title: Household malaria knowledge and its association with bednet ownership in settings without large-scale distribution programs: Evidence from rural Madagascar.
abstract: BACKGROUND
  Insecticide-treated bednets are effective at preventing malaria. This study focuses on household-level factors that are associated with bednet ownership in a rural area of Madagascar which had not been a recipient of large-scale ITN distribution.
  
  
  METHODS
  Data were gathered on individual and household characteristics, malaria knowledge, household assets and bednet ownership. Principal components analysis was used to construct both a wealth index based on household assets and a malaria knowledge index based on responses to questions about malaria. Bivariate and multivariate regressions were used to determine predictors of household bednet ownership and malaria knowledge.
  
  
  RESULTS
  Forty-seven of 560 households (8.4%) owned a bednet. In multivariate analysis, higher level of malaria knowledge among household members was the only variable significantly associated with bednet ownership (odds ratio 3.72, P < 0.001). Among respondents, predictors of higher malaria knowledge included higher education levels, female sex and reporting fever as the most frequent or dangerous illness in the community. Household wealth was not a significant predictor of bednet ownership or respondent malaria knowledge.
  
  
  CONCLUSIONS
  In this setting of limited supply of affordable bednets, malaria knowledge was associated with an increased probability of household bednet ownership. Further studies should determine how such malaria knowledge evolves and if malaria-specific education programs could help overcome the barriers to bednet ownership among at-risk households living outside the reach of large-scale bednet distribution programs.
authors: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA ; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Paul J
authors: PJ
authors: Krezanoski
authors: Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA ; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA.
authors: Alexander C
authors: AC
authors: Tsai
authors: Center for Global Health and Development, Boston University, Boston, Massachusetts, USA ; Department of International Health, Boston University School of Public Health, Boston, Massachusetts, USA ; Zambia Center For Applied Health Research and Development (ZCAHRD), Lusaka, Zambia ; Section of Infectious Diseases, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA.
authors: Davidson H
authors: DH
authors: Hamer
authors: Abt Associates, International Health Division, Cambridge, Massachusetts, USA.
authors: Alison B
authors: AB
authors: Comfort
authors: Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA ; Harvard School of Public Health, Boston, Massachusetts, USA ; Ragon Institute of MGH, MIT, and Harvard, Charlestown, Massachusetts, USA ; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: David R
authors: DR
authors: Bangsberg