Factors associated with insecticide-treated net usage among women of childbearing age in Malawi: a multilevel analysis

BackgroundThis study aimed to identify factors at individual and community level influencing insecticide-treated net (ITN) usage among groups of women of childbearing age (WOCBA) in Malawi.MethodsFactors influencing ITN usage in Malawi were assessed through interviews with 16,130 WOCBA (15-49years) across 850 communities who participated in the 2015-2016 Malawi Demographic Health Survey. Multilevel logistic regression analysis was used.ResultsITN use was similar between pregnant women and non-pregnant women with children under 5years (45.9% and 46.9%, respectively), but slightly lower among non-pregnant women without children under 5years (39.1%). Both individual and community characteristics were associated with ITN use among WOCBA and varied significantly across subgroups. Specifically, non-pregnant women with children under 5years living in communities where women had high autonomy in health care decisions had an 18% greater odds of using an ITN compared with those from communities where women had low health care autonomy (adjusted odds ratio [aOR]=1.18; 95% confidence interval [CI] 1.00-1.38). Distance to health care facility influenced ITN usage among pregnant women; those who did not regard distance as a problem had a 44% greater odds of using an ITN than those for whom distance was seen as a problem (aOR=1.44; 95% CI 1.09-1.89). Number of household members, region, urbanization, and community ITN coverage influenced ITN usage across all WOCBA groups.ConclusionThe findings confirmed the importance of assessing various factors affecting ITN usage among groups of WOCBA. Both individual- and community-level factors should be considered when designing and implementing ITN programmes in Malawi.