title: Determinants of Bed Net Use in Southeast Nigeria following Mass Distribution of LLINs: Implications for Social Behavior Change Interventions.
abstract: Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the global malaria control strategy. LLIN ownership, however, does not necessarily guarantee use. Thus, even in the ideal setting in which universal coverage with LLINs has been achieved, maximal malaria protection will only be achieved if LLINs are used both correctly and consistently. This study investigated the factors associated with net use, independent of net ownership. Data were collected during a household survey conducted in Ebonyi State in southeastern Nigeria in November 2011 following a statewide mass LLIN distribution campaign and, in select locations, a community-based social behavior change (SBC) intervention. Logistic regression analyses, controlling for household bed net ownership, were conducted to examine the association between individual net use and various demographic, environmental, behavioral and social factors. The odds of net use increased among individuals who were exposed to tailored SBC in the context of a home visit (OR = 17.11; 95% CI 4.45-65.79) or who received greater degrees of social support from friends and family (ptrend < 0.001). Factors associated with decreased odds of net use included: increasing education level (ptrend = 0.020), increasing malaria knowledge level (ptrend = 0.022), and reporting any disadvantage of bed nets (OR = 0.39; 95% CI 0.23-0.78). The findings suggest that LLIN use is significantly influenced by social support and exposure to a malaria-related SBC home visit. The malaria community should thus further consider the importance of community outreach, interpersonal communication and social support on adoption of net use behaviors when designing future research and interventions.
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Russell
authors.affiliation: The Carter Center, Jos, Nigeria.
authors.forename: Adamu
authors.initials: A
authors.lastname: Sallau
authors.affiliation: The Carter Center, Owerri, Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Emukah
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America; James Cook University, Cairns, Queensland, Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Graves
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Noland
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America; RTI International, Dar es Salaam, Tanzania.
authors.forename: Jeremiah M
authors.initials: JM
authors.lastname: Ngondi
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America; School of Medicine, University of Alabama, Birmingham, Alabama, United States of America.
authors.forename: Masayo
authors.initials: M
authors.lastname: Ozaki
authors.affiliation: Ebonyi State Ministry of Health, Abakaliki, Nigeria.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Nwankwo
authors.affiliation: The Carter Center, Jos, Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Miri
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: McFarland
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.
authors.forename: Frank O
authors.initials: FO
authors.lastname: Richards
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America; Agnes Scott College, Public Health Department, Decatur, Georgia, United States of America.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Patterson
mesh_terms: D000328:Adult; D000846:Anniversaries and Special Events; D003256:Community Participation; D003258:Consumer Behavior; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006792:House Calls; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000295:instrumentation*; D009549:Nigeria; D009570:Nitriles; D011722:Pyrethrins; D012424:Rural Population; D012919:Social Behavior; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D009570:Nitriles; D011722:Pyrethrins; C017180:decamethrin