A subnational profiling analysis reveals regional differences as the main predictor of ITN ownership and use in Nigeria

Abstract

Background: To reduce the malaria burden in Nigeria, the country is scaling up prevention and treatment interventions, especially household ownership and use of insecticide-treated nets (ITNs). Nevertheless, large gaps remain to achieve the goals of the National Malaria Strategic Plan 2014-2020 of universal access to ITNs and their increased use. To inform the targeting of intervention strategies and to maximize impact, the authors conducted a sub-national profiling of household ITN ownership and use in the general population to identify key predictors of ITN ownership and use, and the sub-groups that are at higher risk of low ITN coverage and use.

Methods: The authors conducted a secondary analysis of data from the 2015 Nigeria Malaria Indicator Survey. Using the Chi square automatic interaction detector (CHAID) and multiple logistic regression analysis, the authors examined the key predictors of ITN ownership and use in the general population throughout Nigeria.

Results: The CHAID models identified region of the country as the best predictor of household ownership of at least one ITN and its use in the general population, with higher ownership and use observed in the northern regions. The odds of a household owning an ITN were five times greater in the North West region compared with the North Central region (odds ratio [OR] = 5.47, 95% confidence interval [CI] 4.46-6.72, p < 0.001). The odds of ITN use were two times greater for those living in the North West region compared with the North Central region (OR = 2.04, 95% CI 1.73-2.41, p < 0.001). Other significant predictors were household size, head of household education level, household wealth quintile, and place of residence. The CHAID gain index results identified households in the South West, North Central and South Central regions with low ITN ownership, and the general population in the South South, South East and North Central regions with low ITN use.

Conclusions: This study reveals regional differences in ITN ownership and use in Nigeria. Therefore, the findings from this analysis provide evidence that could inform the NMEP to better target future campaign and routine distribution of ITNs, to achieve universal access and increased use by 2020 in Nigeria.

Keywords: Chi square automatic interaction detection; Insecticide-treated nets; Malaria prevention and treatment; Net use; Nigeria; Sub-Saharan Africa.

Fig. 1

CHAID tree diagram for household ownership of at least one ITN. HH households, N number of households

Fig. 2

CHAID tree diagram for household ownership of at least one ITN. a North West, b North East, c North Central and South South, d South West regions and e South East region

Fig. 2

CHAID tree diagram for household ownership of at least one ITN. a North West, b North East, c North Central and South South, d South West regions and e South East region

Fig. 2

CHAID tree diagram for household ownership of at least one ITN. a North West, b North East, c North Central and South South, d South West regions and e South East region

Fig. 2

CHAID tree diagram for household ownership of at least one ITN. a North West, b North East, c North Central and South South, d South West regions and e South East region

Fig. 3

CHAID tree diagram for the general population who did not use an ITN the previous night. HH households, N number of households

Fig. 4

CHAID tree diagram for the general population who did not use an ITN the previous night: a North West, b North East, c North Central, d South West and South East and e South South region

Fig. 4

CHAID tree diagram for the general population who did not use an ITN the previous night: a North West, b North East, c North Central, d South West and South East and e South South region