Insecticide Treated Net Usage and Its Predictors among HIV Patients Attending an Antiretroviral Therapy Clinic in Ebonyi State, Nigeria

Main Article Content

Olaronke Afolabi
Chukwuemeka Okorie Eze
Collins Nwachi Ugwu
Nneneya Anthony Ajayi
Daniel Ogbonna Aja
Chigozie Jesse Uneke


Insecticide Treated Nets, Ownership, Usage, HIV Patients, Nigeria


Background: Malaria prevention is important among HIV patients to mitigate its associated complications. This study explored the predictors of insecticide-treated net (ITN) usage among HIV patients attending an antiretroviral therapy (ART) clinic in Ebonyi state, Nigeria.

Methodology: It was a cross-sectional study that involved 297 patients who attended an ART clinic in Ebonyi State. An interviewer-administered questionnaire was used to collect relevant data, including perception of malaria prevention, ownership of ITN, condition of ITN, duration of use, and ITN usage. The relationship between ITN usage and other variables was assessed using bivariate analysis and the predictors were determined using multivariate logistic regression.

Results: There were 64 (21.5%) males and 233(78.5%) females. Knowledge of the use of ITN (mean= 4.24 ±0.93) was rated better than knowledge of the use of mosquito repellent (mean = 3.79 ± 1.21) and knowledge of the use of protective clothes (mean= 3.86 ±1.26). 246 (83%) of the study population owned ITN. Only 48% (118) of those with ITNs reported optimal nets (nets without holes). 135 (45.5%) participants reported sleeping under the net every day in the past week. There was a significant relationship between ITN usage and knowledge of the use of ITN, ownership of ITN, duration of use and condition of nets. Predictors of usage of ITN were duration of use (AOR=0.386, 95%C.I for AOR=0.224-0.665) and condition of the nets (AOR=0.399, 95%C.I for AOR=0.226-0.706).

Conclusion: Perception of malaria prevention was high among the study group. Ownership of ITN was high although many of the ITNs were not in good condition. Usage of ITN was largely determined by duration of use and good condition of nets. Yearly assessment of the condition of ITNs and replacement exercise of ITNs (2-3 years) at ART clinics to replace old and worn-out nets among HIV patients are recommended.

Abstract 34 | PDF Downloads 18 EPUB Downloads 16 HTML Downloads 2


1. WHO. World Malaria Report, Geneva: World Health Organization; 2021

2. Njunda AL, Njumkeng C, Nsagha SD, Assob JC and Kwenti TE. The prevalence of malaria in people living with HIV in Yaounde, Cameroon. Biomedic Central Public Health:2016; 16:964.

3. Herrero MD, Rivas P, Rallón NI, Ramírez-Olivencia G and Puente S. HIV and malaria. AIDS Rev2007; 9(2):88–98.

4. Kwenti ET. Malaria and HIV coinfection in sub-Saharan Africa: prevalence, impact, and treatment strategies. Res Rep Trop Med. 2018; 9:123–136.

5. Chalwe V, Van geertruyden JP, Mukwamataba D, Menten J, Kamalamba J, Mulenga M, D'Alessandro U. Increased risk of severe malaria among HIV-1 infected adults, Zambia. Emerging Infectious Diseases. 2009; 15(5):749–755.

6. Soumaré M, Seydi M and Diop SA. The place of malaria in an infectious disease department in Dakar, Senegal. Medicine Tropics (Mars). 2008;68(5):485–490.

7. Kileen, GF (2014). Characterizing, controlling, and eliminating residual material transmission. Malaria Journal.2004; 3:330.

8. Bachou H, Tylleskär T, Kaddu-Mulindwa DH, Tumwine JK. Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda. BMC Infect Dis. 2006;6:160. doi: 10.1186/1471-2334-6-160.

9. Gueye CS, Newby G, Gosling RD, Whittaker MA, Chandramohan D and Slutsker L. Strategies and approaches to vector control in nine malaria eliminating countries: a cross-case study analysis. Plos2016; 6: 52-59.

10. Musa OI, Salaudeen GA, Jimoh RO. Awareness and use of Insecticide Treated Nets among women attending ante-natal clinic in a Northern state of Nigeria J Pak Med Assoc 2009;59(6):354–8.

11. Gamble CL, Ekwaru JP, terKuile FO. Insecticide-treated nets for preventing malaria in pregnancy. Cochrane Database Syst Rev. 2006;2:CD003755.

12. Hill J, HoytJ, Van-EijkAM, Ter- Kuille FO, Webster J and Steketee RW. Prioritizing pregnant women for long-lasting insecticide treated nets through antenatal care clinics. PLoS Med. 2014;11(9):e1001717

13. Uneke CJ, Ezeoha AE, Uro-Chukwu H, Ezeonu, CT, Ogbu O, Onwe F and Edoga C. Improving Nigerian health policymakers’ capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop. The Pan African Medical Journal 2015; 21:212-215.

14. Micheal, GC, Aliya I and Grema BA. Knowledge of Malaria and Adherence to its preventive measures among adults attending out patient’s clinics of a Nigerian Tertiary Hospital. African Journal of Medical and Health Sciences 2017; 16:41-51

15. Adongo PB, Kirkwood B, Kendall C. How local community knowledge about malaria affects insecticide-treated net use in northern Ghana. Trop Med Int Health 2005;10(4):366–78.

16. Isah EC, Ofili AN, Ogbebor CE, Obahiagbon I. and Isah AO. Knowledge of malaria and the practices towards its control among urban dwellers in Benin City. Nigeria Postgraduate Medicine Journal2007; 14:125–128.

17. Kimbi HK, Nkesa SB, Ndamukong-Nyanga JL Knowledge and perceptions towards malaria prevention among vulnerable groups in the Buea Health District, Cameroun. BMC Public Health 2014,883:1471-2458.

18. Dun-Dery F, Kuunibe N, Meissner P, Winkler V, Jahn A, Müller O, Determinants of the use of insecticide-treated mosquito nets in pregnant women: a mixed-methods study in Ghana. International Health 2022; (14)6:619–631.

19. Akaba GO, Otubu JAM, Agida ET, Onfowokan O. Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary in Nigeria federal capital territory. Nigerian Journal of Clinical Practice 2013;16; 201-6.

20. Onwujekwe O, Uguru N, Etiaba E, Chikezie I, Uzochukwu B, Adjagba A. The economic burden of malaria on households and the health system in Enugu State southeast Nigeria. PLoS One 2013;8(11):e78362.

21. Makumbe SD, Lawrence DN, Kamoto K, Kabuluzi S. Providing Insecticide treated bed nets in anti-retrieval treatment clinics in Malawi a pilot study. Malawi Medical Journal 2007; 19(3) 111-115.

22. Wagbatsoma, VA, Aigbe EE. ITN Utilization among Pregnant Women Attending ANC in Etsako West LGA, Edo State, Nigeria. Nigerian Journal of Clinical Practice 2010; 13, 144-148

23. Atieli HE, Zhou G, Afrane Y, Lee MC, Mwanzo I, Githeko AK. Insecticide-treated net (ITN) ownership, usage, and malaria transmission in the highlands of western Kenya. Malaria Journal.2011;5:20-26.

24. Ezire O, AdebayoS, IdoghoO, Bamgboye EA, Nwokolo E. Determinants of use of insecticide-treated nets among pregnant women in Nigeria. Int J Womens Health 2015;7:655–61.

25. Diema KK, Konlan KD, Aarah- Bapuah AM, Abdulai JA. “Barriers to sustained use of the insecticide treated bednet in the upper east region of Ghana. International Journal of Community Medicine and Public Health 2017;4(2):500–505.

26. Oladimeji KE, Tsoka-Gwegweni JM, Ojewole E and Yunga ST. Knowledge of malaria prevention among pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, South West Nigeria Malar J 2019;18:92

27. Adebayo AM, Akinyemi OO, Cadmus EO. Ownership and utilisation of insecticide-treated mosquito nets among caregivers of under-five children and pregnant women in a rural community in southwest Nigeria. J Prev Med Hyg. 2014;55(2):58–64

28. Nnedu ON, John-Steward GC, Singa BO, Piper B , Otieno PA , Guidryg A et al. Prevalence and correlates of insecticide-treated bednet use among HIV-1-infected adults. AIDS Care 2012; 24(12):1559_64.