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LLIN Evaluation in Uganda Project (LLINEUP): factors associated with ownership and use of long-lasting insecticidal nets in Uganda: a cross-sectional survey of 48 districts.

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Gonahasa, Samuel, Maiteki-Sebuguzi, Catherine, Rugnao, Sheila, Dorsey, Grant, Opigo, Jimmy, Yeka, Adoke, Katureebe, Agaba, Kyohere, Mary, Lynd, Amy, Hemingway, Janet ORCID: https://orcid.org/0000-0002-3200-7173, Donnelly, Martin ORCID: https://orcid.org/0000-0001-5218-1497, Kamya, Moses R and Staedke, Sarah G (2018) 'LLIN Evaluation in Uganda Project (LLINEUP): factors associated with ownership and use of long-lasting insecticidal nets in Uganda: a cross-sectional survey of 48 districts.'. Malaria Journal, Vol 17, Issue 1, p. 421.

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Abstract

Background
Long-lasting insecticidal nets (LLINs) are a key malaria control intervention. To investigate factors associated with ownership and use of LLINs in Uganda, a cross-sectional community survey was conducted in March–June 2017, approximately 3 years after a national Universal Coverage Campaign (UCC).
Methods
Households from 104 clusters (health sub-districts) in 48 districts were randomly selected using two-staged cluster sampling; 50 households were enrolled per cluster. Outcomes were household ownership of LLINs (at least one LLIN), adequate LLIN coverage (at least one LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Associations between variables of interest and outcomes were made using multivariate logistic regression.
Results
In total, 5196 households, with 29,627 residents and 6980 bed-nets, were included in the analysis. Overall, 65.0% of households owned at least one LLIN (down from 94% in 2014). In the adjusted analysis, factors most strongly associated with LLIN ownership were living in a wealthier household (highest tercile vs lowest; adjusted odds ratio [aOR] 1.94, 95% CI 1.66–2.28, p < 0.001) and time since the last UCC (29–37 vs 42–53 months; aOR 1.91, 95% CI 1.60–2.28, p < 0.001). Only 17.9% of households had adequate LLIN coverage (down from 65% in 2014). Factors most strongly associated with adequate coverage were fewer residents (2–4 vs ≥ 7; aOR 6.52, 95% CI 5.13–8.29, p < 0.001), living in a wealthier household (highest tercile vs lowest; aOR: 2,32, 95% CI 1.88–2.85, p < 0.001) and time since the last UCC (29–37 vs 42–53 months; aOR 2.13, 95% CI 1.61–2.81, p < 0.001). Only 39.5% of residents used a LLIN the previous night. Age was strongly associated with LLIN use, as were household wealth and time since the last UCC. Children < 5 years (44.7%) and residents > 15 years (44.1%) were more likely to use nets than children aged 5–15 years (30.7%; < 5 years: aOR 1.71, 95% CI 1.62–1.81, p < 0.001; > 15 years: aOR 1.37, 95% CI 1.29–1.45, p < 0.001).
Conclusions
Long-lasting insecticidal net ownership and coverage have reduced markedly in Uganda since the last net distribution campaign in 2013/14. Houses with many residents, poorer households, and school-aged children should be targeted to improve LLIN coverage and use.
Trial registration This study is registered with ISRCTN (17516395)

Item Type: Article
Subjects: QX Parasitology > Insects. Other Parasites > QX 510 Mosquitoes
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > Preventive Medicine > WA 240 Disinfection. Disinfestation. Pesticides (including diseases caused by)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
Faculty: Department: Biological Sciences > Vector Biology Department
Depositing User: Stacy Murtagh
Date Deposited: 23 Nov 2018 11:16
Last Modified: 23 Nov 2018 11:16
URI: http://archive.lstmed.ac.uk/id/eprint/9670

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