Utilization and associated factors of long-lasting insecticide-treated nets among households in Gondar Zuria district, Northwest Ethiopia: a mixed methods study, 2025.

BACKGROUND

Malaria is a major public health problem in Ethiopia, and long-lasting insecticide-treated nets (LLINs) are one of the primary preventive strategies used to control it. Gondar Zuria District, Central Gondar Zone's highest malaria-reporting district, reached 100% LLIN coverage in 2023. However, malaria cases remain high, suggesting gaps in LLIN utilization. Therefore, this study aimed to assess LLIN usage and determinants in Gondar Zuria District.

METHODS

Community-based mixed-methods study was conducted from February 1 to 28, 2025 among 700 participants selected through multistage sampling. Quantitative data was collected via interviewer-administered questionnaires and entered into EpiData version 4.6.0.2 and exported to SPSS version 25 for analysis. A binary logistic regression model was fitted, and statistical significance was determined using 95% confidence intervals (CI) and a p-value ≤ 0.05. Qualitative data were collected through purposively sampled interviews (n = 7) and key informant interviews (n = 3) and analyzed thematically.

RESULTS

The prevalence of ITN utilization was 55.6% (95% CI: 51.9%-59.3%) and was significantly associated with perceived severity (AOR = 1.74; 95% CI: 1.27-2.39), LLINs-to-family size ratio (AOR = 2.09; 95% CI: 1.51-2.91), and occupation specifically, being a government employee (AOR = 3.45; 95% CI: 1.57-7.58). The mixed methods design therefore provided a more comprehensive understanding by revealing behavioral and contextual factors that were not captured through quantitative data alone. Qualitative findings complemented the quantitative results by explaining why LLIN utilization remained low, highlighting misconceptions about net safety, doubts about effectiveness, discomfort due to heat, and structural barriers such as lack of space for hanging nets.

CONCLUSION

LLIN utilization in Gondar Zuria District fell below the national target (100%). Misconceptions and misinformation contribute to irregular use and reduced trust. Beyond distribution and health education, community-based behavior changes strategies such as household follow-ups by health workers and integrating LLIN promotion into local forums alongside routine net condition monitoring are essential to improve consistent use and advance malaria elimination efforts.