Factors associated with insecticide-treated mosquito nets utilization for malaria prevention in Burkina Faso: finding from cross-sectional household survey

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Aristide Hien, M.A. Serge Somda, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4668651/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Nov, 2025 Read the published version in Malaria Journal → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction : The World Health Organization recommends insecticide-treated mosquito nets (ITNs) as one of the main interventions to control malaria spread. The leading driver of this intervention is use of ITN; however, socio-demographic characteristics factors, access and possession of ITN could also influence its usage. Therefore, the present study aimed to document the factors associated with using ITNs to eliminate malaria in Burkina Faso. This study's findings would be useful to the National Malaria Control Programme and other stakeholders engaged in the promotion of ITNs to fight malaria cases. Methods : Data were collected from a quasi-experimental cross-sectional study in Burkina Faso. An analytical approach including a descriptive and an explanatory component was used. For the descriptive aspect of the analysis, possession, access, and use of ITNs were described. The factors associated with ITN use were assessed using univariate and multivariate binary logistic regression analyses, with the level of significance at 5%. The data were analyzed using Stata 16.1 software. Results : The results of the saturated model showed that the type of textile of the IBD (polyester: odds ratio (OR) = 1.23; 95% confidence interval (CI) [1.13, 1.33]) and age of the IBD (6–11 months, OR = 0.91, 95% CI [0.83, 0.997]; ≥ 12 months OR = 0.52, 95% CI [0.401, 0.675]) are influential factors for the use of ITNs. On the other hand, the level of ITN possession (excessive ITNs; OR = 0.66; 95% CI [0.597, 0.74]) and the household poverty quintile showed a positive correlation with the use of ITNs (mean OR = 0.791, 95% CI [0.694, 0.902]; rich OR = 0.656, 95% CI [0.573, 0.751], and very rich OR, = 0.557, 95% CI [0.484,0.641]). Conclusion : There is a strong association between ITN use, type of textile, age of ITNs and number of ITNs in possession. Strengthening health education on the benefits and importance of ITN use will improve the appropriate use of ITNs among the population of Burkina Faso. Introduction Malaria is a major cause of mortality and morbidity in developing countries. According to the World Health Organization (WHO), 249 million cases of malaria recorded worldwide in 2022, 233 million (around 94%) were in the WHO African Region, with Nigeria (27%), the Democratic Republic of the Congo (12%), Uganda (5%), and Mozambique (4%), accounting for nearly 50% of all cases. Around70% of the global malaria burden is concentrated in 11 countries: Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda, and, Tanzania. [ 1 , 2 ]. One of the main interventions against malaria is the use of insecticide-treated mosquito nets (ITNs), which are recommended by WHO as protection against mosquito bites. Sleeping under an ITN decreases the incidence of malaria by reducing contact with mosquitoes through physical barrier as well as insecticidal effect [ 3 – 5 ]. Malaria is a major public health issue endemic throughout Burkina Faso [ 6 , 7 ]. It is a seasonal disease, with peak season occurring from June to October. In order to combat this scourge, the country has opted for prevention by committing to a policy of free distribution of ITNs. The number of households with at least one ITN for every two people increased from 19% in 2010 to 33% in 2017–18 and to 41% in 2021 [ 6 – 9 ]. Although continuing to increase, this indicator is yet significantly below the target of the National Malaria Control Program (PNLP), which aims for 100% of the population, especially for children under 5 years of age and pregnant women, to have access to and sleep under an ITN [ 10 ]. Moreover, improving accessibility to this preventive tool has not yet led to its regular usage in households. The percentage of the population who uses an ITN, if they have access to it, has increased markedly from 2% in 2003 to 32% in 2010 and 61% in 2021 [ 8 , 9 , 11 ]. Previous studies have shown that the main driver of ITN use is access to the tool [ 11 – 14 ]; however, individual, family, and community factors also influence the use of ITNs. At the individual level, factors that influence the use of nets include age, gender, education, degree of control over household decisions, ITN fabric preferences, knowledge and beliefs about malaria, and risk perception of the disease [ 15 – 23 ]. The determinants of ITN usage at the household level include household size and composition, as well as the number and arrangement of sleeping rooms [ 14 , 18 ]. At the community level, place of residence, environmental conditions, and malaria seasonality influence ITN use [ 20 , 22 , 23 ]. Socioeconomic factors, such as the high economic status of the household, access to healthcare, and education, are major predictors of ITN ownership and usage; however, the relative purchasing power decreases when nets are distributed free or are heavily subsidized [ 16 , 22 , 23 ]. Several studies have also shown that children under five and women, but not adolescents, are prioritized for ITNs, especially when they are limited in availability and for sharing spaces of bedtime [ 14 ]. Based on these results and the low or non-usage of ITNs in communities, it is necessary to document the factors associated with the usage of ITNs in Burkina Faso. This evidence would shed light on the factors limiting the usage of ITNs. Together, these aspects will facilitate adaption to the orders, distribution, and awareness strategies to combat malaria. Thus, the present study aimed to document the factors associated with the usage of ITNs in Burkina Faso so as to contribute to the fight against malaria in the community. Materials and methods Study setting More than 40% of the population in Burkina Faso lives below the poverty line. The 2021–2022 Human Development Index (HDI) report from the United Nations Development Program (UNDP) ranks Burkina Faso 184th out of 191 countries [ 24 ]. The national economy is based primarily on agriculture and mining production. Although agriculture is the main occupation of approximately 82% of the population, today, it is hampered due to security reasons, which limits access to rural areas [ 25 ]. Despite some recent improvement, the health situation in Burkina Faso is still characterized by high general and specific mortality rates. Mothers and children constitute the most vulnerable groups. Interestingly, life expectancy at birth is improving in Burkina Faso. Overall, it increased from 42.2 years in 1975 to 61.9 years in 2019, i.e., an increase of 19.7 years [ 8 , 11 , 26 – 28 ]. The country's epidemiological profile is marked by the persistence of a high burden of morbidity due to endemic diseases and the continually rising burden of non-communicable diseases. Currently, malaria is the leading cause of consultation and mortality in health facilities. Study population For this study, the target population represented all ITNs, households, and individuals residing in the study areas in Burkina Faso. Sampling and sample size The health districts were organized according to the eco-climatic zones and the residence environment. Six health districts were identified in each eco-climatic zone (sahelian zone, dry savanna zone, and wet savanna zone). Then, two health districts were selected in urban areas and four in rural areas in each eco-climatic zone. Subsequently, 14 enumeration zones (EZ) were chosen in the health districts according to the number of households based on the 2019 General Population and Housing Census (RGPH-2019) established by the National Institute of Statistics and Demography (INSD). Fifteen (15) households were selected in each EZ with equal probability according to a systematic drawing after a prior census of all households in the specific EZ. All ITNs were observed in each household. Therefore, the sample consisted of 18 Health district (HD), 252 EZs, and 3,780 households. In each selected household, the head or the representative and two members (men and women) selected randomly were surveyed using the household and the individual questionnaire, respectively. Data sources Data used in this study were collected from a quasi-experimental cross-sectional survey with a similar aim to assess the acceptability and use of different types of ITN textiles by communities in Burkina Faso. Therefore, our study consisted of two arms with similar characteristics. To improve the similarities between the arms, the eco-climatic zones were stratified into Sahelian zone, dry savanna zone, and wet savanna zone and the place of residence (urban vs. rural). Data analysis The analytical approach used in this study included a descriptive and an explanatory component. In the descriptive part of the analysis, we aimed to describe the possession, access, and use of ITNs. Additionally, the relationships between the independent and dependent variables (Textile type of ITNs, possession of ITNs, age of ITNs, ITNs’ color, household well-being quintile, place of residence, eco-climate zone) were assessed, and the confidence intervals (CIs) of ownership, access, and use levels were estimated. The level of significance retained for the analysis was 5%. Univariate and multivariate binary logistic regression analyses were applied to evaluate the factors associated with ITN usage. Odds ratios (OR) and adjusted OR (AOR) were estimated to assess the association strength, and 95% CIs were used to evaluate the significance. Data were analyzed using Stata 16.1 software. Results Study population characteristics A total of 3,780 households were surveyed and divided according to the eco-climatic zone in equal proportions of 33.3%. The distribution according to the area of residence indicated that 2520 (66.7%) households were located in rural areas. The average household size in our sample was 5.2 individuals and varied from 4.8 in the wet savanna zone to 5.7 in the Sahelian zone. The households were predominantly headed by men (79.3%). The average age of the respondents was 32.5 years. Regarding ITNs, 12,946 mosquito nets were observed during data collection. All polyester (50.8%) and polyethylene (49.2%) mosquito nets observed from the brand were impregnated with insecticide. Polyester-type ITNs were common in rural areas (54.4%) depending on the eco-climatic zone in the Sahelian zone (60.6%). On the other hand, the polyethylene type ITNs were commonly observed in the dry (53.1%) and wet savanna (55.9%) areas. The polyester- and polyethylene-type mosquito nets were mainly white (78%). Possession, access, and use of ITNs The universal household ITN coverage is the percentage of households with at least one ITN for every two people. Data analysis showed that this proportion was 73.4% in the study area and varied from 69.3% in the Sahelian zone to 76.9% in the wet savanna zone. Moreover, the universal coverage was higher in rural areas (75.2%) compared to urban areas (69.8%). Access to an ITN was measured by the percentage of the population who could have slept under an ITN if each was used by a maximum of two people in the household. The comparison of the indicators of access and usage of ITNs highlights a behavioral gap, showing that available ITNs are not being used. Table 1 shows that 77.3% of the de facto population of the households surveyed have access to an ITN. The access to an ITN in the household is lower in the urban areas (75.8%) compared to the rural areas (80.7%). Intriguingly, the wet savanna zone had the highest access rate (81.6%). The usage of the ITN by household members the night before the interview is estimated at 69.4% overall. Insignificant differences have been detected between the areas of residence (70.7% in urban areas compared to 69.0% in rural areas). Furthermore, 89.8% of the population with access to an ITN within their household used an ITN the day before the survey. This ratio was lower in urban areas (87.6%) compared to rural areas (91.0%). The Sahelian zone had the highest ratio (92.4%). Table 1 Distribution of households according to universal coverage, their overall access, and use of ITNs by area of residence and eco-climatic zone Characteristics Place of residence Eco-climatic zone Together Urban Rural Sahelian zone Dry Savanna zone Wet Savanna zone Possession No ITN 7.6 4.2 6.0 6.5 3.6 5.3 % of households with at least one ITN, but insufficient for all household members 22.5 20.6 24.8 19.4 19.5 21.2 % of households with at least one ITN for two people 69.8 75.2 69.3 74.1 76.9 73.4 Access % population who could have slept under an ITN if each net in the household was used by a maximum of two people 80.7 75.8 75.0 75.6 81.6 77.3 Usage % of the population who slept under an ITN the previous night 70.7 69 69.3 59.4 69.9 69.4 Access/Use ratio of ITNs 87.6 91.0 92.4 78.5 85.7 89.8 Factors associated with ITN use The results of the bivariate and multivariate logistic regression, presented in Table 2 , describe the influence of specific characteristics of the ITN, household, and living environment on the usage of ITN. The results of the saturated model show that the type of textile of the MII (polyester OR = 1.227; 95% CI [1.136, 1.325]), the place of residence (rural OR = 1.130, 95% CI [1.021, 1.250]), and young age of ITN (6–11 months, OR = 1,748, 95% CI [1,359, 2,248]; < 6 months, OR = 1,922 CI [1,482, 2,492]) are factors favorable for the usage of ITNs. On the other hand, the level of ITN possession (too many ITNs; OR = 0.664 CI [0.597, 0.74]) and the eco-climatic zone (Dry Savanna zone, OR = 0.431, 95% CI [0.392, 0.474]; Wet savanna zone, OR = 0.621, 95% CI: [0.562, 0.686]) are unfavorable factors for the use of ITNs. Furthermore, household poverty quintile showed a negative correlation with ITN usage (Average, OR = 0.791, 95% CI [0.694, 0.902]; rich, OR = 0.656, 95% CI: [0.573, 0.751], and very rich, OR = 0.557, 95% CI [0.484, 0.641]). Table 2 Explanatory analysis of ITNs’ usage Characteristics n OR (95% CI) AOR (95% CI) Textile type of ITNs Polyethylene 6888 1.00 1.00 Polyester 6058 1,280*** [1,189, 1,378] 1.227*** [1.136, 1.325] Possession of ITNs Not enough ITNs 2955 1.00 1.00 Just right​ 6575 0.960 [.874, 1.055] 0.932 [0.846, 1.027] Too many ITNs 3416 0.688*** [0.62, 0.764] 0.664*** [0.597, 0.74] Age of ITNs ≥ 12 months 266 1.00 1.00 6–11 months 9396 2,233*** [1,748, 2,851] 1,748*** [1,359, 2,248] < 6 months 3284 2,362*** [1,836, 3,037] 1,922*** [1,482, 2,492] ITNs’ color White 12184 1.00 1.00 Blue 385 1,907*** (1,217-2,987) 1.471 (0.91–2.377) Other 376 1.586** (0.981–2.563) 1.027 (0.625–1.69) Household well-being quintile Very poor 2453 1.00 1.00 Poor 2292 1.058 [0.931, 1.202] 0.923 [0.808, 1.053] Average 2808 0.861** [0.765, 0.970] 0.791*** [0.694, 0.902] Rich 2846 0.657*** [0.585 ,0.738] 0.656*** [0.573, 0.751] Very rich 2544 0.576*** [0.511, 0.648] 0.557*** [0.484, 0.641] Place of residence Urban 3853 1.00 1.00 Rural 9093 0.877*** [0.809, 0.951] 1.130** [1.021, 1.250] Eco-climate zone Sahelian zone 4435 1.00 1.00 Dry Savanna zone 4397 0.393*** [0.359, 0.431] 0.431*** [0.392, 0.474] Wet Savanna zone 4114 0.601*** [0.546, 0.661] 0.621*** [0.562, 0.686] *** p < .01, ** p < .05, * p < .1 Discussion The present study was conducted to identify factors associated with the usage of ITNs for malaria prevention in Burkina Faso. Using ITNs reduces malaria transmission through increased mosquito mortality rates and reduced bites [ 29 ]. Although we used the most recent and representative data at the national level, the possession and use of ITNs in households remain well below the goal of the PNLP, i.e., at least 90% of the population, 100% of children < 5-years-old, and 100% of pregnant women in Burkina Faso sleep under an ITN [ 10 ]. These results are supported by the findings of other studies across various African countries [ 30 – 33 ]. Webster et al. found that the median rate of household ITN ownership in 26/42 sub-Saharan African countries was 12.9%, ranging from 0.5% in Guinea to 50.0% in Mali [ 30 ]. In a study conducted in Niger, Thwing et al. showed that during the rainy season, the usage of ITNs by children < 5-years-old and pregnant women did not increase; these findings complied with the Roll back malaria (RBM) objectives (80%). Our results showed that factors such as the type of textile (polyester), the age of the ITN (< 6 months and 6–11 months), the level of ITN possession (too many ITNs in the household), the quintile well-being of the household (average, rich, and very rich), the environment of residence (rural), and the eco-climatic zone (dry and wet Savanna) were significantly associated with the use of ITNs in Burkina Faso. These factors are often neglected by malaria programs in the ITN ordering and distribution strategies. Regarding the textile type, polyester nets were common across households in Burkina Faso, as also observed by Koenker et al. [ 21 ]. This result was consistent with that of Magloire et al. in Cameroon [ 33 ] and Sara et al. in Vietnam [ 35 ]. Additionally, Kim et al. used a human-centered design to determine consumer preferences for ITNs in Ghana and found that polyethylene ITNs were perceived as rough and warm, while polyester ITNs were perceived as softer and less warm [ 36 ]. Indubitably, some funders of malaria programs do not focus on user preferences regarding textiles or other characteristics, such as color and shape; they argue that this does not impede the rate of LLIN usage across countries [ 21 ]. Therefore, the present study provides convincing data in favor of strong consideration of the type of polyester textile while purchasing ITNs intended for mass distribution campaigns. Furthermore, the present study shows the influence of possessing a sufficient quantity of ITNs on its usage. Living in a household with a sufficient number to cover all members was a determinant factor in the usage of ITNs. The WHO recommends universal coverage to achieve “availability of sufficient ITNs,” i.e., for each household, there should be at least one ITN for every two inhabitants [ 37 ]. This result was supported by a cross-national analysis of data from 15 African countries, which showed that having sufficient intra-household access to an ITN was a strong determinant of individual ITN use [ 19 ]. Although several studies have focused on improving the inequality of access to ITNs between rich and poor through mass campaigns, we identified the households’ standard of living as one of the major factors that influence the usage of ITNs. The level of ITN usage by households decreases with wealth; this finding is corroborated by many household surveys showing higher ITN usage among poorer households [ 38 – 41 ]. Nevertheless, wealthier households might use ITNs more often because they have better access to health information and can afford to purchase additional nets if necessary. Difficulties and limitations The difficulties encountered during this survey included high security and humanitarian issues, making access difficult in certain areas. This led to the replacement of an entire health district (Bitou health district was replaced by that of Garango, which had received the same type of textile and was located in the same eco-climatic zone), and 63 ZDs distributed across nine health districts were replaced by those from the same health district. Nevertheless, the present study has some limitations. First, it is a cross-sectional study, i.e., the dependent and explanatory variables were measured simultaneously; therefore, any causality of the associations cannot be guaranteed. Second, the memory and self-reporting of the information in this survey could lend bias to the data. Thus, descriptive and multivariate analysis methods were combined to reduce these limitations and the putative biases of this study. Conclusion The present study aimed to identify the factors associated with ITN usage to project the country’s future net orders. These findings contribute toward effective elimination of malaria according to the needs-based service approach in Burkina Faso. Therefore, considering the characteristics of ITNs and households, individual preferences, and contextual factors for promoting and distributing mosquito nets are crucial for preventing malaria in Burkina Faso. Abbreviations AOR Adjusted odds ratios CI Confidence intervals GPHC General population and housing census HD Health district HDI Human Development Index INSD National Institute of Statistics and Demography INSP National Institute of Public Health ITN Insecticide-treated mosquito nets OR Odds ratios PADS Health development support program PNLP National malaria control program RBM Roll back malaria WHO World Health Organization ZD Enumeration zones Declarations Ethical aspects This study was conducted in compliance with the ethical principles of health research and good clinical practices. The study protocol was approved by the institutional ethics committee of the National Institute of Public Health (INSP) (approval no. 2023-001/MSHP/SG/INSP/CEI) on January 31, 2023, before sample collection. Consent for publication Not applicable. Availability of data and materials All data generated or analysed during this study are included in this published article Competing interests The authors declare that they have no competing interests. Funding This study received support from the Global Fund through the Health Development Support Program in Burkina Faso. The authors alone are responsible for the findings and conclusions presented in this manuscript and they do not necessarily reflect the official views of the Global Funds or the Health Development Support Program. The funders are not involved in the design of the study, collection and interpretation of data and in writing of this manuscript. Authors' contributions BH, HH, HSA, SS, and MN conceived the study idea, designed the study, secured the funding and reviewed the manuscript. BH wrote the initial draft of the manuscript with feedback from HH, HAS, SS and MN reviewed the manuscript. All authors read and approved the final manuscript Acknowledgements We would like to express our gratitude to the Health Development Support Program (PADS) from Burkina Faso for funding this study through the Global Fund. We would like to thank them for providing all necessary ITNs for this study. We gratefully acknowledge all the fieldworkers, supervisors, and data managers for their work in the field. Finally, we extend our gratitude to all participants in the study sites. References WHO. World malaria report 2023 [Internet]. World Health Organization. 2023 [cité 1 juill 2024]. 283 p. Disponible sur: https://www.who.int/publications/i/item/9789240086173 . Venkatesan P. The 2023 WHO World malaria report. 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Using a Human-Centered Design Approach to Determine Consumer Preferences for Long-Lasting Insecticidal Nets in Ghana. Glob Health Sci Pract 24 juin. 2019;7(2):160–70. WHO. Toolkit for Integrated Vector Management in Sub-Saharan Africa (A) [Internet]. World Health Organization. 2016 [cité 7 juin 2024]. Disponible sur: https://books.google.com/books?hl=fr& lr=&id=oXeyDwAAQBAJ&oi=fnd&pg=PR7&dq=WHO.+Toolkit+for+Integrated+Vector+Management+in+Sub-Saharan+Africa+(A).+Geneva:+World+Health+Organization%3B+2016.&ots=e_0cjmTEU4&sig=MPa0oJBiUnMP58kfW_RA2ndo1Fo Singh M, Brown G, Rogerson SJ. Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review. Malar J 1 août. 2013;12(1):268. Kilian A, Balayo C, Feldman M, Koenker H, Lokko K, Ashton RA et al. The Effect of Single or Repeated Home Visits on the Hanging and Use of Insecticide-Treated Mosquito Nets following a Mass Distribution Campaign - A Cluster Randomized, Controlled Trial. PLOS ONE. 16 mars. 2015;10(3):e0119078. Auta A. Demographic Factors Associated with Insecticide Treated Net use Among Nigerian Women and Children. North Am J Med Sci janv. 2012;4(1):40–4. Tassembedo M, Coulibaly S, Ouedraogo B. Factors associated with the use of insecticide-treated nets: analysis of the 2018 Burkina Faso Malaria Indicator Survey. Malar J. 17 mai. 2021;20(1):220. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4668651","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":325239012,"identity":"dd9e0833-e3f3-49e3-bebd-6bb8f1213ce2","order_by":0,"name":"Hermann Badolo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACAwYGMwaGAoYENvYGENeCWC0GQC08B0BcCRK0MEgkgPhEaDFnP7ztwQcDmzw+yedXN/wokGDgb+9OwKvFsiet3HCGQVoxm3RO2c0eoMMkzpzdgN9hB3LMpHkMDie2Seek3eABajGQyCWg5fwbqBbJM2k3/xCl5QbMFgn2Y7eJssVyxrMySbBfeHLYbssYSPAQ9Is5f/I2iQ8VNnny7cef3Xzzx0aOv70XvxYkwGMAJolVDgLsD0hRPQpGwSgYBSMIAAC6bkNwsZXLUgAAAABJRU5ErkJggg==","orcid":"","institution":"Institut national de santé publique","correspondingAuthor":true,"prefix":"","firstName":"Hermann","middleName":"","lastName":"Badolo","suffix":""},{"id":325239013,"identity":"074891bf-44b9-49ea-8a08-92a1e4da8fa5","order_by":1,"name":"Hervé Hien","email":"","orcid":"","institution":"IRSS, Centre national de la recherche scientifique et technologique","correspondingAuthor":false,"prefix":"","firstName":"Hervé","middleName":"","lastName":"Hien","suffix":""},{"id":325239014,"identity":"eba09eb5-45f6-43e6-a8c5-400cce8a95e4","order_by":2,"name":"S. Aristide Hien","email":"","orcid":"","institution":"IRSS, Centre national de la recherche scientifique et technologique","correspondingAuthor":false,"prefix":"","firstName":"S.","middleName":"Aristide","lastName":"Hien","suffix":""},{"id":325239015,"identity":"015e0078-8561-4527-870b-6875ae049ec1","order_by":3,"name":"M.A. Serge Somda","email":"","orcid":"","institution":"Université Nazi Boni","correspondingAuthor":false,"prefix":"","firstName":"M.A.","middleName":"Serge","lastName":"Somda","suffix":""},{"id":325239016,"identity":"37e6c7b6-8ffe-491a-b632-c8794c400c7e","order_by":4,"name":"Herman Bazié","email":"","orcid":"","institution":"Institut national de santé publique","correspondingAuthor":false,"prefix":"","firstName":"Herman","middleName":"","lastName":"Bazié","suffix":""},{"id":325239017,"identity":"94636ff4-52bc-4240-b77e-12926e08b3a9","order_by":5,"name":"Yisso Fidèle Bacyé","email":"","orcid":"","institution":"Université Thomas Sankara","correspondingAuthor":false,"prefix":"","firstName":"Yisso","middleName":"Fidèle","lastName":"Bacyé","suffix":""},{"id":325239018,"identity":"c30f5b1c-e281-4d2e-b188-4b8bfa18756e","order_by":6,"name":"Cheick Omar Diallo","email":"","orcid":"","institution":"Institut national de santé publique","correspondingAuthor":false,"prefix":"","firstName":"Cheick","middleName":"Omar","lastName":"Diallo","suffix":""},{"id":325239019,"identity":"de888f91-1f80-4577-9922-25b08605b22c","order_by":7,"name":"Alfred Tiono","email":"","orcid":"","institution":"Institut national de santé publique","correspondingAuthor":false,"prefix":"","firstName":"Alfred","middleName":"","lastName":"Tiono","suffix":""},{"id":325239020,"identity":"2260fa89-c8c9-4e2d-8bfc-bec6ec5fd252","order_by":8,"name":"Matilibou Guira","email":"","orcid":"","institution":"Programme national de développement sanitaire","correspondingAuthor":false,"prefix":"","firstName":"Matilibou","middleName":"","lastName":"Guira","suffix":""},{"id":325239021,"identity":"8ccb5f13-6e8d-495a-8411-0783556706f8","order_by":9,"name":"Nicolas Meda","email":"","orcid":"","institution":"Université Joseph Ki- Zerbo","correspondingAuthor":false,"prefix":"","firstName":"Nicolas","middleName":"","lastName":"Meda","suffix":""}],"badges":[],"createdAt":"2024-07-01 14:10:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4668651/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4668651/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-025-05621-1","type":"published","date":"2025-11-05T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95564437,"identity":"d248caf4-c841-41c5-a97c-308a8b18abed","added_by":"auto","created_at":"2025-11-10 16:09:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757570,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4668651/v1/d30ffe38-8790-46a9-8081-8b49321becb1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with insecticide-treated mosquito nets utilization for malaria prevention in Burkina Faso: finding from cross-sectional household survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria is a major cause of mortality and morbidity in developing countries. According to the World Health Organization (WHO), 249\u0026nbsp;million cases of malaria recorded worldwide in 2022, 233\u0026nbsp;million (around 94%) were in the WHO African Region, with Nigeria (27%), the Democratic Republic of the Congo (12%), Uganda (5%), and Mozambique (4%), accounting for nearly 50% of all cases. Around70% of the global malaria burden is concentrated in 11 countries: Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda, and, Tanzania. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the main interventions against malaria is the use of insecticide-treated mosquito nets (ITNs), which are recommended by WHO as protection against mosquito bites. Sleeping under an ITN decreases the incidence of malaria by reducing contact with mosquitoes through physical barrier as well as insecticidal effect [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria is a major public health issue endemic throughout Burkina Faso [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is a seasonal disease, with peak season occurring from June to October. In order to combat this scourge, the country has opted for prevention by committing to a policy of free distribution of ITNs. The number of households with at least one ITN for every two people increased from 19% in 2010 to 33% in 2017\u0026ndash;18 and to 41% in 2021 [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although continuing to increase, this indicator is yet significantly below the target of the National Malaria Control Program (PNLP), which aims for 100% of the population, especially for children under 5 years of age and pregnant women, to have access to and sleep under an ITN [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, improving accessibility to this preventive tool has not yet led to its regular usage in households. The percentage of the population who uses an ITN, if they have access to it, has increased markedly from 2% in 2003 to 32% in 2010 and 61% in 2021 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have shown that the main driver of ITN use is access to the tool [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; however, individual, family, and community factors also influence the use of ITNs. At the individual level, factors that influence the use of nets include age, gender, education, degree of control over household decisions, ITN fabric preferences, knowledge and beliefs about malaria, and risk perception of the disease [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The determinants of ITN usage at the household level include household size and composition, as well as the number and arrangement of sleeping rooms [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. At the community level, place of residence, environmental conditions, and malaria seasonality influence ITN use [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Socioeconomic factors, such as the high economic status of the household, access to healthcare, and education, are major predictors of ITN ownership and usage; however, the relative purchasing power decreases when nets are distributed free or are heavily subsidized [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Several studies have also shown that children under five and women, but not adolescents, are prioritized for ITNs, especially when they are limited in availability and for sharing spaces of bedtime [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on these results and the low or non-usage of ITNs in communities, it is necessary to document the factors associated with the usage of ITNs in Burkina Faso. This evidence would shed light on the factors limiting the usage of ITNs. Together, these aspects will facilitate adaption to the orders, distribution, and awareness strategies to combat malaria.\u003c/p\u003e \u003cp\u003eThus, the present study aimed to document the factors associated with the usage of ITNs in Burkina Faso so as to contribute to the fight against malaria in the community.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eMore than 40% of the population in Burkina Faso lives below the poverty line. The 2021\u0026ndash;2022 Human Development Index (HDI) report from the United Nations Development Program (UNDP) ranks Burkina Faso 184th out of 191 countries [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The national economy is based primarily on agriculture and mining production. Although agriculture is the main occupation of approximately 82% of the population, today, it is hampered due to security reasons, which limits access to rural areas [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite some recent improvement, the health situation in Burkina Faso is still characterized by high general and specific mortality rates. Mothers and children constitute the most vulnerable groups. Interestingly, life expectancy at birth is improving in Burkina Faso. Overall, it increased from 42.2 years in 1975 to 61.9 years in 2019, i.e., an increase of 19.7 years [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The country's epidemiological profile is marked by the persistence of a high burden of morbidity due to endemic diseases and the continually rising burden of non-communicable diseases. Currently, malaria is the leading cause of consultation and mortality in health facilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eFor this study, the target population represented all ITNs, households, and individuals residing in the study areas in Burkina Faso.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSampling and sample size\u003c/h2\u003e \u003cp\u003eThe health districts were organized according to the eco-climatic zones and the residence environment. Six health districts were identified in each eco-climatic zone (sahelian zone, dry savanna zone, and wet savanna zone). Then, two health districts were selected in urban areas and four in rural areas in each eco-climatic zone. Subsequently, 14 enumeration zones (EZ) were chosen in the health districts according to the number of households based on the 2019 General Population and Housing Census (RGPH-2019) established by the National Institute of Statistics and Demography (INSD). Fifteen (15) households were selected in each EZ with equal probability according to a systematic drawing after a prior census of all households in the specific EZ. All ITNs were observed in each household. Therefore, the sample consisted of 18 Health district (HD), 252 EZs, and 3,780 households.\u003c/p\u003e \u003cp\u003eIn each selected household, the head or the representative and two members (men and women) selected randomly were surveyed using the household and the individual questionnaire, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData sources\u003c/h2\u003e \u003cp\u003eData used in this study were collected from a quasi-experimental cross-sectional survey with a similar aim to assess the acceptability and use of different types of ITN textiles by communities in Burkina Faso. Therefore, our study consisted of two arms with similar characteristics. To improve the similarities between the arms, the eco-climatic zones were stratified into Sahelian zone, dry savanna zone, and wet savanna zone and the place of residence (urban vs. rural).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe analytical approach used in this study included a descriptive and an explanatory component. In the descriptive part of the analysis, we aimed to describe the possession, access, and use of ITNs. Additionally, the relationships between the independent and dependent variables (Textile type of ITNs, possession of ITNs, age of ITNs, ITNs\u0026rsquo; color, household well-being quintile, place of residence, eco-climate zone) were assessed, and the confidence intervals (CIs) of ownership, access, and use levels were estimated. The level of significance retained for the analysis was 5%.\u003c/p\u003e \u003cp\u003eUnivariate and multivariate binary logistic regression analyses were applied to evaluate the factors associated with ITN usage. Odds ratios (OR) and adjusted OR (AOR) were estimated to assess the association strength, and 95% CIs were used to evaluate the significance. Data were analyzed using Stata 16.1 software.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy population characteristics\u003c/h2\u003e \u003cp\u003eA total of 3,780 households were surveyed and divided according to the eco-climatic zone in equal proportions of 33.3%. The distribution according to the area of residence indicated that 2520 (66.7%) households were located in rural areas. The average household size in our sample was 5.2 individuals and varied from 4.8 in the wet savanna zone to 5.7 in the Sahelian zone. The households were predominantly headed by men (79.3%). The average age of the respondents was 32.5 years.\u003c/p\u003e \u003cp\u003eRegarding ITNs, 12,946 mosquito nets were observed during data collection. All polyester (50.8%) and polyethylene (49.2%) mosquito nets observed from the brand were impregnated with insecticide. Polyester-type ITNs were common in rural areas (54.4%) depending on the eco-climatic zone in the Sahelian zone (60.6%). On the other hand, the polyethylene type ITNs were commonly observed in the dry (53.1%) and wet savanna (55.9%) areas. The polyester- and polyethylene-type mosquito nets were mainly white (78%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePossession, access, and use of ITNs\u003c/h2\u003e \u003cp\u003eThe universal household ITN coverage is the percentage of households with at least one ITN for every two people. Data analysis showed that this proportion was 73.4% in the study area and varied from 69.3% in the Sahelian zone to 76.9% in the wet savanna zone. Moreover, the universal coverage was higher in rural areas (75.2%) compared to urban areas (69.8%).\u003c/p\u003e \u003cp\u003eAccess to an ITN was measured by the percentage of the population who could have slept under an ITN if each was used by a maximum of two people in the household. The comparison of the indicators of access and usage of ITNs highlights a behavioral gap, showing that available ITNs are not being used.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that 77.3% of the de facto population of the households surveyed have access to an ITN. The access to an ITN in the household is lower in the urban areas (75.8%) compared to the rural areas (80.7%). Intriguingly, the wet savanna zone had the highest access rate (81.6%).\u003c/p\u003e \u003cp\u003eThe usage of the ITN by household members the night before the interview is estimated at 69.4% overall. Insignificant differences have been detected between the areas of residence (70.7% in urban areas compared to 69.0% in rural areas).\u003c/p\u003e \u003cp\u003eFurthermore, 89.8% of the population with access to an ITN within their household used an ITN the day before the survey. This ratio was lower in urban areas (87.6%) compared to rural areas (91.0%). The Sahelian zone had the highest ratio (92.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of households according to universal coverage, their overall access, and use of ITNs by area of residence and eco-climatic zone\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eEco-climatic zone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTogether\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSahelian zone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDry Savanna zone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWet Savanna zone\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePossession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo ITN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% of households with at least one ITN, but insufficient for all household members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% of households with at least one ITN for two people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAccess\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% population who could have slept under an ITN if each net in the household was used by a maximum of two people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUsage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% of the population who slept under an ITN the previous night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccess/Use ratio of ITNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with ITN use\u003c/h2\u003e \u003cp\u003eThe results of the bivariate and multivariate logistic regression, presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, describe the influence of specific characteristics of the ITN, household, and living environment on the usage of ITN. The results of the saturated model show that the type of textile of the MII (polyester OR\u0026thinsp;=\u0026thinsp;1.227; 95% CI [1.136, 1.325]), the place of residence (rural OR\u0026thinsp;=\u0026thinsp;1.130, 95% CI [1.021, 1.250]), and young age of ITN (6\u0026ndash;11 months, OR\u0026thinsp;=\u0026thinsp;1,748, 95% CI [1,359, 2,248]; \u0026lt; 6 months, OR\u0026thinsp;=\u0026thinsp;1,922 CI [1,482, 2,492]) are factors favorable for the usage of ITNs.\u003c/p\u003e \u003cp\u003eOn the other hand, the level of ITN possession (too many ITNs; OR\u0026thinsp;=\u0026thinsp;0.664 CI [0.597, 0.74]) and the eco-climatic zone (Dry Savanna zone, OR\u0026thinsp;=\u0026thinsp;0.431, 95% CI [0.392, 0.474]; Wet savanna zone, OR\u0026thinsp;=\u0026thinsp;0.621, 95% CI: [0.562, 0.686]) are unfavorable factors for the use of ITNs.\u003c/p\u003e \u003cp\u003eFurthermore, household poverty quintile showed a negative correlation with ITN usage (Average, OR\u0026thinsp;=\u0026thinsp;0.791, 95% CI [0.694, 0.902]; rich, OR\u0026thinsp;=\u0026thinsp;0.656, 95% CI: [0.573, 0.751], and very rich, OR\u0026thinsp;=\u0026thinsp;0.557, 95% CI [0.484, 0.641]).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eExplanatory analysis of ITNs\u0026rsquo; usage\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTextile type of ITNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyethylene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,280*** [1,189, 1,378]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.227*** [1.136, 1.325]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossession of ITNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot enough ITNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJust right​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.960 [.874, 1.055]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.932 [0.846, 1.027]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToo many ITNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.688*** [0.62, 0.764]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.664*** [0.597, 0.74]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of ITNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,233*** [1,748, 2,851]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1,748*** [1,359, 2,248]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,362*** [1,836, 3,037]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1,922*** [1,482, 2,492]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eITNs\u0026rsquo; color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,907*** (1,217-2,987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.471 (0.91\u0026ndash;2.377)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.586** (0.981\u0026ndash;2.563)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.027 (0.625\u0026ndash;1.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold well-being quintile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.058 [0.931, 1.202]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.923 [0.808, 1.053]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.861** [0.765, 0.970]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.791*** [0.694, 0.902]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.657*** [0.585 ,0.738]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.656*** [0.573, 0.751]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery rich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.576*** [0.511, 0.648]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.557*** [0.484, 0.641]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.877*** [0.809, 0.951]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.130** [1.021, 1.250]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEco-climate zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSahelian zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDry Savanna zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.393*** [0.359, 0.431]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.431*** [0.392, 0.474]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWet Savanna zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.601*** [0.546, 0.661]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.621*** [0.562, 0.686]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study was conducted to identify factors associated with the usage of ITNs for malaria prevention in Burkina Faso. Using ITNs reduces malaria transmission through increased mosquito mortality rates and reduced bites [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough we used the most recent and representative data at the national level, the possession and use of ITNs in households remain well below the goal of the PNLP, i.e., at least 90% of the population, 100% of children\u0026thinsp;\u0026lt;\u0026thinsp;5-years-old, and 100% of pregnant women in Burkina Faso sleep under an ITN [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These results are supported by the findings of other studies across various African countries [\u003cspan additionalcitationids=\"CR31 CR32\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Webster et al. found that the median rate of household ITN ownership in 26/42 sub-Saharan African countries was 12.9%, ranging from 0.5% in Guinea to 50.0% in Mali [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In a study conducted in Niger, Thwing et al. showed that during the rainy season, the usage of ITNs by children\u0026thinsp;\u0026lt;\u0026thinsp;5-years-old and pregnant women did not increase; these findings complied with the Roll back malaria (RBM) objectives (80%).\u003c/p\u003e \u003cp\u003eOur results showed that factors such as the type of textile (polyester), the age of the ITN (\u0026lt;\u0026thinsp;6 months and 6\u0026ndash;11 months), the level of ITN possession (too many ITNs in the household), the quintile well-being of the household (average, rich, and very rich), the environment of residence (rural), and the eco-climatic zone (dry and wet Savanna) were significantly associated with the use of ITNs in Burkina Faso. These factors are often neglected by malaria programs in the ITN ordering and distribution strategies.\u003c/p\u003e \u003cp\u003eRegarding the textile type, polyester nets were common across households in Burkina Faso, as also observed by Koenker et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This result was consistent with that of Magloire et al. in Cameroon [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and Sara et al. in Vietnam [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Additionally, Kim et al. used a human-centered design to determine consumer preferences for ITNs in Ghana and found that polyethylene ITNs were perceived as rough and warm, while polyester ITNs were perceived as softer and less warm [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Indubitably, some funders of malaria programs do not focus on user preferences regarding textiles or other characteristics, such as color and shape; they argue that this does not impede the rate of LLIN usage across countries [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, the present study provides convincing data in favor of strong consideration of the type of polyester textile while purchasing ITNs intended for mass distribution campaigns.\u003c/p\u003e \u003cp\u003eFurthermore, the present study shows the influence of possessing a sufficient quantity of ITNs on its usage. Living in a household with a sufficient number to cover all members was a determinant factor in the usage of ITNs. The WHO recommends universal coverage to achieve \u0026ldquo;availability of sufficient ITNs,\u0026rdquo; i.e., for each household, there should be at least one ITN for every two inhabitants [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This result was supported by a cross-national analysis of data from 15 African countries, which showed that having sufficient intra-household access to an ITN was a strong determinant of individual ITN use [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough several studies have focused on improving the inequality of access to ITNs between rich and poor through mass campaigns, we identified the households\u0026rsquo; standard of living as one of the major factors that influence the usage of ITNs. The level of ITN usage by households decreases with wealth; this finding is corroborated by many household surveys showing higher ITN usage among poorer households [\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Nevertheless, wealthier households might use ITNs more often because they have better access to health information and can afford to purchase additional nets if necessary.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDifficulties and limitations\u003c/h2\u003e \u003cp\u003eThe difficulties encountered during this survey included high security and humanitarian issues, making access difficult in certain areas. This led to the replacement of an entire health district (Bitou health district was replaced by that of Garango, which had received the same type of textile and was located in the same eco-climatic zone), and 63 ZDs distributed across nine health districts were replaced by those from the same health district.\u003c/p\u003e \u003cp\u003eNevertheless, the present study has some limitations. First, it is a cross-sectional study, i.e., the dependent and explanatory variables were measured simultaneously; therefore, any causality of the associations cannot be guaranteed. Second, the memory and self-reporting of the information in this survey could lend bias to the data. Thus, descriptive and multivariate analysis methods were combined to reduce these limitations and the putative biases of this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study aimed to identify the factors associated with ITN usage to project the country\u0026rsquo;s future net orders. These findings contribute toward effective elimination of malaria according to the needs-based service approach in Burkina Faso. Therefore, considering the characteristics of ITNs and households, individual preferences, and contextual factors for promoting and distributing mosquito nets are crucial for preventing malaria in Burkina Faso.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR Adjusted odds ratios\u003c/p\u003e\n\u003cp\u003eCI Confidence intervals\u003c/p\u003e\n\u003cp\u003eGPHC General population and housing census\u003c/p\u003e\n\u003cp\u003eHD Health district \u003c/p\u003e\n\u003cp\u003eHDI Human Development Index\u003c/p\u003e\n\u003cp\u003eINSD National Institute of Statistics and Demography\u003c/p\u003e\n\u003cp\u003eINSP National Institute of Public Health\u003c/p\u003e\n\u003cp\u003eITN Insecticide-treated mosquito nets \u003c/p\u003e\n\u003cp\u003eOR Odds ratios \u003c/p\u003e\n\u003cp\u003ePADS Health development support program \u003c/p\u003e\n\u003cp\u003ePNLP National malaria control program \u003c/p\u003e\n\u003cp\u003eRBM Roll back malaria\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e\n\u003cp\u003eZD Enumeration zones\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical aspects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in compliance with the ethical principles of health research and good clinical practices. The study protocol was approved by the institutional ethics committee of the National Institute of Public Health (INSP) (approval no. 2023-001/MSHP/SG/INSP/CEI) on January 31, 2023, before sample collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received support from the Global Fund through the Health Development Support Program in Burkina Faso. The authors alone are responsible for the findings and conclusions presented in this manuscript and they do not necessarily reflect the official views of the Global Funds or the Health Development Support Program. The funders are not involved in the design of the study, collection and interpretation of data and in writing of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBH, HH, HSA, SS, and MN conceived the study idea, designed the study, secured the funding and reviewed the manuscript. BH wrote the initial draft of the manuscript with feedback from HH, HAS, SS and MN reviewed the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to the Health Development Support Program (PADS) from Burkina Faso for funding this study through the Global Fund. We would like to thank them for providing all necessary ITNs for this study. We gratefully acknowledge all the fieldworkers, supervisors, and data managers for their work in the field. Finally, we extend our gratitude to all participants in the study sites.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. World malaria report 2023 [Internet]. World Health Organization. 2023 [cit\u0026eacute; 1 juill 2024]. 283 p. Disponible sur: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240086173\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240086173\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesan P. The 2023 WHO World malaria report. Lancet Microbe 1 mars. 2024;5(3):e214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFegan GW, Noor AM, Akhwale WS, Cousens S, Snow RW. Effect of expanded insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study. Lancet. 2007;370(9592):1035\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabluetzel A, Diallo DA, Esposito F, Lamizana L, Pagnonl F, Lengeler C, et al. Do insecticide-treated curtains reduce all-cause child mortality in Burkina Faso? 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Malar J d\u0026eacute;c. 2023;22(1):1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanavati SE, Kelly GC, Vo TH, Tran LK, Ngo TD, Tran DT, et al. Mosquito Net Ownership, Utilization, and Preferences among Mobile and Migrant Populations Sleeping in Forests and Farms in Central Vietnam: A Cross-Sectional Study. Am J Trop Med Hyg mai. 2021;104(5):1917\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim S, Piccinini D, Mensah E, Lynch M. Using a Human-Centered Design Approach to Determine Consumer Preferences for Long-Lasting Insecticidal Nets in Ghana. Glob Health Sci Pract 24 juin. 2019;7(2):160\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Toolkit for Integrated Vector Management in Sub-Saharan Africa (A) [Internet]. World Health Organization. 2016 [cit\u0026eacute; 7 juin 2024]. 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The Effect of Single or Repeated Home Visits on the Hanging and Use of Insecticide-Treated Mosquito Nets following a Mass Distribution Campaign - A Cluster Randomized, Controlled Trial. PLOS ONE. 16 mars. 2015;10(3):e0119078.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAuta A. Demographic Factors Associated with Insecticide Treated Net use Among Nigerian Women and Children. North Am J Med Sci janv. 2012;4(1):40\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTassembedo M, Coulibaly S, Ouedraogo B. Factors associated with the use of insecticide-treated nets: analysis of the 2018 Burkina Faso Malaria Indicator Survey. Malar J. 17 mai. 2021;20(1):220.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4668651/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4668651/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: The World Health Organization recommends insecticide-treated mosquito nets (ITNs) as one of the main interventions to control malaria spread. The leading driver of this intervention is use of ITN; however, socio-demographic characteristics factors, access and possession of ITN could also influence its usage. Therefore, the present study aimed to document the factors associated with using ITNs to eliminate malaria in Burkina Faso. This study's findings would be useful to the National Malaria Control Programme and other stakeholders engaged in the promotion of ITNs to fight malaria cases.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e: Data were collected from a quasi-experimental cross-sectional study in Burkina Faso. An analytical approach including a descriptive and an explanatory component was used. For the descriptive aspect of the analysis, possession, access, and use of ITNs were described. The factors associated with ITN use were assessed using univariate and multivariate binary logistic regression analyses, with the level of significance at 5%. The data were analyzed using Stata 16.1 software.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: The results of the saturated model showed that the type of textile of the IBD (polyester: odds ratio (OR)\u0026thinsp;=\u0026thinsp;1.23; 95% confidence interval (CI) [1.13, 1.33]) and age of the IBD (6\u0026ndash;11 months, OR\u0026thinsp;=\u0026thinsp;0.91, 95% CI [0.83, 0.997]; \u0026ge; 12 months OR\u0026thinsp;=\u0026thinsp;0.52, 95% CI [0.401, 0.675]) are influential factors for the use of ITNs. On the other hand, the level of ITN possession (excessive ITNs; OR\u0026thinsp;=\u0026thinsp;0.66; 95% CI [0.597, 0.74]) and the household poverty quintile showed a positive correlation with the use of ITNs (mean OR\u0026thinsp;=\u0026thinsp;0.791, 95% CI [0.694, 0.902]; rich OR\u0026thinsp;=\u0026thinsp;0.656, 95% CI [0.573, 0.751], and very rich OR, = 0.557, 95% CI [0.484,0.641]).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e: There is a strong association between ITN use, type of textile, age of ITNs and number of ITNs in possession. Strengthening health education on the benefits and importance of ITN use will improve the appropriate use of ITNs among the population of Burkina Faso.\u003c/p\u003e","manuscriptTitle":"Factors associated with insecticide-treated mosquito nets utilization for malaria prevention in Burkina Faso: finding from cross-sectional household survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-24 11:13:52","doi":"10.21203/rs.3.rs-4668651/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-01T20:27:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-19T16:55:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37223888413114316407127578580967286836","date":"2025-03-07T11:27:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-01T01:52:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-01T16:51:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-01T16:49:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2024-07-01T14:08:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f885e40-4f3f-4e48-93c4-b891614f8b5f","owner":[],"postedDate":"July 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T16:08:06+00:00","versionOfRecord":{"articleIdentity":"rs-4668651","link":"https://doi.org/10.1186/s12936-025-05621-1","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-11-05 15:57:24","publishedOnDateReadable":"November 5th, 2025"},"versionCreatedAt":"2024-07-24 11:13:52","video":"","vorDoi":"10.1186/s12936-025-05621-1","vorDoiUrl":"https://doi.org/10.1186/s12936-025-05621-1","workflowStages":[]},"version":"v1","identity":"rs-4668651","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4668651","identity":"rs-4668651","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}