Perception of Caregivers on ITN Utilisation and its Effectiveness among Under 5 Years Children in Chikwawa District, Malawi

Abstract Background In 2020, Malawi had 6.9 million malaria cases and 2,551 deaths, mainly in children under five years of age. The 2017–2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite its widespread availability, Chikwawa District remains severely affected by malaria due to inconsistent net usage. This study explored caregivers’ perceptions of insecticide-treated net utilisation and its effectiveness among children under five years of age in Chikwawa District, Malawi. The study was conducted in Chikwawa District, Malawi. Methods This study used a sequential exploratory mixed methods design with 96 participants, as determined by Cochran’s formula. It lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions. Results The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment. Conclusion There was a strong belief in net efficacy, but challenges such as access, durability, and misinformation remained. The study explored barriers to net utilisation in Malawi, aligning with the journal's focus on health interventions and offering insights for policymakers.