title: Comparing ownership and use of bed nets at two sites with differential malaria transmission in western Kenya.
abstract: BACKGROUND
  Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use.
  
  
  METHODS
  Community forums and a household, cross-sectional survey were used to collect information on factors related to bed net ownership and use in western Kenya. Sites with disparate levels of transmission were selected, including an endemic lowland area, Miwani, and a highland epidemic-prone area, Kapkangani. Analysis of ownership was stratified by site. A combined site analysis was conducted to examine factors associated with use of all available bed nets. Logistic regression modelling was used to determine factors associated with ownership and use of owned bed nets.
  
  
  RESULTS
  Access to bed nets as the leading barrier to their use was identified in community forums and cross-sectional surveys. While disuse of available bed nets was discussed in the forums, it was a relatively rare occurrence in both sites. Factors associated with ownership varied by site. Education, perceived risk of malaria and knowledge of individuals who had died of malaria were associated with higher bed net ownership in the highlands, while in the lowlands individuals reporting it was easy to get a bed net were more likely to own one. A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria. In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season.
  
  
  CONCLUSIONS
  Variations in factors associated with ownership should be acknowledged when constructing messaging and distribution campaigns. Despite reports of bed nets being used for other purposes, those in the home were rarely unused in these communities. Disuse seemed to be related to beliefs that can be addressed through education programmes. As mass distributions continue to take place, additional research is needed to determine if factors associated with LLIN ownership and use change with increasing availability of LLIN.
authors.affiliation: Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA. kernst@email.arizona.edu.
authors.forename: Kacey C
authors.initials: KC
authors.lastname: Ernst
authors.affiliation: National Center for Atmospheric Research, 3450 Mitchell Lane, Boulder, CO, 80301, USA.
authors.forename: Mary H
authors.initials: MH
authors.lastname: Hayden
authors.affiliation: Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Olsen
authors.affiliation: National Center for Atmospheric Research, 3450 Mitchell Lane, Boulder, CO, 80301, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Cavanaugh
authors.affiliation: Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Ruberto
authors.affiliation: Centre for Global Health Research, Kenyan Medical Research Institute, Kisumu-Busia Highway, Kisumu, Kenya.
authors.forename: Maurice
authors.initials: M
authors.lastname: Agawo
authors.affiliation: Centre for Global Health Research, Kenyan Medical Research Institute, Kisumu-Busia Highway, Kisumu, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Munga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003256:Community Participation; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D010067:Ownership / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Bed nets; Challenges; IRS; Kenya; LLINs; Malaria; Ownership; Use