Assessment of household insecticide-treated bed net ownership, utilization, and associated factors in Kersa Woreda, Jimma Zone, Southwest Ethiopia

Abstract

Background

An estimated 40% of the world’s population lives in malaria-prone areas, there are 300–500 million malaria episodes worldwide, and at least one million malaria fatalities occur each year which makes malaria is a major public health concern [1]. In sub-Saharan Africa, malaria claims the lives of about 90% of all people worldwide. Today, there is a growing interest in using ITNs as one of the leading strategies for the prevention and control of malaria. Many studies on ITN use and associated factors have shown that factors influencing ITN use differ from place to place, with very few similarities; specifically, there are no studies conducted in the study area on ITN ownership, utilization, or associated factors.

Methods

A community-based cross-sectional study was conducted from April 2023 to June 2023. A multistage sampling technique was employed to recruit the study participants. From twenty Malaria kebeles, six kebeles were selected by the lottery method, and study households were selected by the systematic random sample technique. A total of 770 planned sample sizes were calculated by using a single population formula. A trained data collector was used to collect the data, and the data entry and analysis were performed with SPSS 27.0. Simple frequency distribution and descriptive analyses were performed to describe participants’ sociodemographic, ownership, and utilization. Bivariate and multivariate analyses were performed to determine associations between dependent and independent variables, with a p-value < 0.05 indicating statistical significance.

Results

Data were collected from a total of 766 study participants, for a response rate of 99.5%. The majority (89%) of the respondents had at least one ITN, and 83.5% of the households reported sleeping under the ITN the night preceding the survey. Knowledge about ITN as a preventive agent for malaria [AOR 2.028, 95% CI: 1.010, 4.070], the presence of pregnant mothers in the household [AOR 4.373, 95% CI: 1.70, 11.203], willingness to buy ITN [AOR 2.106, 95% CI: 1.330, 3.335] and home visited by health extension workers [AOR 2.002, 95% CI: 1.228, 4.540] were identified as factors associated with ITN utilization by households.

Conclusion

ITN ownership and utilization were 89% and 83.5%, respectively. Knowledge about the use of the ITN for preventing malaria, the presence of pregnant mothers in the household, willingness to buy the ITN, and home visits by HEW were identified as factors associated with ITN utilization. The ITN distribution for malaria cases and the mechanism for accessing the ITN in the market need to be considered by health authorities. Continuing to apply IEC/BCC interventions to increase the knowledge of the community on the ITN and of home visits and support the proper utilization of the ITN is highly important.

Background

An estimated 40% of the world’s population lives in malaria-prone areas, there are 300–500 million malaria episodes worldwide, and at least one million malaria fatalities occur each year which makes malaria is a major public health concern [1]. In sub-Saharan Africa, malaria claims the lives of about 90% of all people worldwide. This is due to the fact that Plasmodium falciparum, the most dangerous of the four human malaria parasites, is the primary source of infections in Africa [2]. Malaria claims the lives of an estimated one million Africans annually, the majority of whom are children under five. The region will not achieve the global technical objective (2016–2030) of reducing malaria incidence and mortality by at least 90% compared to 2015, despite notable advancements since 2000 [2, 3].

Malaria poses a significant threat to 76% of Africa’s population, with children, pregnant women, and HIV-positive individuals being especially susceptible [4, 5]. Artemisinin combination treatments (ACTs) are relatively rarely used to treat malaria, with Africa accounting for 89% of cases and 85% of deaths from the disease happening in children under five [5]. Around 75% of Ethiopia’s people, or 68% of its total population, reside in malarial zones. Due to the varied ecoclimatic conditions in the nation, the pattern of malaria transmission is seasonal and unstable, typically exhibiting recurrent focal and cyclic extensive epidemics [6]. In recent years, this illness has been regularly listed as one of the top three causes of morbidity and death. Likewise, in 2004 it was stated to be the primary cause of morbidity and death, responsible for 15.5% of OPDs, 20.4% of hospital admissions, and 27.0% of fatalities [6, 7].

Malaria is thought to be the most common infectious disease in Oromia. It is thought to be transmitted in almost 75% of the state and 63% of the municipalities [8]. Between 3.2 million and 2.1 million people in the Jimma zone are susceptible to contracting malaria. Of the 35 kebeles in Kersa woreda, malaria kebeles make up 57% of the total population [9].

It is generally acknowledged that insecticide-treated bed nets (ITNs) are a successful malaria preventive measure. ITNs stop the spread of malaria by eliminating or rerouting infected mosquitoes from contacting individual net users and treating net homes [10]. ITN intervention programs have gained popularity thanks to the World Health Organization’s Rollback Malaria Partnership and the Millennium Development Goals, which both sought to reach 80% ITN usage among pregnant women and children under five in Africa by the end of 2010 [10, 11].

The effects of ITN therapies have been assessed in several studies. Communities with high ITN utilization rates may also benefit neighboring homes without ITN ownership or use. Children in Kenyan homes without nets were less likely to contract malaria when they were within 300 m of homes with nets, according to a randomized controlled trial conducted in Western Kenya. The study also revealed that ITNs had a greater effect on mosquito populations in the area or community than they did on individual net users [12].

ITNs have proven to be very beneficial in terms of mosquito killing, significant transmission reduction, and increased child survival in settings with varying levels of transmission risk (from low to very high risk), according to scientifically controlled research. ITNs have been demonstrated to protect nonusers in the community who reside close to netted households when a significant fraction of the population uses them, most likely as a result of the widespread mortality of female malaria vector mosquitoes [13]. According to studies, using these medicines regularly can lower under-five death rates overall in malaria-endemic areas by about 20%. These nets offer a physical barrier against the biting of malaria-infected mosquitoes, which bite at night [14].

An ITN was possessed by 180 (56.6%) of the respondents in a Nigerian survey [15], and A study of pregnant women visiting ANC revealed that 9.3% of them owned an ITN [16]. Additional studies conducted in Kenya likewise revealed that 71% of study participants were proprietors [17]. According to research conducted in Sub-Saharan Africa, ITN ownership ranged from 3 to 80% among different districts and countries [18]. Additionally, Ghanaian research revealed that 81.3% of ITNs were owned [19]. Another study carried out in Nigeria revealed that 10.1% of families owned ITNs, while 23.9% of households owned any nets at all [20]. Another study conducted in Mozambique revealed that 58.3% of homes had one ITN for every two people, while 69.2% of households possessed at least one ITN [21]. According to a Cameroonian study, the overall coverage of ITN was 43.5% and that of intermittent preventive therapy (IPT) was 88.7% [22]. According to research done in Ethiopia, 91% of households had at least one ITN [23]. Other study conducted in southern Ethiopia also showed that ownership of at least one LLIN among households of school age children was 19.3% [24]. Study in Seka district of southwest Ethiopia also revealed that 90% of the study household possessed ITN [25].

Two-thirds (64%) of homes in Malaria Areas have at least one long-lasting insecticide-treated net (LLIN), according to the results of the 2015 Malaria Indicator Survey. For every two persons who spent the night before the survey, almost 32% of the households had at least one LLIN, and half of the household population (49%) had access to an LLIN [26]. Additionally, research carried out in northern Ethiopia revealed that 59% of the 815 households questioned had at least one ITN [27]. Additionally, a survey conducted in eastern Ethiopia revealed that 62.4% of families had and used at least one mosquito net [28].

According to one analysis, between 2003 and 2021, the average incidence of ITN utilization was 70% [29]. According to research done in Nigeria, 86.1% of people living in rural areas and 74.1% of people living in urban areas used ITNs [30]. According to a Nigerian study, 8.4% of expectant mothers used the ITN to prevent malaria [16]. A different study conducted in Ghana revealed that 66.4% of people used ITNs [19]. An investigation conducted in Kenya found that the percentage of people who used ITNs was 56.3%, with differences between the rainy and dry seasons (62% vs. 49.6%) [17]. Additional studies conducted in Malawi revealed that the percentage of people using ITN increased from 57.8% in 2010 to 69% in 2015 [31]. Another study conducted in Burkina Faso revealed that young children who slept with their mothers throughout the rainy and dry seasons reported self-reported compliance rates of 66% and 98%, respectively [32]. A study carried out in northern Ethiopia revealed that 76.1% of the questioned households reported and witnessed sleep, and 82% of children slept under the ITN the night before the survey [33].

A study carried out in rural Burkina Faso revealed that the primary factors affecting not sleeping under the International Trade Network (ITN) during the rainy season were challenges associated with changing sleeping places throughout the night and the temperature inside households [32]. According to reports from Sub-Saharan Africa, having multiple sleeping locations, knowing that ITN can prevent malaria, having a hanging ITN, being highly literate, having antenatal clinic attendance that promotes utilization, hot weather, and the absence of visible mosquitoes are all factors that affect ITN utilization [34]. According to others study, factors that affect ITN utilization include age, financially disadvantaged households, the number of ITNs in a household, and the number of people who have three or more ITNs [21, 35].

Age > 24 months, women with no formal education or only a primary school, living in a family headed by a woman, and living in a household with inadequate ITN supply were all substantially linked to lower probabilities of ITN, according to another study conducted in Malawi [31]. Additionally, a study conducted in Nigeria revealed that maternal education was a predictor of ITN use [36]. ITN utilization among pregnant women is influenced by several characteristics, including maternal age, income, gravidity, parity, number of family members, past ITN usage during the previous pregnancy, and accessibility to the ITN, according to another study [37]. Pregnant women who use ITNs are more likely to have higher educational status, have prenatal care visits, and have good awareness of malaria prevention techniques, according to another systematic review [38].

Additionally, a study conducted in southern Ethiopia revealed that the existence of a radio in the home, the head of the household’s income, and sex were all predictive of ITN consumption [39]. Additionally, a different study revealed that having two or more ITNs and believing they shield people from mosquito bites were indicators of ITN use among households with children under five [40]. A Gambella study demonstrated that the number of ITNs, household size, number of family members sharing sleeping areas, household age, and discomfort of using ITNs were all predictive factors of ITN utilization [41]. Additional research conducted in Ethiopia revealed that the existence of a hanging bed, knowing that the ITN reduces malaria, and having two or more locations to sleep were all associated with the use of ITNs [42]. The lack of a mosquito net or the absence of malaria are among the reasons why the ITN is not being used; other reasons include the ITN’s ineffectiveness and bad condition, which is why it is being conserved [23].

ITNs are becoming more and more popular as one of the most effective ways to prevent and control malaria. This strategy is also a major component of national health extension programs that use community health extension workers, who are trained to prevent and manage malaria [43]. Many studies on ITN use and associated factors have been conducted in the country [23, 33, 39,40,41,42, 44, 45], and the findings of these studies showed that factors influencing ITN use differ from place to place, with very few similarities specifically, there were no studies conducted in the study area on ITN ownership, utilization, and associated factors. Study area is one of the districts with high malaria cases in the zone with frequent outbreak report. Hence, this study aimed to assess ITN ownership, utilization, and associated factors in the study area. This study also intended to generate evidence on the use of the ITN and associated factors to aid the design of appropriate strategies for malaria prevention and control for health authorities.

Methods and materials

Study design and period

A community-based cross-sectional study was conducted from April 2023 to June 2023.

Study area

Kersa Woreda is a member of the Woreda region in the Jimma Zone located 18 km northeast of Jimma town. It has a total area of 978.6 km2 and is bounded by Limmu Kossa and Tiro Afeta Woreda in the north, Ommo Nada Woreda in the east, and Manna Woreda and Jimma Town in the south and Dedo Woreda in the west. The altitude ranges from 1600 to 2400 above sea level, and the temperature ranges from 24 to 28 °C. The annual average rainfall is 1586.6 mm, and the climatic conditions are Wolyna dega. Approximately 98% of the Woreda are Muslim, the rest are Christian, and the majority of the residents are Oromo and others, such as Gurage and Dawro. Economically, the community depends on farming, cash crops such as coffee harvesting and some fruits. In Woreda, there are seven private clinics, one drug store, and twelve drug vendors, and there are thirty-five kebeles, each having one health post with two health extension workers and four functioning health centers. The Woreda had a total population of 188,268 96,017 (51%) were females and the total household size was 39,222.

Source population

Households of selected Malaria kebeles were the source population for the survey.

Study population

The sampled households of the selected Malaria kebeles composed the study population.

Sample size determination

The sample size was determined by using the sample size formula for a single population proportion formula, i.e., n = Z² (P) (1-P)/d².

P = the proportion of households that used the ITN before the survey was taken from Carol’s study on factors associated with the use and nonuse of mosquito nets in the Amhara and Oromia regional states in 2009; the ITN utilization rate was 65% [23].

d = Precision of the estimate = 0.05.

Z = value at 5% level of significance (α) = 1.96.

The calculated sample size was 350. When the sample size was adjusted for a design effect (double the sample size), 700 sample households were included. The expected number of nonrespondents was 70 (10%). Therefore, the total sample size of the study was 770.

Sampling procedure

Multistage sampling was used to obtain the required data. First stage: From the total of twenty Malaria kebeles, six kebeles were selected randomly via the lottery method to have minimum representative sample for this survey. In the second stage, As the total household in each kebele was not equal, proportional allocation to sample was made by dividing sample size to total households in six kebeles( 770/7195 = 0.107). sample size for each kebele was calculated by multiplying 0.107 with total household in the selected kebele and systematic random sampling technique was used to collect data from household. The first household in each kebele was picked by lottery method and the consecutive was selected at each k^th interval by dividing total number of households in the kebele to their allocated sample size (Fig. 1).

Fig. 1

Diagrammatic presentation of sampling procedure of households of kersa Woreda, June 2023

Inclusion and exclusion criteria

For this cross-sectional survey during the data collection, husbands or housewives were interviewed, and those households who had lived in the area for less than six months were excluded from the study.

Variables

Outcome variables

ITN utilization by households.

Independent variables

Age, sex, marital status, religion, occupation, household income, level of education, number of families in the household, number of < 5 children in the household, and presence of pregnant women in the household.

Operational definition

ITNs

Either a long-lasting insecticide-treated bed net that does not require retreatment or retreatable one.

ITN Ownership

HHs with one or more ITNs per household.

ITN utilization

HHs that own an ITN in which one or more members of the HH slept under a net the night preceding the study.

Data collection instrument and procedure

A structured interviewer administered questionnaire that assesses sociodemographic background, household awareness of the ITN, and an observation checklist for the availability of the ITN, type of ITN, and number of ITN available in the household were developed. The questionnaire was translated into Afan Oromo for household survey, and an observation checklist was used during observation.

Data collectors

Six diploma teachers who were perfect in the local language and who were familiar with the community’s norms were selected from Kersa Woreda for data collection. Two public health officers who had experience in malaria prevention and control programs were selected from Jimma town for data collector supervisor by principal investigators. Two days training were given for data collectors and supervisors on the data collection techniques one week prior to the data collection in the Woreda. Trained data collectors also participated during pretesting to adapt themselves for next work.

Data collection fieldwork

The household survey was conducted in the morning for observation of hanged ITNs in a sleeping place and household man or women was interviewed during data collection. The data collectors were regularly supervised throughout the data collection period daily.

Data quality assurance

The questionnaire and checklist were pretested on 5% of the study sample on Tolli Karsu kebele, which was not included in the study by sampling methods during the selection procedures before actual data collection to determine the consistency and clarity of the wording used. The data collectors and supervisor were trained for two days before the actual data collection period regarding the approach and objective of the study on data collection from study participants. All the questionnaires were checked for completeness daily by the supervisor and principal investigator. Data cleaning and checking were performed at the field level and repeated after entry to check for coding errors and missing values by the principal investigator.

Data analysis

After data collection was completed, the data was entered into SPSS version 27.0. The data was cleaned by running simple frequency distributions, summary statistics, and cross-tabulation. Descriptive and summary statistics were used to describe the data about relevant variables. Odds ratios (ORs) with 95% confidence intervals (CIs) and p values were calculated to determine the presence and strength of the associations. Variables with P values < 0.05 in the bivariate logistic regression analysis were included in the multivariate logistic regression analysis with backward stepwise Wald method was used to identify the independent factors that influence ITN utilization by controlling confounding effects among the variables. The backward stepwise method was employed as it starts with full set of independent variable and step by step eliminate variable that is not significant and come up with final variable that best explains the outcome variable. A P value < 0.05 indicates statistical significance, and the data are presented in the tables, figures, and narration.

Results

Sociodemographic characteristics of the respondents

Among the 770 planned study participants, 766 households were interviewed, for a 99.5% response rate. A total of 441 (57.6%) study participants were male, and 325 (42.4%) were female. The highest age category was 35–44 years (264; 35.4%), and the lowest age category was 15–24 years (36; 4.7%). The majority (97.0%) of the respondents were married. Nearly half of the study participants (46.3%) were illiterate, and approximately one-fourth (23.4%) of them were able to read and write. Around two-thirds (60.4%) and one-third (31.2%) of the study participants were farmers and housewives, respectively, in their occupations. The majority (97.3%) of the participants were of Oromo ethnicity, and 96.6% of the study participants were Muslim religious followers (Table 1).

Table 1 Distribution of the sociodemographic characteristics of the Kersa Woreda respondents, June 2023 (n = 766)

Knowledge about malaria

Almost all (99.2%) of the households responded that malaria is a common health problem in their community. Approximately 81.3% of the households indicated that malaria is transmitted by mosquito bites, and 99.6% of the respondents indicated that malaria is preventable (Table 2).

Table 2 Distribution of respondents’ knowledge of malaria prevention methods in Kersa Woreda, June 2023 (n = 766)

Knowledge about the ITN

The majority (99.7%) of the respondents heard about ITN, and 83.4% of them heard from health extension workers. Almost all (99.5%) of the respondents agreed that the ITN can prevent malaria (Table 3) and more than two-thirds (70%) of the respondents indicated that priority should be given to pregnant women and under-five children to sleep under the ITN in case of a shortage in the household (Fig. 2). About 88% of the respondents reported that their home was visited by health extension workers for proper utilization and placement of the ITN.

Table 3 Distribution of respondents’ knowledge and attitudes about ITN utilization by Kersa Woreda, June 2023 (n = 766)

Fig. 2

Distribution of respondents’ attitudes toward to whom priority should be given to sleep under the ITN in Kersa Woreda, June 2023

Ownership of ITNs

The majority (89%) of the respondents had at least one ITN during the survey. Approximately half (52.5%) of the respondents owned two ITNs during the survey. Household observation revealed that more than half (54.5%) of the households had two ITNs and that 30.8% of the households had one ITN. Almost all (99.3%) of the available ITNs were long-lasting (ILL). About 92.7% of households reported that they owned ITNs for two years. Around two-thirds (66.4%) of the respondents took the ITN from health posts, followed by 26.4% from kebeles.

The reason for not having enough ITNs currently was also reported, as there was no recent free distribution by 207 (44.6%), no money to buy by 28 (6.0%), and no available on the market by 202 (43.5%). We did not know where to get by 9 (1.9%), and we did not get before 18 (3.9%) (Table 4). The mean number of ITNs currently owned was 1.824_+0.72, and the mean number of ITNs needed by household was 3.12_+0.96.

Table 4 Distribution of ITN ownership and number of ITNs owned by respondents from Kersa Woreda, June 2023 (n = 766)

ITN utilization

The majority (83.5%) of the respondents reported that any of their family members had slept under the ITN previous night before the survey. Of these, 478 (25.0%) were under five years of age, 103 (5.4%) were pregnant women, 534 (28.0%) were household head males, 480 (25.2%) were mothers, 208 (11.0%) were other family members and 104 (5.5%) were all families. Approximately 88% of the respondents reported that their home was visited by health extension workers for proper utilization and placement of the ITN.

Of the 565 children under five years of age, 478 (84.6%) had slept under the ITN at night before the survey, and of the 117 pregnant women, 103 (88.0%) had slept under the ITN at night before the survey. Regarding the method of malaria prevention, 709 (92.6%) respondents stated that they are using ITNs for malaria prevention, while 544 (71%), 458 (59.8%), and 37 (4.8%) are using an IRS/DDT spray, environmental sanitation, and smoking leaves (makanisa), respectively, for malaria prevention. During observation, 48 (7%) households used the ITN for screening, and 20 (2.9%) used it under-bed to kill fleas and other insects.

Factors affecting ITN utilization

According to our bivariate analysis, the presence of pregnant women in the household, ITN preference as a method of malaria prevention, knowledge of the benefit of ITN, willingness to buy, and home visits by HEWs were found to be significantly associated with ITN utilization (Tables 1, 2 and 3). After bivariate analysis, those factors with significant associations (P < 0.05) were again subjected to multiple logistic regression to exclude confounders and identify final determinant factors affecting ITN utilization.

According to our multivariate analysis, households that were informed about the use of the ITN for preventing malaria were 2.028 times more likely to sleep under the ITN than households that were not aware of the ITN [AOR 2.028, 95% CI: 1.010, 4.070]. Households in which pregnant mothers were present were 4.37 times more likely to sleep under ITN than households in which pregnant mothers were not present [AOR 4.373, 95% CI: 1.70, 11.203]. Households who were willing to buy ITNs were 2.106 times more likely to sleep under the ITN than their counterparts [AOR 2.106, 95% CI = 1.330, 3.335]. Households visited by health extension workers had 2.002 times greater odds of sleeping under the ITN than households not visiting the home [AOR 2.002, 95% CI: 1.228, 4.540] (Table 5).

Table 5 Multivariate analyses of predictors of ITN utilization in Kersa Woreda, June 2023

Discussion

This study assessed the availability, utilization, and associated factors of ITNs in Kersa Woreda, Jimma Zone, Southwest Ethiopia. This study revealed that overall household ITN ownership was 89% during the survey. This finding is greater than those of studies conducted in Nigeria, which showed that 56.6% of households owned ITNs [15], and studies conducted in Kenya, which showed 71% ownership [17]. This finding is also higher than that of a study conducted in Ghana, which showed 81.3% ownership [19], and a study conducted in Mozambique, which showed 69.2% household ITN ownership [21]. This finding is also higher than that reported in Arbaminch Zuria, which was 58.8% [39] and study in southern Ethiopia which showed 19.3% [24].This finding is also higher than that of a malaria indicator survey in which 65.6% of households owned at least one ITN [46]. This might be due to the current focus of the government on malaria elimination and household ITN distribution and advocacy for ITN ownership and use by health extension workers. This findings is consistent with those of studies conducted in Cameron [22], Sub Saharan Africa [18], Northeast Ethiopia [33], Tigray [45], southwest Ethiopia [25], and the Amhara and Oromia regions [23], which showed household ITN ownership of 88.7%, 80%, 86.1%, and 84.5%,90%, 91% respectively.

This study revealed that 83.5% of households reported that any of their family members slept under the ITN the previous night before the survey. This study result is higher than study in Nigeria(8.4% use by pregnant women) [15], study conducted in Ghana showed ITN use of 66.4%( [19], Kenya Showed ITN use of 56.3%( [17], Malawi showed ITN use of 69% [31], Study in Burkina Faso showed ITN use 66% during dry season [32] and study conducted in Africa which showed 70% ITN use [29]. This finding is also higher than that of a study conducted in Arbaminch Zuria, which reported an ITN use of 73% [39]. The difference might be that the current health extension worker coverage in the study area, frequent awareness creation, and follow-up through the health development army might increase the utilization of ITN.

The findings of this study is comparable with the study conducted in Nigeria, which reported 86.1% utilization among study participants [30] and slightly higher than study conducted in northern Ethiopia showed that 82% of the children slept under the ITN the night before the survey and that 76.1% of the surveyed households reported and observed respectively [33]. This result is also higher than that reported in southwest Ethiopia which is 68.3% of household reported slept under ITN the night before the survey( [25].This might be due to that frequent community awareness and follow up by Health extension worker and endemicity of malaria increase the utilization.

This study showed that the presence of pregnant women in the household was significantly associated with ITN utilization, which is also consistent with the findings of a study performed in southern Ethiopia [39], which showed that the presence of a high-risk group in the household was a predictor of ITN utilization. This might be because of frequent ANC visits and counseling on malaria prevention and control by healthcare providers and health extension workers increase their knowledge and ITN utilization. This study also generated evidence that knowledge of the use of ITN for preventing malaria was significantly associated with ITN utilization. This finding is also in line with the findings of previous studies in Africa, belief in the effectiveness of the ITN for preventing malaria is associated with an increased rate of ITN utilization [16]. This finding is also consistent with what was reported in Gambella [41] and the Wonago district of southern Ethiopia [40] and in the Amhara and Oromia regions [23], where household awareness of malaria prevention was significantly associated with increased ITN utilization.

The current study also showed that willingness to buy ITNs was significantly associated with increased ITN utilization, which is consistent with the findings of Nigeria [15], where households that have a positive attitude toward buying ITNs have a higher rate of ITN utilization than others.

This study also showed that visiting a household by a health extension worker was significantly associated with ITN utilization. This finding is consistent with what was reported in southwest Ethiopia, household who were informed by health extension worker were 2.6 time higher rate of ITN use than against those not informed [25]. This result might indicate the functionality of the community health extension program, which includes malaria prevention and control as key activities at the household level, with the majority (75%) of the health extension workers working time at the field level visiting households and monitoring ITN utilization and education on malaria prevention and control activities [43].

Strength and limitations

The data were collected by trained personnel, and the study was conducted at six malaria Kebeles, which fulfilled the minimum recommended sample size for the representativeness of the study. This household-based cross-sectional study on ITN utilization was based on self-reports of individuals sleeping under the ITN the night prior to survey, for which it is difficult to determine consistent use.

Conclusion

This study revealed that ITN ownership and utilization among the study households in Kersa Woreda were 89% and 83.5%, respectively. Presence of pregnant women in the household, knowledge of the ITN prevention against malaria, willingness to buy the ITN, and home visits by the HEW were significantly associated with ITN utilization. The ITN distribution for Malaria kebele and the mechanism for availability in the market need to be considered by health authorities. Continuing to administer IEC/BCC interventions at the facility and community levels to increase the knowledge of communities on the ITN and home visits and support on proper utilization of the ITN for malaria prevention is highly important. Continuous follow-up and awareness on priorities for risk groups (pregnant women and those under five children) in case of shortage are crucial.