Abstract:
Background: Long-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing
malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not
satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the
coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had
not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of
LLITN was done in Ethiopia to fill this knowledge gap.
Methods: The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention
consisted of tailored training of household heads about the proper use of LLITN and community network system.
All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow
up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up
periods.
Results: A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the
project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control
villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in
the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age
groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by
31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization
increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-
64.7) at the twelfth months of the project period.
Conclusion: Household level skill-based training has demonstrated a marked positive effect in the utilization of
LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be
accompanied by a skill-based training of household heads to improve its utilization.
Trail registration: Australian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).
