Background: Long lasting insecticide net (LLIN) is one of the major tools utilized in the control and prevention of malaria across all age groups. Aim: This study compared the accessibility and usage patterns of LLIN in rural communities of Odeda and Imeko-Afon local government areas (LGAs). Materials and Methods: Three villages were selected each from Odeda and Imeko-Afon LGAs using the simple random sampling method. Questionnaires were administered to the head of households, and personal information was collected from individual member of the family. Descriptive analysis was used to summarize important variables. Results: A total of 140 households participated in the study, 70 from each LGA. Of the households surveyed, 87.1% have LLIN in Imeko-Afon LGA and was significantly higher (P = 0.0000) compared to 60% in Odeda LGA (P = 0.000). However, 96.7% and 95.2% of households in Imeko-Afon and Odeda LGAs respectively acquired the LLIN free from the government. The utilization rate by househeads the night prior the study was 72.1% and 57.1% in Imeko-Afon and Odeda LGA respectively (P = 0.115). Of the total respondents, only 47.9% in Imeko-Afon and 32.4% in Odeda sleep under the net everyday (P = 0.000) and 22.9% and 62.1% respectively in both LGAs do not sleep under LLIN (P = 0.000). There was a significant difference (P = 0.000) in the number of respondents that sleep under LLIN every day between the two LGAs. Reason for not sleeping under net was majorly heat. Conclusion: There is a need for more awareness and health education on proper utilization and maintenance of LLIN to enhance the effectiveness of the net.
Keywords: Access, intervention tools, local government area, long lasting insecticide net, malaria, utilization
|How to cite this article:
Adeniran A A, Mogaji O H, Oluwole S A, Abe M E, Bankole O S, Ekpo F U. Commodity utilization of malaria intervention and control tool: Access and utilization of long lasting insecticide net in rural communities of Imeko-Afon and Odeda local government area of Ogun state, Nigeria. Ann Trop Med Public Health 2014;7:85-90
|How to cite this URL:
Adeniran A A, Mogaji O H, Oluwole S A, Abe M E, Bankole O S, Ekpo F U. Commodity utilization of malaria intervention and control tool: Access and utilization of long lasting insecticide net in rural communities of Imeko-Afon and Odeda local government area of Ogun state, Nigeria. Ann Trop Med Public Health [serial online] 2014 [cited 2017 Nov 14];7:85-90. Available from: https://www.atmph.org/text.asp?2014/7/2/85/146382
Malaria infection is widely distributed in tropical and sub-tropical region of the world including Sub-Saharan Africa where the vector, female Anopheles mosquitoes can survive and multiply.  It is one of the principal causes of sickness in Nigeria and imposes enormous socio-economic burden on the country.  Infection is holoendemic with intense all year round transmission and a greater intensity in the wet than the dry seasons. 
The standard tools for the control and prevention of malaria are of two forms, the curative one being the effective case management using chemotherapy and the preventive measures which include the use of intermittent preventive treatment, indoor residual spraying, insecticide treated net and long lasting insecticide net (LLIN). 
Long lasting insecticide net is one of the major commodities advocated for the control and prevention of malaria in Sub-Saharan Africa.  The nets are freely distributed or sold at a subsidized rate by government and non-governmental organizations. Several studies have shown the efficacy and cost effectiveness of the net in the control of malaria where properly used ,,, but the rates of net coverage remain disappointingly low in many African countries, especially among the poorest households. 
In Nigeria, LLIN has been distributed to several communities in states and local government area (LGA), including Ogun state.  However, the coverage rate, utilization, and maintenance of LLIN in most rural communities are not properly documented. It is, therefore, important to determine access, utilization and maintenance of LLIN in rural communities in Nigeria so as to identify challenges preventing the effective utilization of this tool.
|Material and Methods|
The study was conducted in Imeko-Afon and Odeda LGAs. Imeko-Afon LGA is located in the western senatorial district of Ogun state and Odeda LGA is in the central senatorial district of the state. The major languages spoken in Imeko-Afon LGA are the local Imeko dialect and Egun. Tribes include Yoruba, migrating Egun from the neighboring Benin republic and the nomadic Fulani herdsmen. In Odeda LGA, the Egba people are the major ethnic group. The major occupations in the communities include farming, quarrying and trading.
Three villages were randomly selected from each LGA. Abule-Peter, Oke-Bembe and Babalawo Temidire was selected from Imeko-Afon LGA while, in Odeda LGA, the villages selected include Obete-Akanbi, Obete-Abopa and Ijemo Fadipe.
Exhaustive sampling of the villages was done barring those that did not give their consent to the study. Household was defined as a group of people eating from the same bowl. 
Data collection was made using a structured questionnaire. Among questions asked were frequency of sleeping under the net, possession of LLIN, number of LLIN possessed and mode of acquisition. Questionnaires were administered to the head of each household sampled to determine their knowledge about malaria, its vector and their access and utilization of malaria control tools in the household. However, personal information such as education status, age, occupation, frequency of net usage was collected individually from members of each household.
Data from questionnaire were entered into Microsoft Office Excel 2007 (Microsoft corporation) and was analyzed using Statistical Package for Social Sciences, SPSS version 16 (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics was used to summarize important variables, while t-test was used to compare mean number of LLIN per household in the LGAs.
Ethical approval and consent
Ethical consents and approval were obtained from the primary health care center of both Odeda LGA and Imeko-Afon LGA prior to commencement of the study. The village heads of the different communities also consented before the study was conducted. Written consents were collected from all househeads on behalf of respondents from the family after thorough explanation of the purpose of the study.
A total of 140 households from 6 villages participated in the study; with 70 households from each LGA. A total of 374 respondents (168 males and 206 females) participated in the study. [Table 1] shows the demographic characteristics of the respondents from the two LG.
|Table 1: Demographic characteristics of respondents
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Eighty-seven percent of household in Imeko-Afon LGA had LLIN compared to 60% in Odeda LGA that is significant at P = 0.000 [Table 2]. However, there was no significant difference in the means of acquisition of the net (P = 0.702) as most household acquired LLIN free from government.
|Table 2: Comparison of access and utilization of LLIN in the two LGAs
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Of the total respondents from each LGA, 77.1% of respondents from Imeko-Afon LGA sleep under LLIN at least once a week compared to 37.9% in Odeda LGA with a significant difference of P = 0.000. A total 47.9% of the population sampled in Imeko-Afon LGA sleeps under net everyday compared to 32.4% in Odeda LGA with a significant difference of P = 0.000 [Table 3].
|Table 3: Comparison of househeads with LLIN and those sleeping under LLIN
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Educational status was found to have little effect on the frequency of sleeping under the net [Figure 1] in Imeko-Afon compared to Odeda where a larger proportion of respondents not sleeping under the net lack formal education. Also, 81.5% of children <5 in Imeko-Afon LGA sleep under the net but only 45.5% of children <5 in Odeda LGA sleep under LLIN [Table 4]. The highest number of respondents that do not sleep under the net was found in Odeda LGA while Imeko-Afon have the highest number of respondents sleeping under net every day [Figure 2].
|Figure 1: Chart showing comparison in the educational level and frequency on long lasting insecticide net usage in the two local government areas
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|Figure 2: Comparison of frequency of sleeping among respondents from both local government areas
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|Table 4: Comparing utilization of LLIN across the age group
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Knowledge, attitude and practices
A total of 98.6% of heads of households in both LGAs has heard about LLIN before the study. Of those that have LLIN, 83.6% have washed the net at least once in Imeko-Afon and 52.4% in Odeda LGA, which is significant at P = 0.000 [Table 5]. Furthermore, 90.2% of respondents from Imeko-Afon had set up their net compare to the relatively low 66.7% in Odeda. A high proportion of respondents that have set up the net in both LGAs have been using the net for more than 8 months, 94.8% and 82.1%, respectively.
|Table 5: Knowledge, attitude and practices about LLIN
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The free mass distribution of LLIN by government through the Roll Back Malaria program has enhanced access to LLIN by rural communities members in the two LGAs although communities in Imeko-Afon LGA were observed to have higher access rate of 87.1% than the 60% observed in Odeda LGA. The access rate in both LGA is however greater than the 45% earlier reported,  but it is relatively in accordance with findings in Sierra-Leone that reported 87.6% possession after government mass distribution campaign.  Household coverage of 75% was also reported in the Gambia,  which is also in relative agreement with the result obtained from this study. Eight-seven percent of household in Imeko-Afon possessed at least one LLIN with a mean of 2.10 compared to 60% in Odeda with a mean of 1.36. The high coverage and possession found in communities of Imeko-Afon LGA is in relative agreement with the projection of LLIN coverage by the Federal Ministry of Health, Nigeria that LLIN would by 2010 reach at least 80% coverage level and that households would have at least two or more LLIN.  In contrast, result however showed that rural communities in Odeda LGA are still below the target.
Access to LLIN is not affected by education level because of the mass distribution of the material by the government; however, this contradicts previous findings that education and occupation are major predictors in possessing mosquito nets.  This discrepancy can be attributed to free mass distribution of LLIN by government as also reported elsewhere.  The coverage level of LLIN in Odeda LGA is low compared to Imeko-Afon LGA, this is observed in this study as 40% of the households do not have net and 62.1% of respondents from the Odeda LGA were not sleeping under LLIN. It was also observed that 66.7% of the households at Odeda LGA have only one net compared to 57% that have two nets in Imeko-Afon; this is insufficient to cater for all members of the households.
Utilization level is greater in Imeko-Afon LGA than Odeda LGA, this can be as a result of the significant difference observed in the coverage level in the two LGAs and also that majority of the respondents in Imeko-Afon has at least primary education [Figure 1]. This emphasized the enormous impact education have on utilization and is consistent with other observations that maternal education has effect on the use of nets.  Also, the mean coverage of 1.36 and 0.74 LLIN currently in use [Table 2] found in Odeda is insufficient to cater for all members of a household compared with the average of 2.1 mean coverage and 1.7 LLIN currently in use in Imeko-Afon LGA as shown in [Table 6].
|Table 6: Coverage and utilization level of LLIN within households
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The study found out that there is general knowledge about LLIN as a malaria control tool in both LGAs as virtually all househeads with the exception of a single househead in Odeda LGA who claimed not to have heard about LLIN prior the study. Some of the reasons stated for not sleeping regularly under LLIN include heat, problem of how to hang the net and inadequacy of the nets, especially in communities from Odeda LGA where mean of LLIN in use was μ = 1.36 ± 0.53 which is lower than the target of two nets by the Federal Ministry of Health, Nigeria. Majority of household that have hung LLIN have washed it at least once because of dirt or majorly as what they termed necessary before first usage. There were reported cases in Imeko-Afon, were respondents that were not in possession of LLIN at the time of the study have acquired it before but had burnt or discarded it citing reasons as rumors that it kills. In both LGAs, however, a higher proportion of those that are using the net have been using it for more than 8 months.
It is pertinent to improve on the distribution strategy, though it was observed that LLINs were distributed freely in both LGAs. The possession of LLIN of an average of less than two nets to a household is low and does not ensure that all member of the household have the opportunity to sleep under the net everynight. There is need to intensify efforts on LLIN coverage to ensure that every member of the communities will be able to sleep under a net every night. It is also important that the authorities in-charge sustain the program to ensure continuous effective distribution of new LLINs and replacement of old nets. It is necessary to further educate the people on the need to make good use of LLIN by sleeping under it every night, most especially in these rural areas where malaria prevalence is usually high. Further studies on LLIN utilization is, therefore, advised, as this will help equip public health authorities with in-depth information for proper planning and efficient execution in the future and can also be used as a medium to sensitize the populace on the importance and efficacy of LLIN.
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Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]