Effectiveness of long-lasting insecticide treated net use by socioeconomic status: a cross-sectional household study in area along Lake Victoria, Kenya

Abstract

<title>Abstract</title> <bold>Background</bold> This study focused on the importance of integrated vector mosquito management (IVM) in malaria control, particularly the pivotal role of long-lasting insecticide treated nets (LLINs). The objective was to assess the effectiveness of LLINs when properly used by no more than two people, controlling for differences in socioeconomic status (SES). We hypothesized that LLIN effectiveness would differ by SES and that LLIN effectiveness should be analyzed with adjustment for differences in SES. <bold>Methods</bold> We conducted a household level survey in an area in the Lake Victoria region in Suba North Sub-County, Homa Bay County, Western Kenya between June and September 2021. We assessed the number of people living in the home and the number of LLINs along with other demographic data. We calculated the ratio of people reporting sleeping under an LLIN to the total number of LLINs in the home. Through a school based, community survey, researchers administered blood-spot, PCR tests for <italic>Plasmodium</italic> infection. Community workers linked individual malaria tests to homes which participated in the household survey through names and geographic identifiers. A generalized linear model (GLM) tested the associations between household parasitemia risk in children and the ratio of people to LLINs, stratifying on asset-based household level SES measures. <bold>Results</bold> A stratified model by SES level indicated that using LLINs with no more than two people significantly reduced risk in middle SES households (OR 0.32, 95%CI 0.12–0.92) and in combined middle and low SES households (OR 0.37, 95% CI: 0.17–0.87). <bold>Conclusions</bold> Our results suggest that promoting the use of one LLIN by no more than two people, as recommended by WHO, can reduce the risk of malaria. Efforts to promote LLINs as an effective means of preventing malaria in children might encourage LLIN compliance and maintain community level control targets. If households have been excluded from LLIN distribution, LLINs should be distributed immediately along with information about their effectiveness. Strategies to sustain LLINs use and community benefits should be considered. These strategies could also promote community-wide IVM, including the use of LLINs.