Background: Uganda conducted its third mass Long-Lasting Insecticide-treated Net (LLIN) distribution campaign in 2021. The target of the campaign was to ensure that 100% of households own at least 1 LLIN per 2 persons and to achieve 85% use of distributed LLINs. We assessed LLIN ownership, use, and associated factors 3 months after the campaign.
Methods: We conducted a cross-sectional household survey in 14 districts during April 13-30, 2021. We selected households using multistage sampling. We asked about LLIN ownership, use, duration since received until the time of interview, and visually verified the presence of LLINs. Outcomes were having at least one LLIN per 2 household members, and individual LLIN use. We used modified Poisson regression to assess associations between exposures and outcomes.
Results: In total, 5,529 households with 27,585 residents and 15,426 LLINs were included in the analysis. Overall, 95% of households owned ≥1 LLIN, 92% of the households owned ≥1 LLIN <3 months old, 81% of households owned ≥1 LLIN per 2 persons in the household, and 69% of residents slept under an LLIN the previous night. Factors associated with LLIN ownership included believing that LLINs are protective against malaria (aPR=1.13; 95% CI=1.04-1.24). Reported use of mosquito repellents was negatively associated with ownership of LLINs (aPR=0.96; 95% CI=0.95-0.98). The prevalence of LLIN use was 9% higher among persons who had LLINs 3-12 months old (aPR=1.09; 95% CI=1.06-1.11) and 10% higher among those who had LLINs 13-24 months old (aPR=1.10; 95% CI=1.06-1.14) than those who had LLINs <3 months old. Of 3,859 LLINs identified in the households but not used for sleeping the previous night, 3,250 (84%) were <3 months old. Among these 3,250, 41% were not used because owners were using old LLINs, 16% were not used because of lack of space for hanging them, 11% were not used because of fear of chemicals in the net, 5% were not used because of dislike of the smell of the nets, and 27% were not used because of other reasons.
Conclusion: Three months after a LLIN distribution campaign, both LLIN ownership and use remained well below targets. The government should consider distributing additional LLINs to achieve and sustain a target of ≥1 LLIN for 2 household members and behavior change communication before the distribution of LLINs to counter misconceptions about new LLINs.