Coverage and factors associated with the utilization of Pyrethroid-Piperonyl Butoxide treated nets in Matayos Sub-County, Busia County, Kenya.

Abstract

Background: Malaria is among the leading causes of morbidity and mortality in sub-Saharan Africa. Long-Lasting Insecticidal Nets (LLINs) use is key in the fight against malaria. Unfortunately, reports indicate a reduction in efficacy of the conventional LLINs due to insecticidal resistance, hence a recommendation by World Health Organization to deploy LLINs with Piperonyl Butoxide (PBO). Three Lake Endemic counties including Busia with a malaria prevalence of 39% piloted the new type of PBO nets before upscaling to the rest of the country. With limited resources and insufficient information on PBO nets, coverage and utilization may not be guaranteed. Objectives: This study sought to establish the socio-demographic factors, coverage, and factors associated with underutilization of PBO bed nets in Matayos sub-County, Busia County. Methods: A cross-sectional study was conducted from June through July 2022 in Matayos sub-County, Busia County. Multi-stage sampling was used to identify households and study participants. Data on the participants’ socio-demographics, PBO bed net coverage, and factors associated with underutilization were collected using a structured questionnaire. Universal coverage was defined as possessing one LLIN (PBO) net for every two household members. Proper utilization of a bed net was defined as sleeping under a mosquito net the previous night, using the net on all seven days of the week, tucking and hanging the net adequately. Continuous variables were summarized using mean and standard deviations, while categorical variables were presented using frequencies and proportions. Associations were assessed using odds ratios and 95% confidence intervals, factors with p<0.05 were considered statistically significant. Results: A total of 402 people took part in the study, with an average age of 41.2 years. Most of them, about 66.7% (268), lived in rural areas. The majority, 77.9% (313), were women, and 71.4% (287) were married. Almost half of them, 45% (181), had at least 8 years of schooling, and most, 86.6% (347), had jobs that weren't formal. When it comes to bed nets, 86.3% (347) of the people said they had them. Out of those, nearly all, 92.8% (322/347), were the special kind called PBO nets. About 64.9% (261) of households had enough bed nets for everyone, but that was below the target of 80%.The study found that households where the person in charge had informal jobs were less likely to use the PBO nets compared to those with formal jobs (adjusted odds ratio [aOR] = 0.29, 95% confidence interval [CI] = 0.11-0.78). Also, households that didn't have enough nets for everyone were much less likely to use the PBO-treated ones compared to those that did (aOR = 0.01, 95% CI = 0.01-0.03). Conclusion: Low education, single parenting, religion and house hold size socio-demographic factors were not associated with utilization of PBO bed nets. Universal coverage of PBO bed nets was below the national target of 80%, less than what the country aimed for. Respondents with informal occupations and households that had not attained universal coverage were less likely to properly utilize the PBO bed nets in Matayos sub-County, Busia County. Recommendation: Address barriers that influence utilization of PBO bed nets through alternative channels such as community engagement and targeted awareness campaigns, particularly among individuals in informal occupations. There is need for continuous PBO nets distribution through innovative channels like schools and upscale routine net distribution beyond targeted population (child and pregnant women) to supplement mass net distribution to improve universal coverage.