Abstract:
Background
ITNs are known to be highly effective in reducing malaria morbidity and mortality.
However, usage varies among households, and such variations in actual usage may
seriously limit the potential impact of nets and cause spatial heterogeneity on malaria
transmission. Our study examined underlying risk factors in ITNs non- use among
children under five years in Rwanda.
Methods
We conducted a secondary analysis of ITNs utilization among survey respondents using
Rwanda Demographic Health Survey (DHS), a cross sectional study conducted in 2010.
Data was analyzed using STATA 11 Software. The output of analysis was sleeping under
an ITN the night before the survey for children under five years. Multilevel logistic
regression analysis was used to examine underlying risk factors in ITN non-use.
Results:
A total of 6,173 women aged 15-49 years nested within 492 villages were considered.
The ITN non-use among children under five years was 25% with 69% and 71% for boys
and girls respectively. Community wealth index (OR=0.73, 95% CI:0.63-0.85),
community education (OR=0.71, 95% CI:0.59-0.84), altitude (OR=1.36, 95% CI:1.14-
1.61) household with >5 members (OR= 1.42,95% CI:1.23-1.63), household with >3 nets
(OR= 0.39,95% CI:0.33-0.47) , mother attendance to 1 to 4 ANC (OR= 0.45,95%
CI:0.29-0.69) and >4 ANC visits (OR= 0.39,95% CI:0.21-0.70), mother occupation (OR=
1.05,95% CI:0.85-1.29), mother education (OR= 0.65,95% CI:0.56-0.76), mother marital
status (OR= 0.42,95% CI:0.35-0.50) were risk factors associated with non-use of ITNs.
Conclusion:
In Rwanda there is a need to maintain universal ITN coverage and ensure that all ITNs
are used effectively. There is need to target household, mother and community risk
factors by promoting the alleviation poverty, the mother education sessions, the
education of girls, the promotion of birth spacing, the sensitization of mothers to do ANC
visits to ensure that impact of ITNs on the Malaria burden in Rwanda is not diminished
by lack of use.
