Family biosocial variables driving adherence to the use of insecticide treated nets among under-five children managed for malaria in a rural hospital

BACKGROUND: As the distribution and awareness of free insecticide treated nets (ITNs) for malaria control continues to grow in Nigeria in order to meet the coverage target for the year 2010, a large gap exists between acquiring them, using them, and adhering to its use by families of under-five children. Therefore, the family biosocial variables driving its adherence need to be explored if the potential benefits of the nets are to be fully harnessed by families of under-five children in Nigeria. This study was aimed at describing family biosocial variables driving adherence to the use of insecticide treated nets among under-five children managed for malaria in a rural hospital in Eastern Nigeria. MATERIALS AND METHODS: This was descriptive hospital-based study carried out from June 2008 to June 2010 on a cross section of 220 mothers of under-five children who were managed for confirmed malaria within the study period and met the selection criteria were interviewed using a pretested, structured researcher administered questionnaire. The questionnaire instrument elicited information on family biosocial variables. Adherence was assessed in the previous 6 months and graded using an ordinal scoring system of 1-4 points: score of 4 points indicated adherence while scores of 1-3 points meant non-adherence. Operationally, an adherent respondent was defined as one who scored 4 points. An under-five child was defined to have malaria if the mother gave complaint of fever, vomiting and other symptoms suggestive of malaria, had body temperature exceeding 37.5oC with the asexual forms Plasmodium falciparum detected on the peripheral blood film. Reasons for non-adherence were also sought.RESULTS: The adherence rate was 33.2%. The family biosocial variables significantly associated with adherence were maternal age =30 years (p-value=0.03), maternal occupation (house wives) (p-value=0.03), family size less than 4(p-value=0.026) and spouse living together (p-value=0.01). Others included family belief in the benefits of ITNs (p-value=0.002) and source of ITNs (p-value=0.03). The most significant predictor of adherence was living together of spouse (p-value=0.000, OR=3.851, CI=1.76-6.01). The commonest reason for non-adherence was forgetfulness (p-value=0.003).CONCLUSION: Despite high family belief in the benefits of ITNs, adherence to its use was low. Some family biosocial variables played significant roles in driving its adherence. Measures targeted at these variables and widespread family-oriented health promotion programmes are recommended in order to improve on adherence leading to family friendly ITNs communities. KEY WORDS: Malaria, under-five, family biosocial variables, adherence, ITNs, rural Nigeria, hospita