Factors associated with the non-use of insecticide-treated nets in Rwandan children

Background: Insecticide-treated bed nets (ITNs) are highly effective in reducing malaria burden when used properly. However, factors related to individuals, households and community may influence how ITNs are used for malaria control. The study examined influences exerted at these levels to determine if they are associated with ITN non-use among children under 5 years of age in Rwanda. Methods: Using data from the 2010 Rwanda Demographic Health Survey, the investigation was done on the factors associated with ITN non-use among children under 5 years. Descriptive statistics as well as univariate and multilevel logistic regression analyses were used to identify factors associated with ITN non-use. Results: Responses from a total of 6173 women aged 15-49 years living in 492 villages were included in the analysis. Risk factors for children not utilizing ITNs (25 %) included: (Odds ratio [95 % confidence interval]) households with more than five members (1.42 [1.23-1.63]), employed mother (1.33 [1.06-1.66]), and lower household altitude (1.36 [1.14-1.61]). Protective risk factors for ITN use included households with more than three nets (0.39 [0.33-0.47]), mothers who attended one to four visits at antenatal clinics during pregnancy (0.45 [0.29-0.69]), more than four antenatal clinic visits during pregnancy (0.39 [0.21-0.70]), mothers married or living with partner (0.43 [0.36-0.52]), mothers with any education level (0.77 [0.65-0.91]), and households with higher community wealth quintile (0.71 [0.59-0.84]). Conclusions: Rwanda has achieved high coverage of ITN use and proper use has contributed to a decline in malaria in Rwanda; however, maintaining universal ITN coverage is not enough to protect citizens from this disease. Risk factors related to ITN non-use at individual, household and community level include poverty, education, birth spacing, and antenatal clinic attendance. There is a need to address findings with strategies to mitigate the non-use of ITNs for effective malaria prevention in Rwanda.