Determinants of Insecticide-Treated Bed-Net: Knowledge, Attitude, and Practice in a Malaria-Endemic District of Ethiopia

Background: Insecticide-treated bed nets (ITNs) remain a cornerstone of malaria control, yet their population-level impact depends on sustained household ownership and correct use. Evidence on determinants of ITN uptake in rural Ethiopia remains limited. This study assessed knowledge, attitudes, and practices (KAP) regarding ITNs and identified factors associated with net possession and utilization in Dodicha Kebele, a malariaendemic district. Methods: A community-based cross-sectional survey was conducted from 14 January to 17 February 2023. Using systematic random sampling, 124 of 183 households were interviewed using a semi-structured questionnaire, and sleeping spaces were inspected with an observation checklist. Descriptive statistics summarized KAP indicators. Associations between socio-demographic variables and ITN outcomes were assessed using chisquare (χ²) tests and odds ratios (OR) with 95% confidence intervals. Results: Household respondents were predominantly female (71/124, 57.3%); mean age was 36.0 ± 1.2 years (range 16–80). ITN ownership was 61.3% (76/124), with a median of one net per owning household. Consistent use was reported by 54.0% and occasional use by 24.0% of owners. Households with an educated spouse were significantly more likely to own ≥1 ITN (OR = 2.6, 95% CI 1.3–5.3, p < 0.01). Prior health education on ITNs was predictive of ownership (70.7% vs 46.9%; OR = 2.7, 95% CI 1.3–5.9, p = 0.008). Utilization was significantly higher where >1 net was available (100% vs 70.7%, p < 0.001). Knowledge of mosquito bites as the primary mode of malaria transmission was independently associated with ITN use (p < 0.05). Conclusion: ITN coverage in Dodicha Kebele falls below national targets, with substantial gaps between ownership and effective use. Household education—both formal schooling and targeted ITN training—emerged as key determinants. Strengthening behavior-change communication and ensuring provision of at least two nets per household could significantly enhance protective coverage in malaria-endemic settings.