Determinants of long-lasting insecticide-treated nets utilization among community households of Ngoma district, Rwanda

Malaria remains a major public health challenge in sub-Saharan Africa, including Rwanda, where it continues to contribute significantly to morbidity and mortality despite ongoing control efforts. Long-Lasting Insecticidal Nets (LLINs) are widely promoted as an effective preventive intervention; however, their utilization remains inconsistent in many communities. This study aimed to assess the level of LLIN utilization and its determinants among community members in Ngoma District, Rwanda. A cross-sectional study design was used, combining quantitative and qualitative approaches to provide a comprehensive understanding of LLIN use. Quantitative data were collected from 430 adult household members using a structured questionnaire covering socio-demographic characteristics, knowledge, attitudes, perceptions, household and environmental factors, and LLIN utilization. Qualitative data were obtained through key informant interviews with the District Director of Health, Community Environmental Health Officers (CEHO), Community Health Workers (CHWs), and LLIN users to explore lived experiences and contextual factors influencing LLIN use. Quantitative data were coded and analyzed using SPSS version 21.0, employing descriptive statistics such as frequencies and percentages, as well as inferential statistics including Chi-square tests and logistic regression to determine associations and predictors of LLIN utilization. Qualitative data were analyzed using thematic analysis to identify recurring patterns and explanations supporting quantitative findings. The results showed that 54.2% of respondents slept under an LLIN the night before the survey, while 45.8% did not, and only 43.5% reported consistent use every night. A majority of households (64.7%) reported that not all members had access to LLINs. LLIN utilization was significantly associated with age (P=0.032) and gender (P=0.036). Knowledge of malaria transmission was relatively high (71.9%), but only 37.9% of respondents demonstrated good overall knowledge. Although attitudes toward LLIN use were generally positive (60.9%), utilization remained inconsistent. Environmental and behavioral barriers were prominent, with heat (92.1%), forgetfulness (88.8%), lack of awareness (87.4%), and inadequate sleeping arrangements (67.4%) reported as key challenges. Qualitative findings supported these results, revealing that inconsistent use is influenced by heat discomfort, seasonal changes, limited access to nets within households, and daily routines that affect regular use. The study concludes that LLIN utilization in Ngoma District is influenced by a combination of behavioral, environmental, and structural factors, highlighting a persistent gap between LLIN ownership and consistent use.