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Insecticide Treated Net Utilization Among Under-Five Children And Quality in Primary Care (2017) 26 (2): 38-44 2018 Insight Medical Publishing Group Research Article InsecticideResearch Article Treated Net Utilization among Under-Open Access Five Children and Household Net Ownership in Adami Tullu District, Oromia Regional State, Ethiopia: a Community Based Cross-sectional study Bikila Lencha Department of Public Health, College of Medicine and Health Sciences, Maddawalabu University, Bale-Robe, Ethiopia ABSTRACT Background: Children under the age of five years and insecticide net was 188 (25.3%). About two third, 101(63.9%) pregnant women have been identified as the most vulnerable risk of under-five children slept under net the night preceding group for malaria. In addition to scaling up of net distribution, the survey among net owning households. Knowledge that periodic assessment of the utilization and associated factors sleeping under net every night prevents malaria [Adjusted Odds among high risk population is important. Ratio, AOR (95%CI) =4.7 (1.1-9.6)], spouse education [AOR (95%CI) =1.74 (1.2-2.6)], and kebeles (small admistrative Objective: To assess the level of long lasting insecticide unit) i.e. Bochessa [AOR (95%CI) =2.2 (1.2-4.1)], Elka treated nets use and associated factors among under-five Chellemo [AOR (95%CI) =2.3(1.2-4.4)] were associated with children and net ownership of the households. net ownership. Net utilization among under-five children was Methods: A community-based cross-sectional study affected by knowledge that LLIN kills malaria mosquitoes was conducted in Adami Tullu District from February 1-25, [AOR (95%CI) =3.8 (1.15-12.4), knowing fever as a symptom 2014. Cluster randomized sampling technique was used to of malaria [AOR (95%CI) =3.2(1.05-9.6)] and male gender of select 748 households. Data were collected using a structured the child [AOR (95%CI) =6.0 (2.5-12.8). questionnaire and observation checklist. Bivariate and Conclusion: The ownership of long lasting insecticide multivariable logistic regressions were applied for the analysis treated nets and the use among high risk population remained of the independent variables against long lasting insecticide low. Information, Education and Communication (IEC) on the treated nets use among under five children and household net net use need to focus on avoiding gender discrimination among ownership. The results were reported using crude and adjusted under-five child. Further research is needed to study the decline odds ratio (OR) with their 95% confidence interval. in household ownership. Results: Household ownership of at least one long lasting Keywords: LLIN; under-five children; ownership and use Abbreviations Approximately, 60 percent of Ethiopia’s population lives in malarious areas, and 68 percent of the country’s landmass EC-Ethiopian calendar is favorable for malaria transmission, with malaria primarily IEC-Information, Education and Communication associated with altitude and rainfall [2]. IRS-Indoor Residual Spray One of the recent study in Tanzania showed that an increase of 10 % ownership of at least one mosquito net at household LLINs-Long Lasting Insecticidal Nets level is associated with 12 % and 10 % decrease of malaria risk MIS-Malaria Indicator Survey for all age and under-five children per year, respectively [3]. SNNP-Southern Nations Nationalities and Peoples The national strategic plan for malaria prevention and control in Ethiopia aims at scaling up both long lasting insecticide WHO-World Health Organization nets (LLINs) and indoor residual spray (IRS) interventions in Background malaria endemic regions [4]. The malaria indicator surveys (MIS), conducted in 2007, 2011 and 2015 indicated that 65%, World Health Organization (WHO) estimates indicate that 55% and 64% of surveyed households had at least one LLIN, 212 million cases occurred globally in 2015, leading to 429000 respectively, whereas the use by the children under five years, deaths, most of which were in children aged under 5 years in during the night prior to survey, within households with at least Africa. In 2015, 303000 malaria deaths were estimated to have one net was improved from 64% in 2011 to 70% in 2015 [2,5,6]. occurred in children aged under 5 years, equivalent to 70% of the global total. Malaria remains a major killer of children, and A wide gap exists between coverage and utilization of LLINS in is estimated to take the life of a child every 2 minutes [1]. the country [7]. This shows that, mosquito net ownership in itself is 39 Bikila Lencha not synonymous with utilization especially for under-five children. the objectives of the study, were adapted from Ethiopia Malaria Increase in LLIN access (i.e. household ownership) does not Indicator Survey (MIS) 2O11 report [6]. Observational check necessarily translate to equal increase in utilization [8]. The success list was additionally used to verify the status of nets in the of LLIN utilization depends on several factors: such as, willingness household. The questionnaire was prepared in English and then of people to use nets, inconvenience to hang the nets, educational translated to Afaan Oromo (local language of the study area). background, place of residence, age, gender differences and colour It included questions about the respondent’s socio- of nets [5-7]. An increasing number of LLINs have been delivered demographic characteristics, knowledge and perception about to sub-Saharan African countries including Ethiopia, but those malaria and LLINS, and household possession of LLINS and its numbers are still insufficient to achieve universal access [9]. Thus, use by each child in the household during the night preceding periodic assessment of the ownership, utilization and associated the survey. The observational check list contains variables such factors among high risk population is highly recommended [9]. as number of LLINS, number of beds available in the household, Children under the age of five years and pregnant women have number of net already hanged for use and the condition of the been identified as the most vulnerable risk group for malaria. Thus, net. Data were collected by eight trained nurses through house this study aimed at identifying potential factors associated with to house visit LLINs use in under-five children and ownership of LLINs in the households that live in malaria-prone districts. In households where there were married couples, the Method husband or the wife (wife preferred if both available at the same time) responded to the questionnaire. In case when there Study setting and participation were no married couples, the head of the household or another adult above 18 years responded to the questionnaire. If the A community based cross-sectional study was conducted appropriate respondent was not available in the house during among 748 households in Adami Tullu District of East Shewa the initial visit, revisits were done the next day to contact the Zone, which is located at 160kms from Addis Ababa. The appropriate person. study period was from February 1-25, 2014. The district lies at an altitude between 1,500 and 1,750 m above sea level. Data processing and analysis Malaria transmission in the District is seasonal and epidemic This was the part of thesis which was a mixed type [22] type, peaking from September to December. Two species of and its qualitative part was published previously [23]. Data Plasmodium are present in the area; Plasmodium falciparum was entered in to Epi info version 3.5.3 (Center for Disease (about 70%) and P. vivax (about 30%) [11]. All randomly Control and Prevention of the United States of America (CDC), selected households and under five-children living in the 2011, Atlanta-Georgia) and exported to SPSS version 21.0 households were included in the study. for analysis. Descriptive analysis was done to determine the Sample size and sampling methods prevalence of LLIN ownership, IRS coverage and under five children net use. The knowledge section included one question The required sample size was calculated using Epi Info each assessing the cause, symptoms, prevention of malaria version 3.5.3 assuming that 55% of children had slept under and knowledge that net kills malaria mosquito and net protects LLIN among net owning households during the previous night against malaria. The questions were like, “does sleeping under and 44.3% of households own one LLIN in Oromia Region [10]. net every night prevents malaria, mosquito bite causes malaria? Assuming 5% margin of error at 95% confidence level, 5% non- “Is fever a symptom of malaria?” “Knew net kill malaria response rate ,1.5 children per household [11] and design effect mosquitoes”, “Knew net prevents malaria” four of them with a of 1.25 [12], the final sample size was estimated to be 748. Yes or No value and one with True, False and Not sure option. Study households were identified by cluster random Misconception of the respondents was calculated for both sampling technique. Out of 62 rural kebeles, four of them were knowledge of cause and prevention of malaria. For example, selected randomly (Anano Shisho, Boccessa, Elka Chelemo for cause of malaria there were 7 different options including and Gallo Heraphe and). The 30 Gares (used as clusters in the correct answer. They are Mosquito bite, eating immature our study) were selected from kebeles based on geographical sugarcane, eating maize stalk, hunger (empty stomach), exposure proximity. The number of households in each cluster varies to cold or changing weather, witchcraft and exposure to dirty from 15 to 72. Since our sample size is 748 we used all Gares swampy areas. Those six variables were first recorded in SPSS (village that consists of 30 house holds on average) by selecting to give large number for those who didn’t have misconception 25 households from each Gare using table of random numbers and added up in EXCEL program.
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