MULTILEVEL ANALYSIS OF HOUSEHOLD AND COMMUNITY FACTORS ASSOCIATED WITH USE OF MOSQUITO NET FOR UNDER-FIVE CHILDREN IN NIGERIA

Abstract

Malaria remains a public-health concern in Nigeria despite huge global investments in the production and distribution of mosquito nets to protect people from Plasmodium parasites. Children under five years of age are most vulnerable to severe malaria and should be given preference for sleeping under a mosquito net. It is important to understand the household and community-level factors associated with use of mosquito net for under-five children. The aim of this study is to examine the effect of household and community-level factors associated with use of mosquito nets for under-five children in Nigeria. The study was a secondary analysis of data obtained in the 2010 Nigeria Malaria Indicator Survey (MIS). The survey encompasses all the 36 states of Nigeria and FCT. The 2010 NMIS sample was selected using a stratified, two-stage cluster design consisting of 240 clusters. A representative sample of approximately 6,344 households was selected for the survey, however, 1788 households responded to the question of interest which this study is based upon. SPSS version 20 and STATA version 12 were used for the analysis. Descriptive statistics as well as a two-level logistic regression model were used. Overall, 28.2% of the households had mosquito nets out of the total household population. Two-third (67.6%) of household reported using mosquito net for under-five children out of all households with under-five children. There was association between living in areas covered by mosquito net scale-up programs and under-five use of mosquito nets (p<0.005): U-5 households living in areas covered by World Bank project areas and other project bodies were 1.5 times (OR= 1.5. 95% C.I= 1.07 - 2.22) and about 2 times (OR= 1.80. 95% CI= 1.19 - 2.73) respectively more likely to use mosquito nets than households without mosquito net scale-up programmes. There is significant association between sex of head of households and under-five use of net. Under-five household headed by females were about 2 times (OR= 1.94. 95% C.I= 1.14 - 3.23) more likely to use mosquito nets than U-5 households headed by males. Similarly, U-5 children households in the rich category of wealth class were about 2 times (OR= 0.58. 95% C.I= 0.39- 0.86) less likely to use mosquito nets than U-5 children households in the poor third of wealth index while households of U-5 children in the middle of wealth class were less likely (OR= 0.67. 95% C.I= 0.42 - 0.92) to use mosquito nets than the households in the poor wealth category. Furthermore, U-5 household heads above 50 years were about 2 times (OR= 0.59, 95% CI= 0.44 - 0.79) less likely to use mosquito nets than households whose head is below 51 years. Finally, the community level random effect was statistically significant (P<0.001); the residual intra-class correlation for the community was significantly large (9.7%), suggesting that even after controlling for household level and community level factors there were still substantial clustering of net use at the community level. This study has shown that living in areas covered by mosquito net scale-up programmes, gender and age of household head were significant factors associated with use of mosquito nets for under-five children in Nigeria.