Background: The use of insecticide-treated bed nets has been proven to be effective in reducing malaria transmission in highly endemic areas. Use of long-lasting insecticidal nets (LLINs) has been embraced by many malaria endemic countries. LLINs are up to 95% effective in inhibiting blood feeding, when used consistently even after 7 years. The challenge, however, is enhancing their consistent use, especially by the most vulnerable groups (children under 5 years and pregnant women). The study established factors associated with consistent use of bed nets for malaria control among children under 5 years in Soroti district. Methods: The study employed a cross-sectional design, with multi-stage sampling of households. A total of 400 households (HH) were sampled and the HH head in each household interviewed. Key informant interviews (KIIs) were conducted with 7 key informants who were knowledgeable on the subject matter. Data analysis was done using SPSS 17.0 at Univariate, Bivariate and Multivariable levels; after entry and cleaning. Key informants’ data were summarized manually; verbatim quotes and text used to reinforce quantitative data in line with objectives. Results: Only 56.8% of the 690 children under 5 years used bed nets consistently. The factors affecting consistent bed net use were age of the child, their use of bed nets the previous night, occupation of caretaker, respondents’ perceived susceptibility, perceived risk of getting malaria, size and shape of the bed nets. Rectangular nets were difficult to hang daily in huts according to most key informants. Conclusion: Consistent bed net use among under fives is still below the RBM target of 85% by 2015 and can be enhanced by providing conical bed nets and setting aside a health education programme to emphasize the effectiveness of even one mosquito in spreading malaria at night to the entire household and ability of bed nets to stop transmission better than other methods.
This was a population-based cross-sectional household survey that employed both quantitative and qualitative methods of data collection. The study was conducted in Soroti district. Soroti district is located in North-Eastern Uganda, neighbouring Kaberamaido district in the West, Amuria district in the North, Katakwi district in the North-East. In the Southern part of the district lies Kamuli, Kumi, Ngora and Pallisa districts, together with Lake Kyoga. The total land area of the district is 2665 km2, of which 84.8% is dry land and 15.2% water bodies. Soroti district is made up of two counties, 10 sub-counties, 50 parishes and 386 villages. The district had a population of 305,900 people in 2011; consisting majorly of the Iteso. There was a reported relatively high burden of Communicable diseases, especially malaria (51.8%), acute respiratory-tract infections (ARTIs) 47.6%, diarrhoeal diseases 38.6% and maternal-child health conditions 29.6% [31]. The economic activities include subsistence farming, small businesses, fishing and animal rearing. The study population consisted of children under 5 years of age in Soroti district. The eligible population was residents who were present in the sampled Households (HHs) in the previous 12 months to the survey. Individual interviews were conducted with eligible heads of HHs or any adult living together with children under 5 years in each household. Qualitative data was obtained from key informants, including the DHO, malaria control focal person, ADHO-Environmental Health, ADHO-MCH, DHE, project officers of Stop Malaria Project, Teso Safe Motherhood Project and World Vision Soroti. HHs with at least one child under 5 years of age were included in the survey. The respondents were the heads of HHS or their designated spouse or any member of the household who was aged 18 years and above and also individual heads of HHS who lived with children under 5 years daily for the previous 12 months. The sample size for the study was calculated using Kish Leislie’ formula 1965 [48] for a cross-sectional study, with a 5% additional number to cater for non-response. where Zα/2: Z-value corresponding to alpha level of significance of 5%; P: estimated proportion of bed net use among children under 5 years in Uganda. P = 41%, obtained from Uganda Malaria Indicator Survey, 2009. q: 1 − p; d: absolute precision; g: design effect because of multi-stage cluster sampling. A total of 7 key informants were interviewed. The study involved interviewing 400 heads of HHs and 7 key informants purposively chosen with respect to their positions and technical knowledge on consistent use of bed nets in the district. Quantitative and qualitative methods of data collection were used. Quantitative data was obtained using interviewer administered semi-structured household questionnaires while qualitative data was obtained through key informant interviews with 7 key informants. For quantitative data collection, research assistants were trained for 2 days on the all the aspects of survey procedures meanwhile, for qualitative data collection, the Principal Investigator (PI) conducted key informant interviews with 7 key informants. A written consent was obtained before conducting Key informant interviews. The interviews were guided by open-ended questions in the KI guide. The PI listened critically and wrote down notes of all responses to the questions asked using short hand. Tools were pre-tested in Arapai parish and appropriate adjustments made to ensure a complete capture of required data. Pre-testing also facilitated transformation of semi-structured questionnaires into structured which eased data entry and analysis. The questionnaires were checked and edited by the principal investigator and research assistants during and after the data collection exercise. Data was checked for completeness by filling-up any missing links and reconciling any mismatches. Coding of none pre-coded data was done after the whole data collection exercise. Data in each uniquely identified questionnaire was entered into SPSS computer package by the principal investigator. Research Assistants (RAs) were trained for 2 days before data collection commenced. Data collection tools were translated into Ateso, the local dialect to ensure consistency in the way the questions were asked for accuracy of the data collected. A pre-test of the data collection tools was conducted in Arapai parish. That allowed research assistants to practice asking the translated questions to ensure consistency and prompt adjustment of data collection tools. Field editing of data and checking for completeness was done daily by the principal investigator and RAs. Key informants were interviewed by the principal investigator to ensure accurate asking of questions and capture of all responses appropriately. The PI listened critically and wrote down notes of all responses to the questions asked using short hand. Quantitative data was entered into SPSS computer package, cleaned and analyzed using SPSS 17.0. The questionnaire unique identifiers were used to merge data on each child enumerated in each household to form a single data set on which analysis was based. Univariate, Bivariate and multivariable analysis was done. Analysis was limited to only those children aged 1–4 years (determined by outcome variable) who used bed nets for protection against mosquitos so as to eliminate the influence of household bed net access. Also further assessment of respondents’ knowledge about malaria was under taken (Additional file 1). We received ethical approval from the Uganda National Council of Science and Technology (UNCST), through the Makerere University School of Public Health Higher Degrees Research and Ethics Committee (HDREC). All respondents provided written informed consent upon receiving details of the study. All eligible participants voluntarily consented, anonymity of the participants and respondents were kept confidential throughout the study.
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