title: Long-lasting insecticidal net source, ownership and use in the context of universal coverage: a household survey in eastern Rwanda.
abstract: BACKGROUND
  Universal long-lasting insecticidal net (LLIN) coverage (ULC) has reduced malaria morbidity and mortality across Africa. Although information is available on bed net use in specific groups, such as pregnant women and children under 5 years, there is paucity of data on their use among the general population. Bed net source, ownership and determinants of use among individuals from households in an eastern Rwanda community 8 months after a ULC were characterized.
  
  
  METHODS
  Using household-based, interviewer-administered questionnaires and interviewer-direct observations, data on bed net source, ownership and key determinants of net use, including demographics, socio-economic status indicators, house structure characteristics, as well as of bed net quantity, type and integrity, were collected from 1400 randomly selected households. Univariate and mixed effects logistic regression modelling was done to assess for determinants of bed net use.
  
  
  RESULTS
  A total of 1410 households and 6598 individuals were included in the study. Overall, the proportion of households with at least one net was 92 % while bed net usage was reported among 72 % of household members. Of the households surveyed, a total ownership of 2768 nets was reported, of which about 96 % were reportedly LLINs received from the ULC. By interviewer-physical observation, 88 % of the nets owned were of the LLIN type with the remaining 12 % did not carry any mark to enable type recognition. The odds of bed net use were significantly lower among males and individuals: from households of low socio-economic status, from households with <two bed nets, from households reporting use of ≥two sleeping spaces, and those reporting to have not slept on a bed.
  
  
  CONCLUSIONS
  In this study, despite high a bed net coverage, over 25 % of members reported not to have slept under a bed net the night before the survey. Males were particularly less likely to use bed nets even where nets were available. Household socio-economic status, number of bed nets and type and number of sleeping spaces were key determinants of bed net use. To maximize impact of ULC, strategies that target males as well as those that ensure ITN coverage for all, address barriers to feasible and convenient bed net use including covering over all sleeping space types, and provide net hanging supports, are needed.
authors.affiliation: Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. fkkateera@yahoo.com.|Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. fkkateera@yahoo.com.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kateera
authors.affiliation: Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. cingabire7@gmail.com.
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ingabire
authors.affiliation: Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda. ehakizimana@gmail.com.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hakizimana
authors.affiliation: Department of Cultural Anthropology and Development Studies and Centre for International Development Issues, Radboud University, 6500 HE, Nijmegen, The Netherlands. alexis.rulisa@gmail.com.
authors.forename: Alexis
authors.initials: A
authors.lastname: Rulisa
authors.affiliation: Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda. perfect.karinda@gmail.com.
authors.forename: Parfait
authors.initials: P
authors.lastname: Karinda
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. m.p.grobusch@amc.uva.nl.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.affiliation: College of Medicine and Health Sciences, University of Rwanda, PO Box 3286, Kigali, Rwanda. lmutesa@gmail.com.
authors.forename: Leon
authors.initials: L
authors.lastname: Mutesa
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. m.vanvugt@amc.uva.nl.
authors.forename: Michèle
authors.initials: M
authors.lastname: van Vugt
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Academic Medical Centre, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands. p.mens@kit.nl.|Royal Tropical Institute/Koninklijk Instituut voor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands. p.mens@kit.nl.
authors.forename: Petra F
authors.initials: PF
authors.lastname: Mens
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010067:Ownership; D011247:Pregnancy; D012432:Rwanda; D011795:Surveys and Questionnaires; D055815:Young Adult