title: Patterns and predictive factors of long-lasting insecticidal net usage in a previously high malaria endemic area in Sri Lanka: a cross-sectional survey.
abstract: BACKGROUND
  Long-lasting insecticidal nets (LLINs) have been widely distributed in Sri Lanka for malaria control. Their effectiveness depends on proper utilisation and maintenance at the household level.
  
  
  METHODS
  A cross-sectional study was performed to examine the patterns and predictive factors of LLIN maintenance and use in Anuradhapura district. Data was collected and analysed from 530 LLIN-owning households, selected by a multi-stage cluster sampling technique. Multivariable logistic regression identified factors associated with proper maintenance at the household level. Hierarchical linear modelling identified factors associated with LLIN use the previous night.
  
  
  RESULTS
  Almost 75% (377/504) of households had used all their LLINs the previous night, while 82.9% (418/504) had used at least one. Only 3.2% (15/474) were maintaining the LLIN in such a way as to maximise its insecticidal efficacy. Six variables were significantly associated (p<0.05) with use the previous night: more residents, fewer plain nets, reporting practical benefits of LLINs, conical shape, newer nets and lack of side effects. Two variables were significantly associated with proper maintenance: increasing level of education and taking safety precautions while washing.
  
  
  CONCLUSIONS
  Results suggest LLIN practices could improve in settings of low malaria transmission if distribution programmes took into account recipient preferences, promoted LLIN use over plain nets, and emphasised the techniques and significance of proper net maintenance.
authors.affiliation: Lincoln College, University of Oxford, Turl St, Oxford OX1 3DR, UK caroline.whidden@lincoln.ox.ac.uk caroline.e.whidden@gmail.com.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Whidden
authors.affiliation: Anti Malaria Campaign, 555/5 Elvitigala Mawatha, Colombo 5, Sri Lanka.
authors.forename: Risintha G
authors.initials: RG
authors.lastname: Premaratne
authors.affiliation: Office of the Regional Director of Health Services, Anuradhapura, Sri Lanka.
authors.forename: S Ravindra
authors.initials: SR
authors.lastname: Jayanetti
authors.affiliation: Department of Parasitology, Faculty of Medicine, P.O. Box 271, Kynsey Road, Colombo 8, Sri Lanka.
authors.forename: S Deepika
authors.initials: SD
authors.lastname: Fernando
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006796:Household Work; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods; D061214:Patient Safety; D010549:Personal Satisfaction; D057566:Self Report; D013188:Sri Lanka / Q000453:epidemiology; D055815:Young Adult
keywords: Knowledge; Long-lasting insecticidal net; Malaria; Practice; Sri Lanka