Household predictors of malaria episode in northern Uganda: its implication for future malaria control.

backgroundUses of indoor residual spraying (IRS), long-lasting insecticidal nets (LLINS) and treatment with artemisinin-based combination therapy (ACT) are greatly promoted in the northern part of Uganda as mitigating strategies for malaria episodes. Unfortunately, the region remains the fourth highest malaria burden in Uganda with a prevalence of 12%. This study assesses household predictors of malaria episodes in northern Uganda and their impact on malaria episodes at the household level.

methodsA cross-sectional study was conducted in four districts of Gulu, Oyam, Kitgum and Agago covering sixteen villages in northern Uganda. Data was collected through a pre-tested structured questionnaire and systematically coded for analysis using R software.

resultsIn total, 193 households were surveyed with 112 (58%) of them headed by women and 605 individuals were declared to have spent the night before the interview in the 193 households. On average, there were at least two-bed nets (317/159) per household and a total of 460 individuals out of 535 (86%) spent the night before the interview under a bed net. The usage of bed nets in the study area overall was 86% while malaria incidence was 50% higher in children than in adults. Hierarchical clustering on principal components (HCPC) categorizes households in northern Uganda into three types: 1) households that use bed nets and sleep in houses sprayed with insecticides; 2) households that use bed nets but no indoor residual spraying with insecticides and 3) households that have no bed nets and no indoor residual spraying. When given a choice between IRS and treated bed nets, 1 in 3 households preferred treated bed nets. At the same time, data suggests that bed nets were perceived as unnecessary once the IRS was applied. If true, the driving force for spraying insecticides indoors then becomes the lack of a bed net.

conclusionsMalaria episodes were strongly related to lack of bed nets or use thereof, and directly linked to the number of individuals in a household. Children were prone to malaria more than adults by a ratio of 2:1. The three categories of households in northern Uganda as revealed by HCPC provide an opportunity to tailor-make preventive/intervention malaria messages to fit the individual household clusters.