their 95% confidence intervals, with significance set at p < 0.05. LLIN ownership was nearly universal, with 95.7% (95% CI 93.3–97.2) of households reporting at least one LLIN. However, only 47.6% (95% CI 42.9–52.3) had adequate coverage (≥ 1 net per two persons). Overall, 72.9% (95% CI 70.9–74.9) of the study population reported sleeping under a LLIN the previous night and 93.4% (95% CI 91.5–94.9) of existing nets were utilized. In multivariable analysis, rural residence (aPR = 1.14, 95% CI 1.05–1.24, p = 0.002), and adequate household LLIN coverage (aPR = 1.09, 95% CI 1.01–1.19, p = 0.037) were significantly associated with LLIN use. Net material was also significantly associated with use, with polyester (aPR = 1.21, 95% CI 1.09–1.33) and polyethylene nets (aPR = 1.16, 95% CI 1.04–1.30, p = 0.008) being more likely to be used than LLINs made of both types of materials. While LLIN ownership remains high, gaps in household coverage continue to undermine universal protection. Consistent use is more likely where households have adequate LLINs and when the material aligns with user preferences. Ensuring that every household receives an adequate number of LLINs, while also accounting for the practical factors that shape their use, remains central to the success of Uganda’s malaria control strategy.

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