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Background <p>Malaria remains a critical global health challenge, with over 68% of Ethiopia’s population living in at-risk areas. While Long-Lasting Insecticidal Nets (LLINs) are a cornerstone of prevention, their effectiveness depends on consistent use. This study aimed to assess LLIN ownership and utilization patterns and identify socio-behavioral and physical determinants of their effectiveness in endemic communities.</p> Methods <p>A community-based, cross-sectional survey was conducted from October 2024 to January 2025 across 11 administrative regions in Ethiopia. Using a two-stage stratified cluster sampling technique, data were collected from 9,222 households (34,427 individuals) through face-to-face interviews and direct physical observations. Data analysis was performed using the SPSS Complex Samples module and hierarchical multivariable logistic regression.</p> Results <p>The survey found a household LLIN ownership rate of 71.5%, while the proportion of sufficient LLINs for every two people was 58.3%. Among those who owned nets, the overall utilization rate was 59.9%, with significantly higher rates in rural areas (72.7%) than in urban areas. Vulnerable groups achieved higher usage levels, specifically pregnant women (78.5%) and children under five (67.2%). Multivariable analysis identified age and pregnancy status as significant predictors of LLIN use. Pregnant women had the highest utilization rate (78.5%), with about twice the odds of net use compared with non-pregnant women (OR = 2.03, 95% CI: 1.7–2.38, <i>p</i> &lt; 0.001). Similarly, adults aged 25–49 years had 1.8 times higher odds of net use compared to individuals in the baseline age group (OR = 1.81, 95% CI: 1.63–2.02, <i>p</i> &lt; 0.001). Major barriers to consistent utilization included limited confidence in hanging nets (60.5%, <i>p</i> &lt; 0.001) and the widespread misconception (64.1%) that malaria risk is confined to the rainy season.</p> Conclusion <p>Although Ethiopia has made strides in LLIN ownership and prioritized protection for vulnerable demographics, overall utilization remains below the 80% threshold required for community-wide protection. To bridge the gap between ownership and consistent use, national strategies should transition toward skill-based interventions and targeted communication to address practical barriers and seasonal misconceptions.</p>

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Assessment of Long-Lasting Insecticidal Net (LLIN) ownership, utilization, and associated barriers in malaria-endemic communities of Ethiopia

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  • 发表日期：

    2026年7月6日

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  • Abate Waldetensai,
  • Geremew Tasew,
  • Delenasaw Yewhalaw,
  • Habte Tekie,
  • Bokretsion G. Brhane,
  • Solomon Kinde,
  • Fekadu Gemechu,
  • Selam Yirga,
  • Esayas Kinfe,
  • Alemnesh Hailemariam,
  • Henok Tadesse,
  • Hiwot Solomon,
  • Gudissa Assefa,
  • Dereje Dilu,
  • Seife Bashaye,
  • Yonas Wuletaw,
  • Bedri Abdulatif,
  • Tilahun Kebede,
  • Samson Tadiwos,
  • Gashaw Gebrewold,
  • Samuel Hailu,
  • Fitsum Tesfaye,
  • Getachew Tollera,
  • Messay Hailu,
  • Yan Guiyun,
  • Araya Eukubay,
  • Araya Gebresillassie

摘要

Background

Malaria remains a critical global health challenge, with over 68% of Ethiopia’s population living in at-risk areas. While Long-Lasting Insecticidal Nets (LLINs) are a cornerstone of prevention, their effectiveness depends on consistent use. This study aimed to assess LLIN ownership and utilization patterns and identify socio-behavioral and physical determinants of their effectiveness in endemic communities.

Methods

A community-based, cross-sectional survey was conducted from October 2024 to January 2025 across 11 administrative regions in Ethiopia. Using a two-stage stratified cluster sampling technique, data were collected from 9,222 households (34,427 individuals) through face-to-face interviews and direct physical observations. Data analysis was performed using the SPSS Complex Samples module and hierarchical multivariable logistic regression.

Results

The survey found a household LLIN ownership rate of 71.5%, while the proportion of sufficient LLINs for every two people was 58.3%. Among those who owned nets, the overall utilization rate was 59.9%, with significantly higher rates in rural areas (72.7%) than in urban areas. Vulnerable groups achieved higher usage levels, specifically pregnant women (78.5%) and children under five (67.2%). Multivariable analysis identified age and pregnancy status as significant predictors of LLIN use. Pregnant women had the highest utilization rate (78.5%), with about twice the odds of net use compared with non-pregnant women (OR = 2.03, 95% CI: 1.7–2.38, p < 0.001). Similarly, adults aged 25–49 years had 1.8 times higher odds of net use compared to individuals in the baseline age group (OR = 1.81, 95% CI: 1.63–2.02, p < 0.001). Major barriers to consistent utilization included limited confidence in hanging nets (60.5%, p < 0.001) and the widespread misconception (64.1%) that malaria risk is confined to the rainy season.

Conclusion

Although Ethiopia has made strides in LLIN ownership and prioritized protection for vulnerable demographics, overall utilization remains below the 80% threshold required for community-wide protection. To bridge the gap between ownership and consistent use, national strategies should transition toward skill-based interventions and targeted communication to address practical barriers and seasonal misconceptions.