Sleeping on the floor decreases insecticide treated bed net use and increases risk of malaria in children under 5 years of age in Mbita District, Kenya

Children who sleep on the floor are less likely to use long-lasting insecticidal nets (LLINs); however, the relationship between sleeping location and Plasmodium falciparum infection has not been investigated sufficiently. This study revealed whether sleeping location (bed vs floor) is associated with P. falciparum infection among children 7–59 months old. More than 60% of children slept on the floor. Younger children were significantly more likely to sleep in beds [odds ratio, OR 2·31 (95% confidence interval (CI) 2·02–2·67)]. Nearly 70% of children slept under LLINs the previous night. LLIN use among children who slept on the floor was significantly less than ones sleeping in beds [OR 0·49 (95% CI 0·35–0·68)]. The polymerase chain reaction (PCR) based P. falciparum infection rate and slide based infection rate were 65·2 and 29·7%, respectively. Both infections were significantly higher among children slept on the floor [OR1·51 (95% CI 1·08–2·10) for PCR base, OR 1·62 (95% CI 1·14–2·30) for slide base] while net availability was not significant. Sleeping location was also significant for slide based infection with fever (⩾37·5 °C) [2·03 (95% CI 1·14–3·84)] and high parasitemia cases (parasite ⩾2500 µL−1) [2·07 (95% CI 1·03–4·50)]. The results suggest that sleeping location has a direct bearing on the effectiveness of LLINs.