Sleeping Space Characteristics and Intra-household Sleeping Arrangements in Eastern Madagascar Open Access

Keusch, Nicole Grace (2015)

Permanent URL:


Background/Objective: Relatively little is known about sleeping arrangements and intra-household mosquito net use in Madagascar--information that is needed to guide information, education and communication campaigns associated with malaria control activities. The objective of this thesis is to describe intra-household sleeping arrangement patterns in order to support an assessment on factors associated with mosquito net use.

Methodology: A community-based, cross sectional household survey using a three-stage cluster sample design was conducted on the East Coast of Madagascar April-May 2010 to evaluate long-lasting insecticidal net (LLIN) ownership and use after a large bednet campaign. A probability sample of households was selected and a standard questionnaire, which included an inventory or roster of each household member, bednet and sleeping space. Demographic information and information linking each household member to the sleeping space used the night before the survey was recorded. Intra-household, sleeping arrangements were analyzed and described and stratified by type of sleeping space and LLIN coverage or non-coverage. Multivariable models were constructed to explore factors associated with selected sleeping arrangement patterns.

Results: On average there were 1.7 sleeping spaces per household and the average number of persons per sleeping space decreased as the number of sleeping spaces per household increased. Among all sleeping spaces, the most commonly occurring sleeping arrangement is one or more children aged 5 to 14 years with no other person-type categories present. As the number of sleeping spaces per household increased, the proportion sleeping spaces with single person-type sleeping arrangements increased, whereas the proportion of sleeping spaces occupied by three or more person-type sleeping arrangements decreased. The sleeping arrangement patterns for temporary sleeping spaces and sleeping spaces not covered by LLINs differed from the sleeping arrangement patterns for all household-sleeping spaces.

Discussion: An important pattern observed was the relationship between at least one man aged 15 to 49 years, at least one woman aged 15 to 49 years and at least one child under the age of 5 years sharing a sleeping space. This relationship hinged on the woman aged 15 to 49 years, who was significantly associated with sharing a sleeping space with each of the other two person-types, whereas men aged 15 to 49 and children under the age of 5 years were much more likely to share a sleeping space when a woman aged 15 to 49 years was present. This suggests women aged 15 to 49 in general may be an important priority target population when addressing intra-household LLIN coverage and use.

Table of Contents

Introduction and Rationale. 7

Definition of Terms. 13

Literature Review. 15

Intra-household use of mosquito nets. 16

Acceptability of mosquito nets in relation to sleeping arrangements. 18

Sleeping arrangements and use: qualitative data. 19

Sleeping arrangements and use. 21

Methodology. 24

Study Design. 24

Population and Sample size. 24

Sampling Procedures. 26

Sample size. 28

Study Questionnaire and Procedures. 29

Enumeration. 29

Data Collection and Entry. 30

Data Analysis. 30

Ethical Considerations. 33

Results. 34

Population Description and Characteristics. 34

Sleeping Arrangements by Sleeping Spaces in all Households. 37

Most commonly occurring sleeping arrangements among sleeping spaces covered by LLINs. 40

Most commonly occurring sleeping arrangements among temporary sleeping spaces. 41

Associations Between Person Type Categories Sharing Sleeping Spaces and LLIN Coverage. 47

Models for Sleeping Arrangements. 51

Discussion and Conclusions. 55

Discussion. 55

Limitations. 58

Next Steps. 60

References. 62

Supplemental Tables. 65

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files