Associations between Household Characteristics and Mosquito Bed Net Utilisation among Under-Five Children in Africa: A Critical Focus on Household Size, Sleeping Rooms, and Demographic Characteristics of Household Heads

Background: Research has shown that the use of insecticide-treated nets (ITNs) reduces malaria incidence and mortality. Despite the relatively high ownership of ITNs and the substantial presence of malaria-causing agents in sub-Saharan Africa (SSA), considerable empirical evidence points to a significant underutilisation of ITNs in the region. Objective: This study examines the influence of household characteristics (Household Size, Sleeping Rooms, and Demographic characteristics of Household Heads) on the use of ITNs among children under five years of age (under-five children) in five sub-Saharan African (SSA) countries. Methods: This quantitative cross-sectional investigation employed data extracted from the Malaria Indicator Survey (MIS) encompassing five SSA countries, namely Ghana, Nigeria, Niger, Senegal, and Mali. The study sample comprised 59,005 participants, weighted for representativeness. The analytical procedures included descriptive statistics and multivariate logistic regression modelling, with the intent of elucidating household determinants impacting the utilisation of ITNs. Results: Among the total of 59,005 weighted participants, the aggregate use of ITNs was 37.7%. Larger households (10+ members) (Adjusted OR=0.710; CI: 0.52, 0.98; p=0.035) had less likelihood of using ITNs for under-five children whereas households with 10+ sleeping rooms (Adjusted OR=2.37; CI: 1.11, 5.05; p=0.025) had higher odds of using ITNs for under-five children. The age, gender, and marital status of household heads did not show any statistically significant associations with ITN utilisation among the under-five children. Maternal education played a vital role, with primary (Adjusted OR=0.805; CI: 0.73, 0.89; p<0.001) and secondary education (Adjusted OR = 0.761; CI: 0.70, 0.82; p<0.001) significantly linked to lower ITN usage. Conclusions: This study indicates that disparities in household characteristics significantly shape patterns of ITN utilisation. Focused interventions could be implemented to enhance malaria prevention strategies and overall public health results in the selected countries.