Determinants of Utilization of Long-Lasting Insecticidal Nets ( LLINs ) for Malaria Prevention in Fashoda County, Upper Nile State, South Sudan

Background: Malaria remains a leading cause of morbidity and mortality in South Sudan, particularly in Fashoda County, Upper Nile State. Despite widespread distribution of Long-Lasting Insecticidal Nets (LLINs), utilization rates remain inconsistent, undermining the effectiveness of vector control interventions. Understanding the determinants influencing LLINs use is critical for improving malaria prevention in this resource-limited, conflict-affected setting. Objective: This study examined factors affecting LLINs utilization among households in Fashoda County, focusing on community knowledge, socio-economic status, cultural beliefs and practices, and accessibility to LLINs distribution mechanisms. Methods: A cross-sectional analytical design was employed among 334 household respondents selected through probability-proportional-to-size cluster sampling across four settlement clusters. Data were analysed using descriptive statistics, Spearman rank correlation, and ordinal logistic regression in SPSS v25. Results: Descriptive analysis revealed 66.5% of respondents were strongly aware of LLINs, yet only 50.3% reported consistent nightly usage. Spearman correlation indicated significant positive associations with knowledge (rₛ = 0.72, p < 0.01), socio-economic factors (rₛ = 0.68, p < 0.01), and accessibility (rₛ = 0.74, p < 0.01), while cultural beliefs had a moderate negative effect (rₛ = –0.33, p < 0.05). Ordinal regression confirmed knowledge (β = 30.63, p < 0.001), income capacity (β = 45.10, p < 0.001), and easy access (β = 6.19, p < 0.001) as significant positive predictors, whereas negative cultural beliefs (β = –1.21, p = 0.027) reduced utilization likelihood. Conclusion: LLINs utilization in Fashoda County is shaped by converging knowledge, socio-economic, cultural