Ownership and utilization of long-lasting insecticide nets among caregivers of children under-5 years in Ogun State, Nigeria: A rural-urban comparison

Background: Long-lasting insecticides nets (LLINs) are a key prevention tool that has been found to reduce uncomplicated malaria by 51% and decrease all-cause mortality by 18% in children. LLINs have been shown to be effective in reducing childhood morbidity and mortality by reducing mosquito bites while sleeping. This is a comparative cross-sectional study designed to determine and compare the ownership and utilization of LLINs among caregivers of children under 5 years in a rural and an urban area of Ogun State. Materials and Methods: A community-based comparative cross-sectional study on 575 caregivers of children under 5 years living in the urban and rural area of Ogun State was done using a multistage cluster sampling technique to recruit respondents. A pretested semi-structured interviewer-administered questionnaire was used to collect information on LLINs ownership and use. Analysis and statistical calculation were done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P = 0.05. Logistic regression model was used to describe predictors of LLIN ownership and utilization among the respondents. Results: The study shows that 80% of caregivers of under-five living in the rural area compared with 63.5% living in the urban area owned LLINs (P < 0.001). Percentage of children under-five who slept under LLINs the night prior the study was 50.2% in the urban versus 52.4% in the rural households (P = 0.252). Stagnant water and dirty surroundings were identified as mode of transmission of malaria among 32.6% urban versus 44.8% rural respondents and 44.2% urban versus 29.7% rural respondents respectively (P = 0.005). Children were identified as one of the most vulnerable groups for malaria infection by 44.6% urban versus 33.8% rural respondents (P = 0.008). The LLINs was hanged on the bed by 81.2% urban versus 64.4% rural respondents (P = 0.018). The predictors of ownership of LLINs were as follows: urban residence (OR 0.34 [95% confidence interval [CI] 0.22-0.53]), caregiver with higher education (OR 4.85 [95% CI 1.42-16.55]), and the predictors of utilization of LLINs were as follows: level of education of the caregiver (OR 2.87 [95% CI 1.11-7.41]), possession of LLINs at immunization (OR 2.92 [95% CI 2.02-4.22]). Conclusion: Free distribution of LLINs may not necessarily lead to use. Behavior change interventions that address the community level perceptions that positively position LLINs as an effectiv