Linking insecticide-treated mosquito nets to malaria: The roles of malaria Knowledge and household-income

Background: Drawing on the theory of the health belief model, this study examined the interplay between insecticide-treated mosquito nets, malaria-knowledge, household income, and malaria. The study was premised on the notion that insecticide-treated mosquito nets are positively related to malaria prevalence; and that knowledge mediates the relationship between insecticide-treated mosquito nets and malaria. Furthermore, household-income was hypothesised to have a moderating effect on the direct and indirect relationships (through malaria knowledge) between insecticide-treated mosquito nets and the prevalence of malaria. Methods: The hypothesised relationships were examined using panel data collected from ten regions of Ethiopia during 2011 – 2015. Structural equation modelling and the random effect model were used to test the hypotheses. Statistical analyses were performed using Stata version 13.0. Results: The results were consistent with our proposed hypotheses, showing a significant relationship between the research variables. Accordingly, our findings suggest that malaria knowledge contributes to improving the relationship between insecticide-treated mosquito nets and malaria prevalence. The results revealed a positively significant indirect effect (β = 0.47, p = 0.003) as well as a positively significant direct effect (β = 0.28, p = 0.001). Further, the study showed a positive impact of household-income in strengthening the relationship between insecticide-treated mosquito nets and malaria through knowledge, with a considerable value (β = 0.13, p = 0.000). Conclusion: The findings are potentially useful for the health sector to ensure success in infectious disease prevention and control, particularly malaria, and to explain how various factors contribute to the relationship.