Knowledge, Attitudes, Ownership, and Utilization of Mosquito Nets among Mothers/Caregivers of under Five Children in South Sudan
DOI:
https://doi.org/10.6000/1929-4247.2026.15.01.6Keywords:
Knowledge, Attitudes, Ownership, Utilization, Treated mosquito nets, South SudanAbstract
Background: Malaria is a leading cause of illness and death in under five and pregnant women. Despite insecticide-treated nets' mass distribution, their utilization is low. ITNs persisted in a preventive intervention and a physical barrier to mosquitoes. We explore fever prevalence, health-seeking, knowledge, attitudes, practices, and ITN ownership and utilization among mothers/caregivers of U-5 children in South Sudan.
Methods: A community-based descriptive cross-sectional survey was implemented in 23 counties with high malaria incidences. Mothers/caregivers of U-5 were recruited. A multi-stage cluster random sampling technique was used. Trained enumerators were employed to administer a questionnaire adopted from the malaria indicator survey. Kobo collects v.2022.2 was used, and SPSSTM 27 was used for analysis.
Results: A total of 466 interviews were completed, bypassing 460 sample size estimates. Of 466, 89.3% (n=416) were mothers/caregivers of U-5. 73% were females. The majority is 25-34 years old, with 34.3% (95% CI 30 - 39). 60.1% had no formal education, 91.8% (89.5 - 94.2) were employed in the private sector, and Fever prevalence in U-5 was 56.1%. Treatment was sought for 59.2% of U-5 with fever, and 25.1% received timely care. 46% received treatment from a government hospital, 9% from private, and 44.9% received ACT. Utilization of any nets and ITNs was 72% and 69.4%. Overall ownership and usage were 72.3% and 71.9%; 73.1% of females used ITNs, and 72.2% were religious believers. 94% U-5 with at least one ITN slept under an ITN last night.
Conclusion: The majority of respondents had a better understanding of malaria prevention but poor seeking behavior. Low ownership and utilization of ITNs were revealed. Thus, improvement in community education towards early treatment-seeking and ITN usage is required. Our findings would be useful for effective treatment, response to control, and prevention in highly endemic zones of South Sudan.
References
Sabin L, Hecht EMS, Brooks MI, Singh MP, Yeboah-Antwi K, Rizal A, et al. Prevention and treatment of malaria in pre-gnancy: what do pregnant women and health care workers in East India know and do about it? Malar J 2018; 17(1): 207. DOI: https://doi.org/10.1186/s12936-018-2339-9
Alonso Y, Lusengi W, Manun'Ebo MF, Rasoamanan-jaranahary AM, Rivontsoa NM, Mucavele E, et al. The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of the Congo. BMJ Glob Health 2022; 7(11): e010079. DOI: https://doi.org/10.1136/bmjgh-2022-010079
World Malaria Report 2024. https://www.who.int/data/gho/data/themes/malaria
Ayeni GO, Olagbegi OM, Nadasan T, Abanobi OC, Daniel EO. Factors Influencing Compliance with The Utilization of Effective Malaria Treatment and Preventive Measures in Wulu, South Sudan. Ethiop J Health Sci [Internet] 2020 Jul 1 [cited 2024 May 6]; 30(4).
Identifying exceptional malaria occurrences in the absence of his: Ingenta Connect [Internet]. [cited 2024 Jun 11]. Available from: https://www.ingentaconnect.com/content/iuatld/pha/ 2019/00000009/00000003/art00004
Draebel T, Gueth Kueil B. Lay perceptions of malaria and therapeutic itinerary of resettled pregnant women in South Sudan. Int Health 2014; 6(4): 317-21. DOI: https://doi.org/10.1093/inthealth/ihu047
Ravi N, Holsted E, Kadiebwe B, Salthouse A, Sattar A. A malaria knowledge, attitudes, and practice survey in a rural community in Guinea. Malar J 2022; 21(1): 329. DOI: https://doi.org/10.1186/s12936-022-04357-6
Alam MdZ, Islam MdS. Is there any association between undesired children and the health status of under-five children? Analysis of a nationally representative sample from Bangladesh. BMC Pediatr 2022; 22: 445. DOI: https://doi.org/10.1186/s12887-022-03489-7
Shifera N, Endale A, Debela D, Yosef T. Acute malnutrition and its contributing factors among children under five years in rural kebeles of Shashemene Oromia, Ethiopia. Front Nutr 2022; 9: 1053928. DOI: https://doi.org/10.3389/fnut.2022.1053928
Deka S, Kalita D, Hazarika NK. Prevalence and Risk Factors of Intestinal Parasitic Infection in Under-Five Children With Malnutrition: A Hospital Based Cross-Sectional Study. J Fam Med Prim Care 2022; 11(6): 2794-801. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1742_21
Menalu MM, Bayleyegn AD, Tizazu MA, Amare NS. Assessment of Prevalence and Factors Associated with Malnutrition Among Under-Five Children in Debre Berhan Town, Ethiopia. Int J Gen Med 2021; 14: 1683-97. DOI: https://doi.org/10.2147/IJGM.S307026
Jubayer A, Islam MH, Nayan MM. Malnutrition among under-five children in St. Martin's Island, Bangladesh: A cross-sectional study on prevalence and associated factors. SAGE Open Med 2022; 10: 20503121221116246. DOI: https://doi.org/10.1177/20503121221116246
Abu-Manga M, Al-Jawaldeh A, Qureshi AB, Ali AME, Pizzol D, Dureab F. Nutrition Assessment of Under-Five Children in Sudan: Tracking the Achievement of the Global Nutrition Targets. Child Basel Switz 2021; 8(5): 363. DOI: https://doi.org/10.3390/children8050363
Gelaw NB, Tessema GA, Gelaye KA, Tessema ZT, Ferede TA, Tewelde AW. Exploring the spatial variation and associated factors of childhood febrile illness among under-five children in Ethiopia: Geographically weighted regression analysis. PLOS ONE 2022; 17(12): e0277565. DOI: https://doi.org/10.1371/journal.pone.0277565
Margwe JA, Lupindu AM. Knowledge and Attitude of Pregnant Women in Rural Tanzania on Prevention of Anaemia. Afr J Reprod Health 2018; 22(3): 71-9.
Buck E, Finnigan NA. Malaria. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jul 8]. Available from: http://www.ncbi.nlm.nih.gov/books/ NBK551711/
Elmardi KA, Adam I, Malik EM, Kafy HT, Abdin MS, Kleinschmidt I, et al. Impact of malaria control interventions on malaria infection and anaemia in low malaria transmission settings: a cross-sectional population-based study in Sudan. BMC Infect Dis 2022; 22(1): 927. DOI: https://doi.org/10.1186/s12879-022-07926-x
Wondemagegn AT, Mulu A. Effects of Nutritional Status on Neurodevelopment of Children Aged Under Five Years in East Gojjam, Northwest Ethiopia, 2021: A Community-Based Study. Int J Gen Med 2022; 15: 5533-45. DOI: https://doi.org/10.2147/IJGM.S369408
Omar A, Mehriban N. Assessment of nutritional status of under 5-year-old children in Banadir Hospital, Mogadishu, Somalia. Matrix Sci Pharma 2019; 3: 32. DOI: https://doi.org/10.4103/MTSP.MTSP_12_19
Asmare AA, Agmas YA. Determinants of coexistence of stunting, wasting, and underweight among children under five years in the Gambia; evidence from 2019/20 Gambian demographic health survey: application of multivariate binary logistic regression model. BMC Public Health 2022; 22: 1621. DOI: https://doi.org/10.1186/s12889-022-14000-3
Renzaho AMN, Dachi G, Ategbo E, Chitekwe S, Doh D. Pathways and approaches for scaling-up of community-based management of acute malnutrition programs through the lens of complex adaptive systems in South Sudan. Arch Public Health 2022; 80(1): 203. DOI: https://doi.org/10.1186/s13690-022-00934-y
Eriga F, Gulom G, Alege JB. Predictors of under-weight among children younger than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan: a community-based cross-sectional study. BMC Public Health 2024; 24: 1400. DOI: https://doi.org/10.1186/s12889-024-18836-9
Chanda E, Doggale C, Pasquale H, Azairwe R, Baba S, Mnzava A. Addressing malaria vector control challenges in South Sudan: proposed recommendations. Malar J 2013; 12: 59. DOI: https://doi.org/10.1186/1475-2875-12-59
Malaria | WHO | Regional Office for Africa [Internet]. [cited 2024 Aug 6]. Available from: https://www.afro.who.int/health-topics/malaria#: ~: text=In%202022%2C%2095%25%20of% 20all%20malaria%20deaths%20%28580,Region%2C%20compared%20to%20593%20000%20cases%20in%202021.
Lindsay SW, Thomas MB, Kleinschmidt I. Threats to the effectiveness of insecticide-treated bednets for malaria control: thinking beyond insecticide resistance. Lancet Glob Health 2021; 9(9): e1325-31. DOI: https://doi.org/10.1016/S2214-109X(21)00216-3
Kitila FL, Petros RM, Jima GH, Desalegn T, Sorsa A, Massey IY, et al. Under-five mortality and associated factors in southeastern Ethiopia. PLoS ONE 2021; 16(9): e0257045. DOI: https://doi.org/10.1371/journal.pone.0257045
Atem MD. South Sudan Conflict: Identifying Challenges and Opportunities in Implementing Peacebuilding Through Sustainable Development 2022 [cited 2024 Jun 21]; Available from: https://mspace.lib.umanitoba.ca/handle/ 1993/36223
Nyavor KD, Kweku M, Agbemafle I, Takramah W, Norman I, Tarkang E, et al. Assessing the ownership, usage, and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana. Pan Afr Med J 2017; 28: 67. DOI: https://doi.org/10.11604/pamj.2017.28.67.9934
Bal M, Das A, Ghosal J, Pradhan MM, Khuntia HK, Pati S, et al. Assessment of the effectiveness of DAMaN: A malaria intervention program initiated by the Government of Odisha, India. PloS One 2020; 15(9): e0238323. DOI: https://doi.org/10.1371/journal.pone.0238323
Sabin LL, Rizal A, Brooks MI, Singh MP, Tuchman J, Wylie BJ, et al. Attitudes, knowledge, and practices regarding malaria prevention and treatment among pregnant women in Eastern India. Am J Trop Med Hyg 2010; 82(6): 1010-6. DOI: https://doi.org/10.4269/ajtmh.2010.09-0339
Linn SY, Maung TM, Tripathy JP, Shewade HD, Oo SM, Linn Z, et al. Barriers in distribution, ownership, and utilization of insecticide-treated mosquito nets among migrant population in Myanmar, 2016: a mixed methods study. Malar J 2019; 18(1): 172. DOI: https://doi.org/10.1186/s12936-019-2800-4
South Sudan Ministry of Health, Health Sector Strategic Plan 2023-2027 (HSSP) https://www.afro.who.int/countries/south-sudan/news/south-sudan-develops-next-health-sector-strategic-plan-2023-2027
Ayeni GO, Olagbegi OM, Nadasan T, Abanobi OC, Daniel EO. Factors Influencing Compliance with The Utilization of Effective Malaria Treatment and Preventive Measures in Wulu, South Sudan. Ethiop J Health Sci [Internet] 2020 Jul 1 [cited 2024 Jun 11]; 30(4). DOI: https://doi.org/10.4314/ejhs.v30i4.5
Jacob IA. The temporal and spatial incidence and transmission of malaria in South Sudan (2011-2018). South Sudan Medical Journal 2020; 13(5): 200-202
A good night's sleep and the habit of net use: perceptions of risk and reasons for bed net use in Bukoba and Zanzibar. Malar J 2013; 12: 203. DOI: https://doi.org/10.1186/1475-2875-12-203
Oladimeji KE, Tsoka-Gwegweni JM, Ojewole E, Yunga ST. Knowledge of malaria prevention among pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, South West Nigeria. Malar J 2019; 18: 92. DOI: https://doi.org/10.1186/s12936-019-2706-1
Dambhare DG, Nimgade SD, Dudhe JY. Knowledge, attitude and practice of malaria transmission and its prevention among the school going adolescents in Wardha District, Central India. Glob J Health Sci 2012; 4(4): 76-82. DOI: https://doi.org/10.5539/gjhs.v4n4p76
Yimer F, Animut A, Erko B, Mamo H. Past five-year trend, current prevalence and household knowledge, attitude and practice of malaria in Abeshge, south-central Ethiopia. Malar J 2015; 14: 230. DOI: https://doi.org/10.1186/s12936-015-0749-5
Kebede Y, Abebe L, Alemayehu G, Sudhakar M, Birhanu Z. School-based social and behavior change communication (SBCC) advances community exposure to malaria messages, acceptance, and preventive practices in Ethiopia: A pre-posttest study. PLOS ONE 2020; 15(6): e0235189. DOI: https://doi.org/10.1371/journal.pone.0235189
Munisi DZ, Nyundo AA, Mpondo BC. Knowledge, attitude, and practice towards malaria among symptomatic patients attending Tumbi Referral Hospital: A cross-sectional study. PLoS ONE 2019; 14(8). DOI: https://doi.org/10.1371/journal.pone.0220501
MoH R. WHO | Regional Office for Africa 2017 [cited 2024 May 6]. South Sudan Malaria Indicator Survey 2017. Available from: https://www.afro.who.int/publications/south-sudan-malaria-indicator-survey-2017
Adebayo AM, Akinyemi OO, Cadmus EO. Ownership and utilisation of insecticide-treated mosquito nets among caregivers of under-five children and pregnant women in a rural community in southwest Nigeria. J Prev Med Hyg 2014; 55(2): 58-64.
Taremwa IM, Ashaba S, Adrama HO, Ayebazibwe C, Omoding D, Kemeza I, et al. Knowledge, attitude, and behaviour towards the use of insecticide-treated mosquito nets among pregnant women and children in rural Southwestern Uganda. BMC Public Health 2017; 17(1): 794. DOI: https://doi.org/10.1186/s12889-017-4824-4
Das S, Rahman MM, Rahaman MM, Noor M, Akter M, Uddin MJ, et al. Knowledge, attitude, and prevention practices of garment factory workers regarding the largest Dengue outbreak on record in Bangladesh. Transbound Emerg Dis 2022; 69(2): 360-8. DOI: https://doi.org/10.1111/tbed.13987
Andegiorgish AK, Goitom S, Mesfun K, Hagos M, Tesfaldet M, Habte E, et al. Community knowledge and practice of malaria prevention in Ghindae, Eritrea, a Cross-sectional study. Afr Health Sci 2023; 23(1): 241-54. DOI: https://doi.org/10.4314/ahs.v23i1.26
Adewole AO, Cash S, Umar A, Ajumobi O, Bala U, Waziri N, et al. Malaria frontline project: pre-intervention Malaria baseline assessment in Kano and Zamfara States, 2016.
de Sousa Pinto L, Arroz JAH, Martins M do RO, Hartz Z, Negrao N, Muchanga V, et al. Malaria prevention knowledge, attitudes, and practices in Zambezia Province, Mozambique. Malar J 2021; 20(1): 293. DOI: https://doi.org/10.1186/s12936-021-03825-9
Govender I, Rangiah S, Kaswa R, Nzaumvila D. Malnutrition in children under the age of 5 years in a primary health care setting. South Afr Fam Pract 2021; 63(1): 5337. DOI: https://doi.org/10.4102/safp.v63i1.5337
Kiarie J, Karanja S, Busiri J, Mukami D, Kiilu C. The prevalence and associated factors of undernutrition among under-five children in South Sudan using the standardized monitoring and assessment of relief and transitions (SMART) methodology. BMC Nutr 2021; 7(1): 25. DOI: https://doi.org/10.1186/s40795-021-00425-3
Determinants of the use of insecticide-treated mosquito nets in pregnant women: a mixed-methods study in Ghana - PubMed [Internet]. [cited 2024 Jul 10]. Available from: https://pubmed.ncbi.nlm.nih.gov/35064966/
Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey | Malaria Journal | Full Text [Internet]. [cited 2024 Jul 11]. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-021-03738-7
Pooseesod K, Parker DM, Meemon N, Lawpoolsri S, Singhasivanon P, Sattabongkot J, et al. Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border. Malar J 2021; 20(1): 305.
Taremwa IM, Ashaba S, Kyarisiima R, Ayebazibwe C, Ninsiima R, Mattison C. Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study. BMC Public Health 2022; 22(1): 373. DOI: https://doi.org/10.1186/s12889-022-12771-3
Adedokun ST, Uthman OA. Individual and contextual correlates of mosquito net use among women in Nigeria. Malar J 2020; 19(1): 138. DOI: https://doi.org/10.1186/s12936-020-03219-3
Canavati SE, Kelly GC, Vo TH, Tran LK, Ngo TD, Tran DT, et al. Mosquito Net Ownership, Utilization, and Preferences among Mobile and Migrant Populations Sleeping in Forests and Farms in Central Vietnam: A Cross-Sectional Study. Am J Trop Med Hyg 2021; 104(5): 1917-24. DOI: https://doi.org/10.4269/ajtmh.20-0711
Mahmoud MH, Chikuni RL, Tawfik GM, Rashidy AI, Salama AE, Sulaiman LJ, et al. Global Usage Rate of Bed Nets During the Last Ten Years: A Systematic Review and Meta-Analysis [Internet]. Rochester, NY; 2020 [cited 2024 May 6]. DOI: https://doi.org/10.21203/rs.3.rs-90881/v1
Ng'ang'a PN, Aduogo P, Mutero CM. Long-lasting insecticidal mosquito nets (LLINs) ownership, use, and coverage following mass distribution campaign in Lake Victoria basin, Western Kenya. BMC Public Health 2021; 21(1): 1046. DOI: https://doi.org/10.1186/s12889-021-11062-7
Afagbedzi SK, Alhassan Y, Kenu E, Malm K, Bandoh DAB, Peprah NY, et al. Universal coverage and utilization of free long-lasting insecticidal nets for malaria prevention in Ghana: a cross-sectional study. Front Public Health [Internet] 2023 May 25 [cited 2024 May 7]; 11. DOI: https://doi.org/10.3389/fpubh.2023.1140604
Njumkeng C, Apinjoh TO, Anchang-Kimbi JK, Amin ET, Tanue EA, Njua-Yafi C, et al. Coverage and usage of insecticide-treated nets (ITNs) within households: associated factors and effect on the prevalence of malaria parasitemia in the Mount Cameroon area. BMC Public Health 2019; 19(1): 1216. DOI: https://doi.org/10.1186/s12889-019-7555-x
Baktayan NA, Assabri AM, Farea BA, Farea AA. Knowledge and Utilization of Long Lasting Impregnated Nets among Housewives in Al Moneera City and Al Koozi Villages, Hodeidah Governorate, Republic of Yemen 2007. Health (N Y) 2021; 13(3): 306-22. DOI: https://doi.org/10.4236/health.2021.133025
Pooseesod K, Parker DM, Meemon N, Lawpoolsri S, Singhasivanon P, Sattabongkot J, et al. Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border. Malar J 2021; 20(1): 305. DOI: https://doi.org/10.1186/s12936-021-03837-5
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