Factors Associated with Sustained Use of Long-Lasting Insecticide-Treated Nets Following a Reduction in Malaria Transmission in Southern Zambia.
Understanding factors influencing sustained use of long-lasting insecticide-treated nets (LLIN) in areas of declining malaria transmission is critical to sustaining control and may facilitate elimination. From 2008 to 2013, 655 households in Choma District, Zambia, were randomly selected and residents were administered a questionnaire and malaria rapid diagnostic test. Mosquitoes were collected concurrently by light trap. In a multilevel model, children and adolescents of 5-17 years of age were 55% less likely to sleep under LLIN than adults (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.35, 0.58). LLIN use was 80% higher during the rainy season (OR = 1.8; CI = 1.5, 2.2) and residents of households with three or more nets were over twice as likely to use a LLIN (OR = 2.1; CI = 1.4, 3.1). For every increase in 0.5 km from the nearest health center, the odds of LLIN use decreased 9% (OR = 0.9; CI = 0.88, 0.98). In a second multilevel model, the odds of LLIN use were more than twice high if more than five mosquitoes (anopheline and culicine) were captured in the house compared with households with no mosquitoes captured (OR = 2.1; CI = 1.1, 3.9). LLIN use can be sustained in low-transmission settings with continued education and distributions, and may be partially driven by the presence of nuisance mosquitoes.
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland jpinchoff@gmail.com.
Jessie
J
Pinchoff
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Harry
H
Hamapumbu
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Tamaki
T
Kobayashi
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Limonty
L
Simubali
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Jennifer C
JC
Stevenson
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Douglas E
DE
Norris
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Elizabeth
E
Colantuoni
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Philip E
PE
Thuma
William J
WJ
Moss
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D006801:Humans; D057148:Insecticide-Treated Bednets; D017846:Longitudinal Ligaments; D008288:Malaria / Q000517:prevention & control*; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult; D015024:Zambia