Access to and use gaps of insecticide-treated nets among communities in Jimma Zone, southwestern Ethiopia: baseline results from malaria education interventions

Zewdie Birhanu, Lakew Abebe, Morankar Sudhakar, Gunawardena Dissanayake, Yemane Yihdego, Guda Alemayehu, Delenasaw Yewhalaw

Malaria remains one of the major public health concerns in Ethiopia. Use of long- lasting insecticidal nets (LLINs) is the country's key malaria prevention and control strategy. This study intended to determine access to and usage gap of LLINs in malaria endemic settings in Southwestern Ethiopia. Data were collected from 798 households in three districts (Mana, Kersa and Goma) of Jimma Zone, Southwestern Ethiopia, from December 2013 to January 2014. The data were analyzed using SPSS software package version 17.0. LLINs ownership, access and utilization gap were determined following the procedure developed by Survey and Indicator Task Force of the Roll Back Malaria Monitoring and Evaluation Reference Group. To complement the quantitative data, focus group discussions and interviews were conducted with community groups and key informants. In this study, 70.9 % (95 % CI: 67.8-74.1 %) of the surveyed households had at least one LLIN, and 63.0 % (95 % CI: 59.6-66.3 %) had sufficient LLINs for every member of the household. With respect to access, 51.9 % (95 % CI: 50.5-53.5 %) of the population had access to LLIN. Only, 38.4 % (95 % CI: 36.9-39.9 %) had slept under LLIN the previous night with females and children having priority to sleep under LLIN. This gave an overall use to access ratio of 70.2 % which resulted in behavior-driven failure of 29.8 %. Of the households with sufficient LLIN access, females (AOR = 1.52; 95 % CI:1.25-1.83; P = 0.001) and children aged 0-4 years (AOR = 2.28; 95 % CI:1.47-3.53;P = 0.001) were more likely to use LLINs than other household members. Shape of nets, sleeping arrangements, low risk perception, saving nets for future use, awareness and negligence, and perception of low efficacy of the LLINs contributed to behavioral failures. LLIN use was hampered by lack of ownership and most importantly by behavioral driven gaps. This calls for designing and implementing appropriate behavioral change communication strategies to address behavioral failure. Improving access to LLINs also needs attention. Further, it requires moving beyond the traditional messaging approach for evidence based intervention to address specific needs and gaps.