ABSTRACT
Background: In endemic areas; children under five and pregnant women are vulnerable to malaria and are likely to benefit most from the use of mosquito nets. Use of insecticide treated nets (ITNs) for protection against mosquito bite during sleep is highly effective. Nevertheless; prioritization pertaining to the use of nets does not seem to be optimal inmost endemic setups. Objective: To examine the status of ITNs coverage; use and its determinants for malaria control among children under five and/or pregnant women in Kafta-Humera District in Tigray Regional State. Methods: A comparative cross-sectional quantitative study was conducted in the rural and urban areas of the District. Qualitative data were also collected through focus group discussions (FGDs) to identify views of participants; pertaining to possession and utilization. An early morning survey was also carried out in order to observe the actual behavior of the community towards net use. Result: Net and ITN possession was 84.5and 80.0for rural; but 96.1and 91.1for urban settings; respectively. Net possession was higher among urban (OR 3.33; 95CI 1.39; 7.98) compared to rural areas. Observed net and ITN use during the preceding night by children under five years of age was 68.6and 67.0for rural; and 84.6and 79.5for urban areas; respectively. Likewise; similar practice for net and ITN in 52.1and 64.7of pregnant women was observed in rural and urban areas; respectively. The FGD results of this study suggested that lower net possession in rural areas could be due to insufficiency of mosquito net provision and inequity during distribution. Occupation; family size in rural areas; radio possession in urban areas and relative wealth and number of sleeping places had significant effect in both settings to own a net. Relative wealth; radio possession; malaria education message in rural and occupation in both settings had a positive effect on net use. Conclusion: Not all nets owned by the households were being utilized properly. Yet; maldistribution and shortage of ITN were also observed within rural and urban settings. Effective Information; Education and Communication (IEC) should be promoted and continuous availability of ITNs should be in place to achieve effective control of malaria among the high-risk groups