Long Lasting Insecticide Treated Net and Factors Limiting Effective Utilization in a High Malaria Incidence County of Wulu, South Sudan

Download Article

DOI: 10.21522/TIJPH.2013.05.04.Art061

Authors : Gabriel O. Ayeni, Ebenezer Obi Daniel, Oladapo Michael Olagbegi, Okwuoma C Abanobi


Incidence of malaria disease is still very high in many areas of South Sudan which perhaps might be as a result of poor /noncompliance to preventive measures. The objective of this study was to investigate the use of LLITN, and factors limiting compliance to its utilization.

A case – control study was conducted among population in a typical County of South Sudan. A multistage random sampling technique was used; case-control matching was done. Information relating to access and use of LLITN was gathered and analyzed. Descriptive and inferential data analysis were carried out.

A total of 396 samples (cases=198 and control=198) were analyzed. The finding did not show satisfactory utilization of LLITN. Non-use of LLITN was significantly associated to the occurrence of malaria (OR=19.6, CI=11.78-32.54), p=). Poor understanding and not-taught how to use were significantly associated to the malaria occurrence (OR=4.6, 3.0; CI=2.98-7.28, 1.94 -4.60; p=0.000) and year-round utilization of LLITN (OR=5.2, 3.9; CI=3.27-8.19, 2.49-6.18; p=000). The finding showed poor LLITN retention and year-round use. There was significant association between factors promoting non-compliance and occurrence of malaria (p= 0.000). Also, finding showed care-giver level education is significantly associated to the use of LLITN (p=0.000).

This study showed that the identified LLITN factors had significant association to its year-round regular use the regular use of LLITN and occurrence of malaria. Improving the use of LLITN remains important component especially in developing countries where resources to achieve simultaneous implementation of integrated malaria control programme could not be guaranteed.

Keywords: Malaria, Long Lasting Insecticides Treated Net, Non-compliance, Prevention, South Sudan.


[1]. Ajala, A S and Wilson, N A. (2013): Local Aetiology and Pathways to Care in Malaria among the Ibibio of South-coastal Nigeria; Health, Culture and Society 4, 1:102 DOI 10.5195/hcs.2013.102.

[2]. Adongo P.B, Kirkwood B, Kendall C (2005): How local community knowledge about malaria affects insecticide-treated net use in northern Ghana; J. Trop Medi Intt Health 10, 4: 366–378 DOI: 10.1111/j.1365-3156.2005.01361.x

[3]. Araoye MO (2004): Sample Size Determination in Research Methodology with Statistics for Health and Social Sciences 1st ed. Ilorin: Nathadex Publishers; 2004. p. 115–21.

[4]. Atieli H, Zhou G, Afrane Y, Lee M, Mwanzo I, Githeko A, et al. (2011): Insectice Treated Net (ITN) Ownership, Usage, and Malaria Transmission in the Highlands of Western Kenya. Parasites and Vectors 4: 1–10. pmid:21205315

[5]. Ayele D.G, Zewotir T.T, Mwambi H.G (2012): Prevalence and risk factors of malaria in Ethiopia; Malaria Journal, 11:195 https://doi.org/10.1186/1475-2875-11-195

[6]. Deressa W., Yihdego Y.Y, Kebede Z, Batisso E, Tekalegne A. and Dagne G.A (2014): Effect of combining mosquito repellent and insecticide treated net on malaria prevalence in Southern Ethiopia: a cluster-randomised trial; Parasites & Vectors 7:132 https://doi.org/10.1186/1756-3305-7-132

[7]. Erhart A, Thang N.D, Van Ky P., Thi Tinh T., Van Overmeir C, Speybroeck N, Obsomer V, Xuan Hung L, Khanh Thuan L, Coosemans M. and D'alessandro U. (2005): Epidemiology of forest malaria in central Vietnam: a large scale cross-sectional survey; Malaria Journal; 4:58 https://doi.org/10.1186/1475-2875-4-58

[8]. MOH (2015): Zambia National Malaria Indicator Survey 2015. Lusaka, Zambia: Ministry of Health MOH Government of the Republic of Zambia. [Pinchoff J, Chaponda M, Shields TM, Sichivula J, Muleba M, Mulenga M, Kobayashi T, Curriero FC, Moss WJ (2016): Individual and Household Level Risk Factors Associated with Malaria in Nchelenge District, a Region with Perennial Transmission: A Serial Cross-Sectional Study from 2012 to 2015; Southern Africa International Centers of Excellence for Malaria Research. PLoS One. 11(6):e0156717. doi: 10.1371/journal.pone.0156717. eCollection 2016.

[9]. Roberts D. and Matthews G. (2016): Risk factors of malaria in children under the age of five years old in Uganda Malaria Journal; 15:246 https://doi.org/10.1186/s12936-016-1290-x

[10].  RoSS (2009): Ministry of Health Malaria indicator survey report, Republic of south Sudan.

[11].  Safeukui-Noubissi I, Ranque S, Poudiougou B, Keita M, Traoré A, Traoré D, Diakité M, Cissé MB, Keita MM, Dessein A, Doumbo OK.(2004): Risk factors for severe malaria in Bamako, Mali: a matched case-control study. Microbes Infect.6(6):572-8.

[12].  Sintasath DM, Ghebremeskel T, Lynch M (2005): Malaria prevalence and associated risk factors in Eritrea. Am J Trop Med Hyg. 72: 682-687.

[13].  Snyman K, Mwangwa F, Bigira V, Kapisi J, Clark TD, et al. (2015): Poor housing construction associated with increased malaria incidence in a cohort of young Ugandan children. Am J Trop Med Hyg; 92:1207–13.

[14].  WHO (2013a): Malaria rapid diagnostic test performance. 2009-2011: World Health Organization http://www.who.int/tdr/publications/documents/rdt3.pdf

[15].  WHO (2013b) World Malaria Report 2013. World Health Organization. http://www.who.int/malaria/publications/world_malaria_report_2013/en/

[16].  WHO (2013c): Country Cooperation strategy at a glance: belize. Geneva: World Health Organization; 2013. http://apps.who.int/iris/handle/10665/136963

[17].  WHO (2015): World Malaria Report WMR 2015: Regional and Country profile World Health Organization http://www.who.int/malaria/publications/world-malaria-report-2015/report/en/

[18].  WHO (2016): World Health Organization; Malaria. Intern. travel and health; visited 1st Oct, 2016. http://www.who.int/ith/en/

[19].  Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH (2007): A Review of Malaria Diagnostic Tools: Microscopy and Rapid Diagnostic Test (RDT). Am J Trop Med Hyg, 77 (Suppl 6): 119-127.