Regression Analysis of Determinants of Bed Net Use in Southeast Nigeria following Mass Distribution of LLINs: Implications for Social Behavior Change Interventions 公开

Moore, Cheryl Lynn (2013)

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Background: 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 LLIN 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 aims to investigate the factors associated with net use, independent of net ownership.

Methods and Findings: A secondary data analysis was performed using data collected from a household survey conducted in southeastern Nigeria in November 2011 following a statewide mass LLIN distribution campaign and, in select locations, a community-based behavior change communications (BCC) intervention. Multivariable logistic regression analyses, controlling for household bed net ownership, were employed to examine the association between individual net use and various demographic, environmental, behavioral and social factors. Our findings indicate that the odds of net use increase among individuals who were exposed to tailored behavior change communications (BCC) in the context of a home visit (OR=17.11; 95% CI 4.45-65.79) or who receive a greater degree of social support from friends and family (ptrend < 0.001). Factors that decrease the odds of net use include: 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).

Conclusion: This study suggests that LLIN use is significantly influenced by social support and exposure to a malaria-related BCC home visit. The malaria community should thus further consider the importance of interpersonal communication and social influences on adoption of net use behaviors when designing future research and interventions.

Table of Contents


CHAPTER 1: Introduction 8

Background of the Problem 8 Statement of the Problem 10 Purpose of the Study 11 Significance Statement 12 Definition of Terms 13 CHAPTER 2: Review of the Literature 14 Intrapersonal Level 17 Interpersonal Level 22 Net level 24 Physical Environment Level 25 Community Level 26 Environment Level 27 Concluding summary 28 Relevance to the proposed study 29

CHAPTER 3: Manuscript (for submission to PLoS ONE) 30

Abstract 30 Introduction 31 Methods 33 Results 38 Discussion 40 Conclusion 42 References 44 Figures and Tables 48

CHAPTER 4: Extended Methods 53

CHAPTER 5: Extended Results 56

Extended Tables 61

CHAPTER 6: Extended Discussion/Conclusion 67

Discussion 67 Conclusion 68 REFERENCES 70 APPENDIX A Survey Instrument 75

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