Long-lasting insecticide-treated bed net ownership and use among children under five years of age following a targeted distribution in central Uganda

BACKGROUND: Universal coverage of long-lasting insecticide-treated bed nets (LLINs) for prevention of malaria was adopted by the Uganda National Malaria Control Programme in 2007. The first mass distribution of LLINs was implemented in 2010. Initially, a campaign targeted to households with pregnant women and children aged <five years was carried out, prior to a planned fill-in campaign to achieve universal LLIN coverage. This survey was conducted after the targeted distribution in central Uganda to assess progress in LLIN ownership and usage among children <five years. METHODS: A two-stage, cluster-sample, cross-sectional household survey was carried out in early 2011 in Central region districts surveyed during the 2009 Malaria Indicator Survey (MIS). In the first sampling stage, 30 enumeration areas (EAs) were selected and all households were enumerated. Within each sampled EA, 20 households were randomly selected for interview using two questionnaires: a household questionnaire and a woman’s questionnaire for all women aged 15-49 years, both modified from the MIS. RESULTS: When compared to 2009 MIS results, household ownership of at least one LLIN increased by 47%, from 22 to 69% after the targeted campaign. LLIN use among children <five years increased by 40%, from 11 to 51%. Households with a child <six years old at the time of the survey, a proxy for those targeted, were significantly more likely to have received a campaign bed net (80.7 vs 35.2%, p < 0.001). LLIN ownership and use was equitable after the targeted campaign, with no significant differences by household wealth status. However, the proportion of households with at least one LLIN per two people was still low after the first campaign phase, increasing from 8.5 to 25.9%. CONCLUSIONS: The first phase of the campaign led to substantial increases in both LLIN ownership and equitable use among children <five years in the Central region. However, access to an LLIN within the household was still low after the first phase of the campaign, indicating the need for the universal fill-in campaign.