Use of long-lasting insecticide-treated bed nets in a population with universal coverage following a mass distribution campaign in Uganda

BACKGROUND: Uganda conducted an LLIN mass distribution campaign in 2013 with the goal of achieving universal coverage. Using data from the 2014 malaria indicator survey, this analysis estimated the proportion of the population with access to an LLIN that slept under one the night before the survey and factors associated with not using an LLIN in households that had achieved universal coverage. METHODS: This was a secondary data analysis using the 2014 malaria indicator survey dataset. The outcome was use of an LLIN among households that achieved universal coverage, while independent variables include age, gender, number of household members, residence, number of sleeping rooms, spraying of rooms with insecticide, number of children under 5 years of age, number of women of child-bearing age, relationship structure and community distribution of ant-malarial medicine. RESULTS: Overall, 3361 (62 %) households of the 5345 achieved universal coverage and were included in the analysis giving a total population of 14,450 individuals. Of these, 11,884 (80.10 %) reported to have slept under an LLIN the night before the survey. Children between 6 and 14 years were significantly less likely to use an LLIN when compared to those under 5 years (75.26 vs 83.12 %), adjusted OR, 1.29 (1.11-1.49), p = 0.001. The odds of not using an LLIN, significantly increased from households with five members when compared to those that had one member (79.53 vs 84.88 %), adjusted OR, 2.16 (1.38-3.38), p = 0.001 and rising even further in households with six or more members (78.04 vs 84.88 %), OR, 2.27 (1.36-3.71), p = 0.003. CONCLUSIONS: This analysis has showed that 80 % of the population used an LLIN among households that achieved universal coverage following the 2013 mass distribution campaign, especially among children under 5 years, an operational success in this category. However, children between 6 and 14 years and individuals from households with five or more numbers are less likely to use the LLINs. In order to improve usage in these categories, it may require re-focusing the behaviour change communication message to be all-inclusive, especially in era of universal coverage, and to increase the number of LLINs distributed in households with more than four members during future mass distribution campaigns, respectively.