PC2109: Evaluating the Impact of Comprehensive Family Education on the Use of Long-lasting Insecticidal Nets in Jinja, Uganda

Background: Malaria remains endemic in Uganda, influencing morbidity, mortality and socio-economics. Children under 5 and pregnant women are at particularly high risk of developing both malaria and further complications. Soft Power Mukagwa Allan Stone Community Health (SMACH) has been distributing subsidized long lasting insecticidal nets (LLINs) along with education sessions in Jinja, Uganda for 10 years. However, few studies have investigated LLIN use following distribution, in order to most effectively guide malaria reduction efforts. Our goal is to evaluate the impact of education on proper LLIN usage and assess family-wide understanding of malaria to guide educational goals and reduce malaria in high risk populations, such as children under 5 and pregnant women. We hypothesize that an educational program administered during LLIN distribution may increase correct LLIN usage and knowledge regarding malaria transmission, symptoms, and treatment.

Methods: Households receiving LLINs from SMACH were selected to participate in this study. Standardized questionnaires were used to assess LLIN knowledge and self-reported use, as well as malaria understanding. We collected questionnaires from 966 households, representing approximately 5,000 individuals. Mixed effects logistic regression was performed.

Results: The number of correctly hung nets was significantly higher in families who attended SMACH education sessions versus those who did not (2.5 vs. 2.2, p=0.03). Of the 39.9% of families with children under 5, 8.64% indicated that not every child sleeps under a net. In comparison, 96.6% of pregnant women reported sleeping under a net every night. Between families with and without adults who attended education sessions, there was no difference in the number of participants who slept under LLINs every night (98.1% vs. 96.5%, p=0.15). Additionally, between these families, there was no difference in the number of participants who correctly identified mosquitos as the vector for malaria (94.5% vs. 94.5%, p=0.99). Only 52.3% of educated families and 49.5% of uneducated families identified that fever is a symptom of malaria, with no significant difference (p=0.5). The most common reasons for not hanging all nets included damage (45.7%) or reserving nets for emergencies (29.5%). Lastly 8.79% of families with children under 5 sent the LLINs to school with their children.

Conclusion: Families who attended SMACH education sessions had more nets hung correctly than families who did not receive education. This indicates that culturally sensitive education may help close the gap between LLIN possession and correct usage. While many children under 5 and pregnant women are sleeping under them, there is also significant gap in awareness of malaria symptoms, which may lead to delays in seeking treatment. Understanding these specific inter- and intra-household factors can help refine malaria control efforts in Uganda and improve morbidity and mortality in high risk populations.