Socio-demographic predictors of Insecticide-treated bed net ownership and utilization for protection against malaria by rural community members across five regions of Mainland Tanzania
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Background
Despite decades of control efforts by the National Malaria Control Programme, malaria burden in Tanzania remains high, with transmission intensity varying significantly across regions. Insecticide-treated bed nets (ITNs) are among the core interventions recommended by the World Health Organization for malaria prevention and control in endemic areas. In Tanzania, ITNs are distributed through multiple channels to promote their acquisition and use for protection against malaria. However, persistent gaps in ITN ownership and usage raise concerns about equitable access and utilization. This study aimed to evaluate socio-demographic predictors of ITNs ownership and usage among rural community members in five districts from five regions with varying malaria endemicity.
Methods
A cross-sectional survey was conducted in selected communities (covering 15 villages) from five districts, one each from five regions of Kagera, Kigoma, Njombe, Ruvuma, and Tanga, from July to August 2023. Community members (including those with malaria symptoms and asymptomatic participants) aged ≥6 months were recruited. Demographic, malaria prevention practices, anthropometric, clinical, parasitological and socio-economic status (SES) data were captured using mixed questionnaires configured and installed on Open Data Kit (ODK) software, which runs on tablets. Socio-demographic predictors associated with ITNs ownership and use were determined using logistic regression analysis. The results were presented as crude (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a p-value <0.05 was considered statistically significant.
Results
Among the 10228 enrolled participants, 7939 (77.6%) and 7899 (77.2%) reported owning and using ITNs, respectively. Both ownership and usage varied significantly across districts (p<0.001), with the highest rates reported in Nyasa and the lowest in Kyerwa. Females were more likely than males to own (aOR=1.27, 95% CI:1.12 - 1.45, p<0.001) and use ITNs (aOR=1.27, 95%CI:1.12 - 1.45, p<0.001). Similarly, under-fives had significantly higher odds of ITN ownership (aOR=1.83, 95%CI:1.56 - 2.15, p<0.001) and usage (aOR=2.26, 95%CI:1.62 - 3.15, p<0.001) than school-children with reference to adults. Participants from Nyasa - Ruvuma, Ludewa - Njombe, and Muheza - Tanga also exhibited higher odds of ITN ownership and usage compared to those from Buhigwe - Kigoma, with Kyerwa - Kagera as the reference district (p<0.001). The odds of ITN ownership and usage increased significantly with an increase in education levels (p≤0.200) and SES (p≤0.001).
Conclusion
ITN ownership and usage were relatively high among rural community members in the five surveyed districts; however, both remained below the 80% target projected for 2023. Higher ownership and usage were observed among females, under-fives, individuals with higher education levels, and those from households with higher SES. Disparities based on sex, age groups, socioeconomic status, education, and occupation should be carefully considered in ITN distribution strategies to ensure equitable access and usage of bed nets across all population groups in Tanzania.
