Predictors of Long-Lasting Insecticidal Net Ownership among Households in Gombe Metropolis, North-east Nigeria

Abstract

Malaria continues to be a major public health concern worldwide, with sub-Saharan Africa carrying the highest burden of illness and death. Nigeria contributes a large share of global cases and fatalities, particularly among children under five years. Although long-lasting insecticidal nets (LLINs) are a proven and widely promoted preventive measure, their consistent use remains low in many communities. This study examined the factors influencing LLIN ownership among households in Gombe Metropolis, North-east Nigeria, to provide evidence for improving malaria prevention strategies. A community-based cross-sectional study was conducted among adult household members aged 18 years and above who had lived in Gombe Metropolis for at least six months. A sample size of 420 was determined using Fisher's formula, with a 10% added for non-response. A modified WHO 30-cluster sampling technique was used to select 30 settlements from 282 communities, followed by systematic household selection within clusters. Data were collected in June 2025 using a semi-structured questionnaire adapted from the Nigeria Malaria Indicator Survey and the Nigeria Demographic and Health Survey. The questionnaire captured socio-demographic characteristics, malaria knowledge, LLIN ownership and use, as well as barriers and facilitators to utilization. Data were collected electronically using KoboToolbox and analyzed using Microsoft Excel and Epi Info version 7.2. Chi-square tests and multivariate logistic regression were used to identify factors associated with LLIN ownership (p < 0.05). All 420 questionnaires were completed, giving a 100% response rate. The mean age of respondents was 26 ± 6.0 years, and most were married (88.8%), Muslim (96.2%), and Hausa (46.7%). Overall, 80.7% had good knowledge of malaria and LLINs, while awareness of malaria was almost universal (98.6%). Most households (86.7%) owned at least one LLIN and ownership was significantly associated with antenatal care attendance, malaria knowledge, exposure to health worker and media messages, and community availability of nets (p < 0.05). Despite high awareness and relatively good ownership of LLINs, ownership remains below recommended levels in Gombe Metropolis. Both access-related factors and personal experiences especially comfort and perceptions play important roles in determining LLIN ownership. There are needs to strengthen LLIN distribution through antenatal care services and community platforms, improve targeted health education through health workers and media, and address behavioural barriers such as heat, discomfort, and perceived inconvenience. Community engagement and tailored interventions for vulnerable households are also essential to improve sustained LLIN ownership and reduce malaria transmission.