Household and Community - Based Factors Associated with Universal Coverage of Insecticide - Treated Nets (ITNs). Results from a Cross - Sectional Malaria Survey in Vihiga County, Kenya

Background: Insecticide - treated nets (ITNs) are an essential tool for preventing the spread of malaria. An adequate number of ITNs in households increases the probability of its use. Unfortunately, it's still unclear what factors prevent households from achieving universal coverage of ITNs despite the free mass net distribution every three years. This paper explored the household and community - based factors associated with universal ITN coverage in Vihiga County, Kenya. Methods: A cross - sectional survey was conducted among households in Vihiga County. Households were enrolled through multistage sampling and data was collected through structured questionnaire. Universal coverage was defined as the proportion of households with at least one ITN for every two people. Bivariable analysis was conducted using the chi - square test while determinants of universal coverage of ITNs and usage were assessed using multivariable logistic regression at a statistical significance of P - value<0.05 and 95% confidence interval. Results: The study revealed that 262 (59.55%) had achieved universal coverage. Factors associated with universal coverage included household head marital status (P=0.04), ease in setting up the ITN (P=0.011). Household head married/ living with their partners also had a three times better likelihood of ITNs use (OR=3.46.95%CI= 1.47 - 8.17). Education level was not significant in the attainment of universal net coverage. Conclusion: Only 59.55% of households had attained universal ITN coverage against the global target of at least 80%. Free mass net campaigns should be encouraged with more focus on single household heads or those staying alone. Additionally, a replacement framework of destroyed ITNs should be considered in order to maintain universal ITN coverage.