Insecticide-treated mosquito nets are a cost-effective strategy for malaria vector control and should be treated with insecticides and disposed of regularly. This means that insecticide-treated mosquito nets are a highly effective approach in areas with high malaria prevalence. According to a 2020 World Health Organization report, nearly half of the world’s population is at risk of malaria, with most cases and deaths occurring in sub-Saharan Africa, including Ethiopia. However, significant numbers of cases and deaths have also been reported in WHO regions such as South-East Asia, the Eastern Mediterranean, the Western Pacific and the Americas.
Malaria is a life-threatening infectious disease caused by a parasite that is transmitted to humans through the bites of infected female Anopheles mosquitoes. This persistent threat highlights the urgent need for continued public health efforts to combat the disease.
Studies have shown that the use of ITNs can significantly reduce the incidence of malaria, with estimates ranging from 45% to 50%.
However, the increase in outdoor biting creates challenges that may undermine the effectiveness of appropriate use of ITNs. Addressing outdoor biting is critical to further reducing malaria transmission and improving overall public health outcomes. This behavioural change may be a response to the selective pressure exerted by ITNs, which primarily target indoor environments. Thus, the increase in outdoor mosquito bites highlights the potential for outdoor malaria transmission, highlighting the need for targeted outdoor vector control interventions. Thus, most malaria-endemic countries have policies in place that support the universal use of ITNs to control outdoor insect bites, yet the proportion of the population sleeping under a mosquito net in sub-Saharan Africa was estimated to be 55% in 2015. 5,24
We conducted a community-based cross-sectional study to determine the use of insecticide-treated mosquito nets and associated factors in August–September 2021.
The study was conducted in Pawi woreda, one of the seven districts of Metekel County in Benishangul-Gumuz State. Pawi district is located in Benishangul-Gumuz State, 550 km southwest of Addis Ababa and 420 km northeast of Assosa.
The sample for this study included the head of the household or any household member aged 18 years or older who had lived in the household for at least 6 months.
Respondents who were severely or critically ill and unable to communicate during the data collection period were excluded from the sample.
Instruments: Data were collected using an interviewer-administered questionnaire and an observation checklist developed based on relevant published studies with some modifications31. The survey questionnaire consisted of five sections: socio-demographic characteristics, use and knowledge of ICH, family structure and size, and personality/behavioural factors, designed to collect basic information about the participants. The checklist has a facility to circle the observations made. It was attached to each household questionnaire so that field staff could check their observations without interrupting the interview. As an ethical statement, we stated that our studies involved human participants and studies involving human participants should be in accordance with the Declaration of Helsinki. Therefore, the Institutional Review Board of the College of Medicine and Health Sciences, Bahir Dar University approved all procedures including any relevant details performed in accordance with the relevant guidelines and regulations and informed consent was obtained from all participants.
To ensure data quality in our study, we implemented several key strategies. First, data collectors were thoroughly trained to understand the objectives of the study and the content of the questionnaire to minimize errors. Before full implementation, we pilot-tested the questionnaire to identify and resolve any issues. Standardized data collection procedures to ensure consistency, and established regular monitoring mechanisms to oversee field staff and ensure protocols were followed. Validity checks were included in the questionnaire to maintain a logical sequence of responses. Double data entry was used for quantitative data to minimize entry errors, and collected data were regularly reviewed to ensure completeness and accuracy. Additionally, we established feedback mechanisms for data collectors to improve processes and ensure ethical practices, helping to increase participant trust and improve response quality.
Finally, multivariate logistic regression was used to identify predictors of outcome variables and adjust for covariates. The goodness of fit of the binary logistic regression model was tested using the Hosmer and Lemeshow test. For all statistical tests, a P value < 0.05 was considered the cutoff point for statistical significance. Multicollinearity of independent variables was examined using the tolerance and variance inflation factor (VIF). COR, AOR, and 95% confidence interval were used to determine the strength of association between independent categorical and binary dependent variables.
Awareness of the use of insecticide-treated mosquito nets in Parweredas, Benishangul-Gumuz Region, northwest Ethiopia
Insecticide-treated mosquito nets have become an important tool for malaria prevention in highly endemic areas such as Pawi County. Despite significant efforts by the Federal Ministry of Health of Ethiopia to scale up the use of insecticide-treated mosquito nets, barriers to their widespread use remain.
In some regions, there may be misunderstanding or resistance to the use of insecticide-treated nets, leading to low uptake rates. Some areas may face specific challenges such as conflict, displacement or extreme poverty that could severely limit the distribution and use of insecticide-treated nets, such as the Benishangul-Gumuz-Metekel area.
This discrepancy may be due to several factors, including the time interval between studies (on average, six years), differences in awareness and education about malaria prevention, and regional differences in promotional activities. Use of ITNs is generally higher in areas with effective education and better health infrastructure. In addition, local cultural traditions and beliefs may influence the acceptability of bed net use. Since this study was conducted in malaria-endemic areas with better health infrastructure and ITN distribution, accessibility and availability of bed nets may be higher compared to areas with lower use.
The association between age and ITN use may be due to a number of factors: young people tend to use ITNs more often because they feel more responsible for their children’s health. In addition, recent health campaigns have effectively targeted younger generations, raising awareness about malaria prevention. Social influences, including peers and community practices, may also play a role, as young people tend to be more receptive to new health advice.
In addition, they tend to have better access to resources and are often more willing to adopt new practices and technologies, making it more likely that they will use IPOs on an ongoing basis.
This may be because education is associated with several interrelated factors. People with higher levels of education tend to have better access to information and a greater understanding of the importance of ITNs for malaria prevention. They tend to have higher levels of health literacy, allowing them to effectively interpret health information and interact with health care providers. In addition, education is often associated with improved socioeconomic status, which provides people with the resources to acquire and maintain ITNs. Educated people are also more likely to challenge cultural beliefs, be more receptive to new health technologies, and engage in positive health behaviors, thereby positively influencing the use of ITNs by their peers.
Post time: Mar-12-2025