Access versus utilization: determinants of insecticide-treated net non-use in Myanmar

Abstract

Background: Vector control has played a pivotal role in malaria control and elimination efforts, with insecticide-treated nets (ITNs) recognized as one of the most effective and widely accepted strategies. This study assessed ITN use and identified factors associated with non-use among individuals with access to ITNs in Myanmar. Methods: Data were drawn from the nationally representative 2015–2016 Myanmar Demographic and Health Survey. Access to ITNs was defined as having at least one ITN per two household members, and ITN use as having slept under an ITN the night before the survey. Descriptive statistics and multivariable logistic regression models were conducted using the “svyset” command in STATA to account for the two-stage stratified cluster sampling design. Results: Among 6,140 individuals with access to ITNs, approximately one-third (31.6%, 95% CI 28.3%–35.0%) reported not using them. Factors associated with higher odds of ITN non-use were age 15–34 years (adjusted odds ratio [aOR]: 1.31; 95% CI 1.07–1.61) and ≥ 50 years (aOR: 1.33; 95% CI 1.07–1.67), rural residence (aOR: 1.82; 95% CI 1.10–3.01), and belonging to the fourth wealth quintile, representing higher socioeconomic status (aOR: 1.74; 95% CI 1.06–2.85). Conclusions: Despite having access to ITNs at that time, a substantial proportion of individuals in Myanmar did not use them. These historical findings highlight behavioural and contextual barriers that existed before recent health system disruptions due to political unrest and COVID-19. Although present-day challenges differ, understanding past determinants of ITN non-use remains valuable for designing behaviour change communication (BCC) strategies, especially in regions where ITN distribution remains feasible.