Geographical Factors Affecting Bed Net Ownership, a Tool for the Elimination of Anopheles-Transmitted Lymphatic Filariasis in Hard-to-Reach Communities.

Stanton, Michelle C ORCID: https://orcid.org/0000-0002-1754-4894, Bockarie, Moses and Kelly-Hope, Louise ORCID: https://orcid.org/0000-0002-3330-7629 (2013) 'Geographical Factors Affecting Bed Net Ownership, a Tool for the Elimination of Anopheles-Transmitted Lymphatic Filariasis in Hard-to-Reach Communities.'. PLoS ONE, Vol 8, Issue 1, e53755.

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Abstract

Vector control, including the use of bed nets, is recommended as a possible strategy for eliminating lymphatic filariasis (LF) in post-conflict countries such as the Democratic Republic of Congo (DRC). This study examined the geographical factors that influence bed net ownership in DRC in order to identify hard-to-reach communities that need to be better targeted. In particular, urban/rural differences and the influence of population density, proximity to cities and health facilities, plus access to major transport networks were investigated. Demographic and Health Survey geo-referenced cluster level data were used to map bed net coverage (proportion of households with at least one of any type of bed net or at least one insecticide-treated net (ITN)), and ITN density (ITNs per person) for 260 clusters. Bivariate and multiple logistic or Poisson regression analyses were used to determine significant relationships. Overall, bed net (30%) and ITN (9%) coverage were very low with significant differences found between urban and rural clusters. In rural clusters, ITN coverage/density was positively correlated with population density (r = 0.25, 0.27 respectively, p<0.01), and negatively with the distance to the two largest cities, Kinshasa or Lubumbashi (r = -0.28, -0.30 respectively, p<0.0001). Further, ownership was significantly negatively correlated with distance to primary national roads and railways (all three measures), distance to main rivers (any bed net only) and distance to the nearest health facility (ITNs only). Logistic and Poisson regression models fitted to the rural cluster data indicated that, after controlling for measured covariates, ownership levels in the Bas-Congo province close to Kinshasa were much larger than that of other provinces. This was most noticeable when considering ITN coverage (odds ratio: 5.3, 95% CI: 3.67-7.70). This analysis provides key insights into the barriers of bed net ownership, which will help inform both LF and malaria bed net distribution campaigns as part of an integrated vector management strategy.

Item Type:	Article
Subjects:	QX Parasitology > Insects. Other Parasites > QX 515 Anopheles WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases WC Communicable Diseases > Tropical and Parasitic Diseases > WC 765 Prevention and control WC Communicable Diseases > Tropical and Parasitic Diseases > WC 880 Filariasis and related conditions (General)
Faculty: Department:	Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0053755
Depositing User:	Mary Creegan
Date Deposited:	20 Feb 2013 10:47
Last Modified:	06 Sep 2019 10:55
URI:	https://archive.lstmed.ac.uk/id/eprint/3318

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