OBJECTIVE: To evaluate the ownership and use of insecticide-treated nets (ITNs) by the local community 2 years after a free distribution campaign in Ethiopia.
METHODS: This is a population-based survey using a two-stage cluster sample design in 115 randomly selected clusters in Oromia and Amhara regional states of Ethiopia, performed in June 2009. Data on the possession and use of ITNs were collected using structured and pre-tested questionnaires through house-to-house visits. Bivariate and multivariate logistic regression analyses were performed to examine the effect of participant's malaria knowledge, location and ITN characteristics on the use of ITNs.
RESULTS: A total of 2874 households participated in the study, and 90.6% of the study population was knowledgeable about ITNs. About 49.1% of households reported at least one ITN; 28.4% owned two or more. ITN coverage was significantly lower in Oromia (34.9%) than in Amhara (76.8%, P<0.001). The average number of ITNs per ITN-owning household was 1.8. In all surveyed households, only 21.8% of all family members, 29.4% of all children under the age of 5 years and 23.2% of all pregnant women had slept under an ITN the night preceding the survey. Among ITN-owning households, 63.0% of all children under the age of 5 years and 52.1% of pregnant women had slept under an ITN the night before the survey. Using multivariate analysis, factors significantly associated with ITN use were number of ITNs in the household, number of ITNs hung over the bed in the household, women's knowledge of ITNs and women's lack of problem in using ITNs, whereas region, area of residence and ITN status were not.
CONCLUSIONS: Household ITN ownership and use remain below the current Roll Back Malaria targets of universal coverage. A replacement strategy is urgently needed to scale-up coverage and use of ITNs.