Patterns and predictive factors of long-lasting insecticidal net usage in a previously high malaria endemic area in Sri Lanka: a cross-sectional survey

Background Long-lasting insecticidal nets (LLINs) have been widely distributed in Sri Lanka for malaria control. Their effectiveness depends on proper utilisation and maintenance at the household level. Methods A cross-sectional study was performed to examine the patterns and predictive factors of LLIN maintenance and use in Anuradhapura district. Data was collected and analysed from 530 LLIN-owning households, selected by a multi-stage cluster sampling technique. Multivariable logistic regression identified factors associated with proper maintenance at the household level. Hierarchical linear modelling identified factors associated with LLIN use the previous night. Results Almost 75% (377/504) of households had used all their LLINs the previous night, while 82.9% (418/504) had used at least one. Only 3.2% (15/474) were maintaining the LLIN in such a way as to maximise its insecticidal efficacy. Six variables were significantly associated (p