Use of insecticide treated nets in children under five and children of school age in Nigeria: Evidence from a secondary data analysis of demographic health survey

BACKGROUND AND OBJECTIVE: Use of insecticide treated nets (ITN), one of the most cost-effective malaria interventions contributes to malaria cases averted and reduction in child mortality. We explored the use of ITN in children under five (CU5) and children of school age to understand factors contributing to ITN use. METHODS: A cross-sectional study analyzed 2018 Nigeria Demographic and Health Survey data. The outcome variable was CU5 or children of school age who slept under ITN the night before the survey. Independent variables include child sex, head of household’s sex, place of residence, state, household owning radio and television, number of household members, wealth quintile, years since ITN was obtained and level of malaria endemicity. Multi-level logistic regression model was used to access factors associated with ITN use among children. RESULTS: In total, 32,087 CU5 and 54,692 children of school age were examined with 74.3% of CU5 and 57.8% of children of school age using ITN the night before the survey. While seven states had more than 80% of CU5 who used ITN, only one state had over 80% of school children who used ITN. ITN use in CU5 is associated with living in rural area (aOR = 1.20, 95% CI 1.14 to 1.26) and residing in meso endemic area (aOR = 3.1, 95% CI 2.89 to 3.54). While In children of school age, use of ITN was associated with female headed households (aOR = 1.14, 95% CI 1.09 to 1.19), meso (aOR = 3.17, 95% CI 2.89 to 3.47) and hyper (aOR = 14.9, 95% CI 12.99 to 17.07) endemic areas. Children residing in larger households were less likely to use ITN. CONCLUSIONS: This study demonstrated increased use of ITN in CU5 from poor households and children living in rural and malaria endemic areas. Findings provide some policy recommendations for increasing ITN use in school children.