Ongoing long-lasting insecticide-treated net distribution efforts are insufficient to maintain high rates of use among children in rural Uganda

ABSTRACT Background Long-lasting insecticide-treated nets (LLINs) remain a cornerstone of malaria control, but optimal distribution strategies to sustain universal coverage are not well-defined Methods We conducted a cross-sectional survey of 2,190 households in the highlands of western Uganda to examine LLIN source and use among children age with elevation and distance to clinic being the primary variables of interest. Results We found that only 64.7% (95% CI 64.0 – 65.5%) of children were reported to have slept under a LLIN the previous night. Compared to those living <1 km from a health center, households at ≥ 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% CI: 0.83 – 0.89, p <.001). Households located farther from a health center received a higher proportion of nets from government distributions compared to households living closer to health centers. Conclusions Continuous, clinic-based distribution efforts were insufficient to sustain high rates of LLIN use among children between mass distribution campaigns. More frequent campaigns and complementary approaches are required to achieve and maintain universal LLIN coverage in rural areas.