Abstract
BACKGROUND: Despite significant distribution of insecticide-treated net (ITNs) by the Government of Uganda to refugees, malaria is major cause of mortality and morbidity among children under five years in refugee settlements. This highlights the persistent challenges and complexities surrounding malaria control and prevention efforts in these settings. Studies that focus on the determinants of ITN utilization among children under five years in refugee settlements in Uganda are not available. Using the 2018-2019 Uganda's Malaria Indicator Survey (UMIS) data, analysis of the individual and household factors associated with utilization of ITN among children under five in refugee settlements of Uganda was conducted. METHODS: This study focused on 589 children under five staying in refugee settlements located in Uganda. The extracted variables from the UMIS included social-economic factors associated with ITN utilization. Descriptive analysis was performed to generate summarized statistics, while inferential statistics by way of bivariate analysis were performed to assess the association between the outcome and the independent variables using the chi-square test, and multivariable logistic regression modelling to assess the magnitude of the associations after controlling for other covariates. All analyses considered the survey sampling design and sampling weights, and are conducted in Stata version 18. RESULTS: The odds of children sleeping under ITN were higher if their mothers had secondary and higher education (8.1 times) as well as primary education (1.5 times). The odds of children sleeping under ITN reduced by 50% if their mothers were pregnant. Interestingly, the odds of children sleeping under ITN were 70% lower if their mothers knew that 'not sleeping in nets' caused malaria. Mothers who were exposed to malaria messages had lower odds of their children sleeping under ITNs. CONCLUSIONS: The results highlight areas of intervention that can increase ITN use in refugee settlements of Uganda. Improving access to education for mothers, providing targeted health education on the importance of ITN, dispelling misconceptions about malaria transmission, facilitating the proper installation of ITNs among others, can all contribute to increased ITN utilization among children under five.