Socio-demographic and contextual drivers of insecticide-treated net (ITN) utilization among women of reproductive age in Togo: a Bayesian multilevel analysis of the 2017 Togo Malaria Indicator Survey

Background: Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention in sub-Saharan Africa. Despite wide-scale distribution, gaps between ITN ownership and utilization persist, particularly among women of reproductive age who are at high risk of malaria infection. This study aimed to identify the determinants of ITN utilization among women of reproductive age in Togo using data from the 2017 Togo Malaria Indicator Survey (TMIS). Methods: This study analyzed data from the nationally representative 2017 Togo Malaria Indicator Survey (TMIS), which included 4,225 women aged 15–49 years residing in households owning at least one ITN. Weighted descriptive statistics and Rao–Scott Chi-square tests were used to summarize ITN use and explanatory variables. A Bayesian multilevel logistic regression model was employed using the brms R package to identify determinants of ITN utilization, accounting for the hierarchical data structure and survey design. Model performance was assessed using the Leave-One-Out Information Criterion (LOOIC) and Bayesian R². Results: Overall, 72.8% (95% CI: 70.2–75.5) of women reported sleeping under an ITN the previous night. Utilization varied significantly by age, marital status, education, household wealth, and region. Age, education, marital status, and exposure to ITN messages were significant predictors at individual level: widowed women had over sixfold higher odds of ITN use compared to never-married women (aOR = 6.61; 95% CrI: 1.81–25.38), and exposure to ITN messages more than doubled the odds of use (aOR = 2.25; 95% CrI: 1.44–3.55). At the household level, female-headed households had 40% lower odds of ITN use (aOR = 0.60; 95% CrI: 0.37–0.95), and medium-sized households (4–6 members) had lower utilization (aOR = 0.35; 95% CrI: 0.19–0.61). At the community level, rural residence tripled the odds of ITN use (aOR = 3.23; 95% CrI: 1.21–8.70), and women living in Savanes had eighteen times higher odds compared to Lomé Commune (aOR = 18.10; 95% CrI: 3.53–100.4). Random-effects modeling indicated that 16.5% and 61.5% of the variance were attributable to cluster- and household-level factors, respectively. Conclusion: ITN utilization among women of reproductive age in Togo is relatively high but uneven. Use is shaped by socio-demographic, household, and community-level factors. Strengthening behavior-change communication, targeting urban and female-headed households, and addressing barriers among adolescents and educated women could improve equitable utilization and accelerate malaria control efforts.