Volume 93, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Understanding factors influencing sustained use of long-lasting insecticide-treated nets (LLIN) in areas of declining malaria transmission is critical to sustaining control and may facilitate elimination. From 2008 to 2013, 655 households in Choma District, Zambia, were randomly selected and residents were administered a questionnaire and malaria rapid diagnostic test. Mosquitoes were collected concurrently by light trap. In a multilevel model, children and adolescents of 5–17 years of age were 55% less likely to sleep under LLIN than adults (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.35, 0.58). LLIN use was 80% higher during the rainy season (OR = 1.8; CI = 1.5, 2.2) and residents of households with three or more nets were over twice as likely to use a LLIN (OR = 2.1; CI = 1.4, 3.1). For every increase in 0.5 km from the nearest health center, the odds of LLIN use decreased 9% (OR = 0.9; CI = 0.88, 0.98). In a second multilevel model, the odds of LLIN use were more than twice high if more than five mosquitoes (anopheline and culicine) were captured in the house compared with households with no mosquitoes captured (OR = 2.1; CI = 1.1, 3.9). LLIN use can be sustained in low-transmission settings with continued education and distributions, and may be partially driven by the presence of nuisance mosquitoes.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. O'Meara WP, Mangeni JN, Steketee R, Greenwood B, , 2010. Changes in the burden of malaria in sub-Saharan Africa. Lancet 10: 545555.[Crossref] [Google Scholar]
  2. Lengeler C, , 2004. Insecticide-treated bed nets and curtains for preventing malaria (review). Cochrane Libr CD000363. [Google Scholar]
  3. Jaenisch T, Sullivan DJ, Dutta A, Deb S, Ramsan M, Othman MK, Gaczkowski R, Tielsch J, Sazawal S, , 2010. Malaria incidence and prevalence on Pemba Island before the onset of the successful control intervention on the Zanzibar Archipelago. Malar J 9: 32.[Crossref] [Google Scholar]
  4. Najera JA, Gonzalez-Silva M, Alonso PL, , 2011. Some lessons for the future from the Global Malaria Eradication Programme (1955–1969). PLoS Med 8: e1000412.[Crossref] [Google Scholar]
  5. Bauch J, Gu J, Maellem M, Ali A, Gosling R, Baltzell K, , 2013. Perception of malaria risk in a setting of reduced malaria transmission: a qualitative study in Zanzibar. Malar J 12: 117.[Crossref] [Google Scholar]
  6. Kobayashi T, Chishimba S, Shields T, Hamapumbu H, Mharakurwa S, Thuma P, Glass G, Moss WJ, , 2012. Temporal and spatial patterns of serologic responses to Plasmodium falciparum antigens in a region of declining malaria transmission in southern Zambia. Malar J 11: 438.[Crossref] [Google Scholar]
  7. Lee PW, Liu CT, do Rosario VE, de Sousa B, Rampao H, Shaio MF, , 2010. Potential threat of malaria epidemics in a low transmission area, as exemplified by Sao Tome and Principe. Malar J 9: 264.[Crossref] [Google Scholar]
  8. Zhou G, Afrane YA, Vardo-Zalik AM, Atieli H, Zhong D, Wamae P, Himeidan YE, Minakawa N, Githeko AK, Yan G, , 2011. Changing patterns of malaria epidemiology between 2002 and 2010 in western Kenya: the fall and rise of malaria. PLoS One 6: e20318.[Crossref] [Google Scholar]
  9. Moonen B, Cohen JM, Snow RW, Slutsker L, Drakeley C, Smith DL, Abeyasinghe RR, Rodriguez MH, Maharaj R, Tanner M, Targett G, , 2010. Operational strategies to achieve and maintain malaria elimination. Lancet 376: 15921603.[Crossref] [Google Scholar]
  10. NMCP, 2012. National Malaria Control Programme Strategic Plan for FY 2011–2015: “Consolidating Malaria Gains for Impact.” Lusaka, Zambia: National Malaria Control Programme, Ministry of Health. [Google Scholar]
  11. WHO, 2014. World Malaria Report 2014. Geneva, Switzerland: World Health Organization. [Google Scholar]
  12. MOH, 2012. Zambia National Malaria Indicator Survey 2012. Lusaka, Zambia: Ministry of Health, Government of the Republic of Zambia. [Google Scholar]
  13. WHO, 2012. World Malaria Report 2012. WHO Global Malaria Programme. Geneva, Switzerland: World Health Organization. [Google Scholar]
  14. Beer N, Ali AS, Eskilsson H, Jansson A, Abdul-Kadir FM, Rotllant-Estelrich G, Abass AK, Wabwire-Mangen F, Bjorkman A, Kallander K, , 2012. A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania. BMC Public Health 12: 606.[Crossref] [Google Scholar]
  15. Koenker HM, Loll D, Rweyamamu D, Ali AS, , 2013. A good night's sleep and the habit of net use: perceptions of risk and reasons for net use in Bukoba and Zanzibar. Malar J 12: 203.[Crossref] [Google Scholar]
  16. Eisele TP, Thwing J, Keating J, , 2011. Claims about the misuse of insecticide-treated mosquito nets: are these evidence-based? PLoS Med 8: e1001019.[Crossref] [Google Scholar]
  17. Batisso E, Habte T, Tesfaye G, Getachew D, Tekalegne A, Kilian A, Mpeka B, Lynch C, , 2012. A stitch in time: a cross-sectional survey looking at long lasting insecticide-treated bed net ownership, utilization, and attrition in SNNPR, Ethiopia. Malar J 11: 115.[Crossref] [Google Scholar]
  18. Minakawa N, Dida G, Sonye GO, Futami K, Kaneko S, , 2008. Unforeseen misuses of bed nets in fishing villages along Lake Victoria. Malar J 7: 165.[Crossref] [Google Scholar]
  19. Kent RJ, Thuma PE, Mharakurwa S, Norris DE, , 2007. Seasonality, blood feeding behavior, and transmission of Plasmodium falciparum by Anopheles arabiensis after an extended drought in southern Zambia. Am J Trop Med Hyg 76: 267274. [Google Scholar]
  20. Mharakurwa S, Thuma PE, Norris DE, Mulenga M, Chalwe V, Chipeta J, Munyati S, Mutamu S, Mason PR, Southern Africa ICEMR Team; , 2011. Malaria epidemiology and control in southern Africa. Acta Trop 121: 202206.[Crossref] [Google Scholar]
  21. Steketee RW, Sipilanyambi N, Chimumbwa J, Banda JJ, Mohamed A, Miller J, Basu S, Miti SK, Campbell CC, , 2008. National malaria control and scaling up for impact: the Zambian experience through 2006. Am J Trop Med Hyg 79: 4552. [Google Scholar]
  22. Moss WJ, Hamapumbu H, Kobayashi T, Shields T, Kamanga A, Clennon J, Mharakurwa S, Thuma PE, Glass G, , 2011. Use of remote sensing to identify spatial risk factors for malaria in a region of declining transmission: a cross-sectional and longitudinal community. Malar J 10: 163.[Crossref] [Google Scholar]
  23. Beer N, Ali AS, Shakely D, Elfving K, Al-Mafazy AW, Msellem M, Petzold M, Bjorkman A, Kallander K, , 2013. High effective coverage of vector control interventions in children after achieving low malaria transmission in Zanzibar, Tanzania. Malar J 12: 38.[Crossref] [Google Scholar]
  24. Loha E, Tefera K, Lindtjorn B, , 2013. Freely distributed bed-net use among chano mille residents, south Ethiopia: a longitudinal study. Malar J 12: 23.[Crossref] [Google Scholar]
  25. Beer N, Ali AS, de Savigny D, Al-Mafazy AA, Ramsan M, Abass AK, Omari RS, Bjorkman A, Kallander K, , 2010. System effectiveness of a targeted free mass distribution of long lasting insecticidal nets in Zanzibar, Tanzania. Malar J 9: 19.[Crossref] [Google Scholar]
  26. Pulford J, Hetzel MW, Bryant M, Siba PM, Mueller I, , 2011. Reported reasons for not using a mosquito net when one is available: a review of the published literature. Malar J 10: 110.[Crossref] [Google Scholar]
  27. Garcia-Basteiro AL, Schwabe C, Aragon C, Baltazar G, Rehman AM, Matias A, Nseng G, Kleinschmidt I, , 2011. Determinants of bed net use in children under five and household bed net ownership on Bioko Island, equatorial Guinea. Malar J 10: 179.[Crossref] [Google Scholar]
  28. Moiroux N, Boussari O, Djenontin A, Damien G, Cottrell G, Henry MC, Guis H, Corbel V, , 2012. Dry season determinants of malaria disease and net use in Benin, west Africa. PLoS One 7: e30558.[Crossref] [Google Scholar]
  29. Winch PJ, Makemba AM, Makame VR, Mfaume MS, Lynch MC, Premji Z, Minjas JN, Shiff CJ, , 1997. Social and cultural factors affecting rates of regular retreatment of mosquito nets with insecticide in Bagamoyo District, Tanzania. Trop Med Int Health 2: 760770.[Crossref] [Google Scholar]
  30. Alaii JA, Hawley WA, Kolczak MS, ter Kuile FO, Gimnig JE, Vulule JM, Odhacha A, Oloo AJ, Nahlen BL, Phillips-Howard PA, , 2003. Factors affecting use of permethrin-treated bed nets during a randomized controlled trial in western Kenya. Am J Trop Med Hyg 68: 137141. [Google Scholar]
  31. Sutcliffe CG, Kobayashi T, Hamapumbu H, Shields T, Kamanga A, Mharakurwa S, Thuma PE, Glass G, Moss WJ, , 2011. Changing individual-level risk factors for malaria with declining transmission in southern Zambia: a cross-sectional study. Malar J 10: 324.[Crossref] [Google Scholar]
  32. Hlongwana KW, Mabaso MLH, Kunene S, Govender D, Maharaj R, , 2009. Community knowledge, attitudes and practices (kap) on malaria in Swaziland: a country earmarked for malaria elimination. Malar J 8: 29.[Crossref] [Google Scholar]
  33. Ndyomugyenyi R, Magnussen P, Clarke S, , 2007. Malaria treatment-seeking behaviour and drug prescription practices in an area of low transmission in Uganda: implications for prevention and control. Trans R Soc Trop Med Hyg 101: 209215.[Crossref] [Google Scholar]
  34. Haji KA, Khatib BO, Smith S, Ali AS, Devine GJ, Coetzee M, Majambere S, , 2012. Challenges for malaria elimination in Zanzibar: pyrethroid resistance in malaria vectors and poor performance of long-lasting insecticide nets. BMC Public Health 6: 82. [Google Scholar]
  35. Larson PS, Mathanga DP, Campbell CH, Jr Wilson ML, , 2012. Distance to health services influences insecticide-treated net possession and use among six to 59 month-old children in Malawi. Malar J 11: 18.[Crossref] [Google Scholar]
  36. Larsen DA, Keating J, Miller J, Bennett A, Changufu C, Katebe C, Eisele TP, , 2010. Barriers to insecticide-treated mosquito net possession 2 years after a mass free distribution campaign in Luangwa District, Zambia. PLoS One 5: e13129.[Crossref] [Google Scholar]
  37. O'Meara WP, Smith N, Ekal E, Cole D, Ndege S, , 2011. Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya. PLoS One 6: e25949.[Crossref] [Google Scholar]
  38. Atieli HE, Zhou G, Afrane Y, Lee MC, Mwanzo I, Githeko AK, Yan G, , 2011. Insectice treated net (ITN) ownership, usage, and malaria transmission in the highlands of western Kenya. Parasit Vectors 4: 110.[Crossref] [Google Scholar]
  39. Adongo PB, Kirkwood B, Kendall C, , 2005. How local community knowledge about malaria affects insecticide-treated net use in northern Ghana. Trop Med Int Health 10: 366378.[Crossref] [Google Scholar]
  40. Norris DE, Norris LC, , 2011. Efficacy of long-lasting insecticidal nets in use in Macha, Zambia, against the local Anopheles arabiensis population. Malar J 10: 254.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 31 Jan 2015
  • Accepted : 19 Jun 2015
  • Published online : 04 Nov 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error