Factors associated with the ownership and use of insecticide-treated nets in Guinea: an analysis of the 2018 Demographic and Health Survey

BackgroundMalaria is a leading cause of outpatient visits and deaths among children in Guinea. Despite several mass distribution campaigns of insecticide-treated nets (ITNs) in Guinea, ITN ownership and use remain low. Identifying the underlying factors affecting household ITN ownership and ITN usage among those with access will allow the Guinea National Malaria Control Programme to develop targeted initiatives to improve bed net ownership and usage.MethodsTo understand national and regional drivers of ITN ownership and use, multivariable binary logistic regression models were applied to data from the 2018 Demographic and Health Survey to identify risk factors of household ITN ownership and risk factors of ITN use among individuals with access. Akaike Information Criterion (AIC) was used for model parameter selection. Odds ratios were estimated with corresponding 95% confidence intervals.ResultsThe proportion of households in Guinea with at least one ITN was 44%, ranging from a low of 25% in Conakry to a high of 54% in Labe. Use of ITNs among those with access was 66.1% nationally, ranging from 35.2% in Labe to 89.7% in N'zerekore. Risk factors for household ITN ownership were household size, marital status of the household head, education level of the household head, and region. For ITN use among those with access, risk factors were age, wealth quintile, marital status, and region. In the seven regions of Guinea and capital of Conakry, risk factors for household ITN ownership were household size in Boke, Faranah, and Kankan; education level of the household head in Boke, Faranah, and N'zerekore; age of the household head in Conakry and Labe; children under five in the household in Kankan; and wealth quintile in Mamou. For ITN use among those with access, risk factors were marital status in Conakry, Faranah, Kindia, Labe, Mamou, and N'zerekore; place of residence in Labe; children under five in the household in Labe; wealth quintile in Mamou; and age in Faranah and N'zerekore.ConclusionsThis analysis identified national and region-specific factors that affect ownership and use among those with access in Guinea. Future ITN and social-behavioural change campaigns in Guinea may particularly want to target larger households, households without children, and areas with lower perceived risk of malaria if universal coverage and usage are to be achieved for optimal malaria prevention.