Contextual and individual factors associated with the non-use of Insecticide Treated Nets to prevent malaria among children under five years in Rwanda: Secondary analysis using Rwanda Demographic Health Survey 2010

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.