Assessment of factors associated with utilization of insecticide treated bed nets among women of reproductive age: Oservations from the Zambia National Malaria indicators survey 2010

Background: Malaria is a major public health problem and principal cause of morbidity and mortality in Zambia. We investigated key factors that may be associated with the utilisation of insecticide-treated nets (ITNs) as a malaria prevention strategy among women of reproductive age (15–49) in Zambia.
Methods: Data on the characteristics of women (n=4567), ownership and utilisation of ITNs were obtained among others from the Zambia National Malaria Indicator Survey of 2010 (ZMIS 2010). Multivariate logistic regression was used to determine predictors of ITN utilisation using Stata 11 (College Station, Texas, USA). Absence, <10% was the most important cause of non-response.
Results: Overall (n=4567), the median age was 27 (IQR 20.3). The proportion of respondents aged 15–19, was 21.1%. Those who resided in rural areas accounted for 59.3% and less than half (40%) had acquired primary level education. The proportion of the women who lived in households with at least one ITN was 69% and those who slept under an ITN on the night before the survey was 46%. Net use among those living in a household with at least one ITN was significantly higher in rural areas than urban areas (52% vs. 38%, P<0.01). The predictors of ITN use included age, having <5 children, information availability and educational level. Whereas use of ITNs was less likely in households with a higher number of children under five years (OR, 0.62; 95%CI 0.42, 0.92), a higher likelihood for use was seen in older women than in younger women (OR, 1.36; 95%CI 1.27, 1.47) who reported having heard any information on malaria (OR, 1.70; 95%CI 1.30, 2.24) and having had a higher level of education (OR, 1.58; 95%CI 1.34, 1.86). The household and eligible women response rates were 97.2% and 89.6% respectively.
Conclusion: ITN ownership did not necessarily mean utilisation in this population. Differential ITNs utilisation observed might indicate limitations in past malaria control efforts. Strategic ITNs utilisation promotional campaigns should thus consider various geographical and demographical contextual differentials such as education levels in this setting.