Correlates of Intra-Household ITN Use in Liberia: A Multilevel Analysis of Household Survey Data
Correlates of Intra-Household ITN Use in Liberia: A Multilevel Analysis of Household Survey Data
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DOI：
10.1371/journal.pone.0158331
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发表时间：
2016-07-12
期刊：
影响因子：
3.7
通讯作者：
Toso, Michael
中科院分区：
文献类型：
--
作者：
Babalola, Stella;Ricotta, Emily;Toso, Michael
疟疾是利比里亚发病和死亡的一个主要原因。与此同时，经杀虫剂处理的蚊帐的拥有率和使用率仍然很低。获取是ITN使用的一个关键决定因素，但不是唯一的决定因素；先前的研究已经确定了影响至少有一个ITNs的家庭使用ITNs的因素。这些因素在个人、家庭和社区层面发挥作用。然而，研究通常没有评估ITN使用的社会心理或观念决定因素。利用2014年家庭调查数据，本文考察了与利比里亚家庭成员使用蚊帐相关的社会人口、观念、家庭和社区因素。采用多水平模型来评估个人、家庭和社区水平的固定效应，以及家庭和集群水平的随机效应。数据显示，在家庭水平上存在显著的残差聚类，表明在这一水平上存在与ITN使用相关的未测量因素。年龄与ITN使用的关系受到性别的影响，因此，与妇女和5岁以下的儿童相比，男性、较大的儿童和青少年在ITN下睡觉的可能性更小。女性看护者对疟疾严重程度的认知、对发现复杂疟疾病例的自我效能感以及对“采取掩护”传播活动的接触与家庭成员使用ITN呈正相关。与家庭规模呈负相关，与itn数量呈正相关。项目应寻求实现普遍覆盖（即每两个家庭成员配备一个ITN），并宣传每个人每晚都需要在ITN下睡觉的观念。项目还应努力加强人们对疟疾严重性的认识，并教育目标受众群体了解疟疾并发症的迹象。鉴于残差聚类在家庭层面的重要性，让男性担任户主和关键决策者的干预措施是相关的。
Malaria is a major cause of morbidity and mortality in Liberia. At the same time, insecticide treated net (ITN) ownership and use remain low. Access is a key determinant of ITN use but it is not the only one; prior studies have identified factors that affect the use of ITNs in households with at least one ITN. These factors operate at the individual, household, and community levels. However, studies have generally not assessed the psychosocial or ideational determinants of ITN use. Using 2014 household survey data, this manuscript examines the socio-demographic, ideational, household, and community factors associated with household member use of ITNs in Liberia. Multilevel modeling was used to assess fixed effects at the individual, household, and community levels, and random effects at the household and cluster levels. The data showed significant residual clustering at the household level, indicating that there were unmeasured factors operating at this level that are associated with ITN use. The association of age with ITN use was moderated by sex such that men, older children, and teenagers were less likely to sleep under an ITN compared to women and children under five years old. Female caregivers' perceived severity of malaria, perceived self efficacy to detect a complicated case of malaria, and exposure to the "Take Cover" communication campaign were positively associated with ITN use by members of her household. The association with household size was negative, while the relationship with the number of ITNs was positive. Programs should seek to achieve universal coverage (that is, one ITN for every two household members) and promote the notion that everyone needs to sleep under an ITN every night. Programs should also seek to strengthen perceived severity of malaria and educate intended audience groups on the signs of malaria complications. Given the significance of residual clustering at the household level, interventions that engage men as heads of household and key decision-makers are relevant.