Ongoing long-lasting insecticide-treated net distribution efforts are 2 insufficient to maintain high rates of use among children in rural Uganda

Abstract

Background: Long-lasting insecticide-treated nets (LLINs) remain a cornerstone of malaria control, but optimal distribution strategies to sustain universal coverage are not well-defined Methods: We conducted a cross-sectional survey of 2,190 households in the highlands of western Uganda to examine LLIN source and use among children age with elevation and distance to clinic being the primary variables of interest Results: We found that only 64.7% (95% CI 64.0 – 65.5%) of children were 55 reported to have slept under a LLIN the previous night. Compared to those living <1 KM from a health center, households at > 2 km were less likely to report the 57 child sleeping under a LLIN (RR 0.86, 95% CI: 0.83 – 0.89, P<.001) Households 58 located farther from a health center received a higher proportion of nets from 59 government distributions compared to households living closer to health centers. Conclusions: Continuous, clinic-based distribution efforts were insufficient to 62 sustain high rates of LLIN use among children between mass distribution 63 campaigns. More frequent campaigns and complementary approaches are 64 required to achieve and maintain universal LLIN coverage in rural areas.