Coverage and Factors associated with utilization of Pyrethroid-Piperonyl Butoxide treated nets in Malaria Endemic Region, Western Kenya

Abstract

Abstract Background: Increased resistance to pyrethroid based Long-Lasting Insecticidal Nets (LLINs) informed WHO recommendation to deploy Piperonyl Butoxide (PBO) based LLINs. Kenya adopted use of PBO nets in endemic areas, though coverage is not known. We determined coverage and factors associated with utilization of PBO nets in a malaria endemic county. Methods: A cross-sectional study was conducted with multi-stage sampling in Matayos Sub-County, Busia County. Data were collected using questionnaire from June-July 2022. Data was analyzed by Stata version 16. Universal coverage was defined as ownership of one PBO net for two household members. Proper utilization was defined as sleeping under a mosquito net the previous night, net usage on all days of the week, hanging the net adequately. Data was collected on net ownership, access, utilization. Proper utilization of nets was the dependent variable. We calculated measures of central tendency and dispersion for continuous variables and proportions for categorical variables. Odds ratio with 95% confidence intervals was used to test for association between dependent and independent variables and variables with a p-value< 0.05 were considered to be statistically significant. Results A total of 402 participants were interviewed; mean age was 41.2 years (±16.7 years), 268 (66.7%) resided in rural areas, 77.9% (313) were female, 71.4% (287) were married, 45% (181) had at least 8 years of formal education and 86.6% (348) had informal occupations. Among all respondents, 86.3% (347) had bed nets, 92.8% (322/347) were PBO nets. A total of 64.9% (261) households attained universal coverage for bed nets. The utilization of PBO treated LLINs was significantly lower in households with heads in informal occupations compared to those in formal occupations (aOR = 0.29, 95% CI = 0.11-0.78). Additionally, households without universal coverage for bed nets had significantly lower odds of utilizing a PBO-treated LLIN compared to those with universal coverage (aOR = 0.01, 95% CI = 0.01-0.03). Conclusion: Universal coverage of PBO nets was below the national target (80%). Occupation and universal coverage were associated with the utilization of PBO nets. We recommend for continuous PBO nets distribution through additional innovative channels.