A new study has highlighted a concerning disparity between insecticide-treated net (ITN) ownership and actual usage among carers of children under 5 in Butiama District, Tanzania, a region with one of the highest malaria rates in the country. The findings were published in the journal Clinical Epidemiology and Global Health.
Although more than 82% of surveyed households reported owning a mosquito net, only 50.8% said they used it the night before the study. The low usage rate falls significantly short of the national average and is especially troubling in Butiama, where malaria prevalence in children under 5 reached 35.15% during the last fiscal year.
Magnus Michael Sichalwe, PhD, director of primary health and preventive services at FWPPS Organization, said: “Despite the high reported ownership of insecticide-treated nets (ITNs) in the Butiama District, malaria prevalence remains alarmingly high. Understanding the socioeconomic and demographic factors influencing ITN utilization is crucial for optimising their effectiveness and advancing malaria elimination efforts in alignment with Sustainable Development Goal 3, Target 3.”
The research, conducted between April and May 2024, involved 384 carers and examined various factors influencing ITN use. Results showed that gender, education, and knowledge about the appropriate time to begin using ITNs were significant predictors of whether families used the nets consistently.
Women were over three times more likely to ensure their children slept under ITNs compared to men, underlining the role women play in child health decisions. Those with at least a primary education were also twice as likely to use ITNs than those without formal education. Meanwhile, carers who understood the importance of using ITNs immediately after childbirth were significantly more likely to adopt consistent protective practices.
Sichalwe said: “The study found that female-headed households were 3.6 times more likely to use insecticide-treated nets (ITNs) than male-headed households. Primary-educated participants were 2.3 times more likely to use ITNs than those with no or incomplete education, while self-employed individuals were 36.6% less likely than peasants or homemakers. Caregivers aware that ITNs should be used immediately after delivery were 2.9 times more likely to use them.”
Barriers to consistent ITN usage were also identified. Nearly a quarter of participants cited discomfort due to heat as a reason for avoiding net use. Others noted health concerns or simply forgetting. Some households lacked ITNs altogether, even though distribution through health facilities and campaigns is ongoing.
“Despite 82.3% owning nets, only 50.8% used them the prior night, with 25% damaged. Key barriers included lack of ownership and discomfort,” Sichalwe noted. “93.5% lived near mosquito breeding sites, heightening malaria risk, emphasising the need for targeted distribution, education, and durable nets.”
The local environment compounds the issue. Over 93% of respondents reported living near mosquito breeding grounds, such as stagnant water and overgrown vegetation. Housing conditions were also a concern. More than two-thirds of the homes surveyed lacked window screens and had open or partially closed eaves, allowing mosquitos easy access.
In terms of occupation, self-employed individuals were significantly less likely to use ITNs than farmers and homemakers. The demands of their work, reduced exposure to health messaging, and differing perceptions of risk may contribute to this disparity.
Despite awareness campaigns, many families still lack practical knowledge about ITN maintenance and frequency of use. Only 58.6% correctly stated that ITNs should be used every night. Public health campaigns, while helpful, appear to be falling short of driving behavioural change.
Looking ahead, Sichalwe outlined strategic steps to improve uptake: “To strengthen malaria prevention in Butiama, future efforts will prioritise the implementation of gender-sensitive educational campaigns and the enhancement of community awareness on proper ITN utilisation. Community health workers will play a key role in sensitisation activities, while collaboration with local leaders such as Village Executive Officers, Ward Executive Officers, and ten-cell leaders will help reinforce education and mobilise community support.”
He added that “future research will explore barriers to ITN use across different demographic groups and evaluate the impact of these interventions to ensure the long-term sustainability and effectiveness of malaria control strategies”.
