title: Family biosocial variables driving adherence to the use of insecticide treated nets among under-five children managed for malaria in a rural hospital in eastern Nigeria.
abstract: BACKGROUND
  As the distribution and awareness of free insecticide treated nets (ITNs) for malaria control continues to grow in Nigeria in order to meet the coverage target for the year 2010, a large gap exists between acquiring them, using them, and adhering to its use by families of under-five children. Therefore, the family biosocial variables driving its adherence need to be explored if the potential benefits of the nets are to be fully harnessed by families of under-five children in Nigeria. This study was aimed at describing family biosocial variables driving adherence to the use of insecticide treated nets among under-five children managed for malaria in a rural hospital in Eastern Nigeria.
  
  
  METHODS
  This was descriptive hospital-based study carried out from June 2008 to June 2010 on a cross section of 220 mothers of under-five children who were managed for confirmed malaria within the study period and met the selection criteria were interviewed using a pretested, structured researcher administered questionnaire. The questionnaire instrument elicited information on family biosocial variables. Adherence was assessed in the previous 6 months and graded using an ordinal scoring system of 1-4 points: score of 4 points indicated adherence while scores of 1-3 points meant nonadherence. Operationally, an adherent respondent was defined as one who scored 4 points. An under-five child was defined to have malaria if the mother gave complaint of fever, vomiting and other symptoms suggestive of malaria, had body temperature exceeding 37.5 degrees C with the asexual forms Plasmodium falciparum detected on the peripheral blood film. Reasons for nonadherence were also sought.
  
  
  RESULTS
  The adherence rate was 33.2%. The family biosocial variables significantly associated with adherence were maternal age =30 years (p-value = 0.03), maternal occupation (house wives) (p-value = 0.03), family size less than 4 (p-value = 0.026) and spouse living together (p-value = 0.01.). Others included family belief, in the benefits of ITNs (p-value = 0.002 and source of ITNs (p-value = 0.03). The most significant predictor of adherence was living together of spouse (p-value = 0.000, OR = 3.851, CI = 1.76-6.01). The commonest reason for non-adherence was forgetfulness (p-value = 0.003).
  
  
  CONCLUSIONS
  Despite high family belief in the benefits of ITNs, adherence to its use was low. Some family biosocial variables played significant roles in driving its adherence. Measures targeted at these variables and widespread family-oriented health promotion programmes are recommended in order to improve on adherence leading to family friendly ITNs communities.
authors: Department of Family Medicine, Federal Medical Centre, Umuahia, Abia state, Nigeria and visiting Consultant Family Physician, St. Vincent De Paul Hospital, Amuric-Omanze, Imo state, Nigeria. ilohgup2009@yahoo.com
authors: G U P
authors: GU
authors: Iloh
authors: A N
authors: AN
authors: Amadi
authors: C E
authors: CE
authors: Obikwu
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005190:Family; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000008:administration & dosage*; D016778:Malaria, Falciparum / Q000517:prevention & control; D008297:Male; D057147:Mosquito Nets / Q000382:microbiology; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors
chemical_list: D007306:Insecticides