{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:42:36Z","timestamp":1787164956397,"version":"build-2736575974"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T00:00:00Z","timestamp":1606953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Indoor residual spraying (IRS) and long-lasting insecticide-treated bednets (LLINs) are common tools for reducing malaria transmission. We studied a cohort in Uganda with universal access to LLINs after 5 years of sustained IRS to explore LLIN adherence when malaria transmission has been greatly reduced. Eighty households and 526 individuals in Nagongera, Uganda were followed from October 2017 \u2013October 2019. Every two weeks, mosquitoes were collected from sleeping rooms and LLIN adherence the prior night assessed. Episodes of malaria were diagnosed using passive surveillance. Risk factors for LLIN non-adherence were evaluated using multi-level mixed logistic regression. An age-matched case-control design was used to measure the association between LLIN non-adherence and malaria. Across all time periods, and particularly in the last 6 months, non-adherence was higher among both children &lt;5 years (OR 3.31, 95% CI: 2.30\u20134.75; p&lt;0.001) and school-aged children 5\u201317 years (OR 6.88, 95% CI: 5.01\u20139.45; p&lt;0.001) compared to adults. In the first 18 months, collection of fewer mosquitoes was associated with non-adherence (OR 3.25, 95% CI: 2.92\u20133.63; p&lt;0.001), and, in the last 6 months, residents of poorer households were less adherent (OR 5.1, 95% CI: 1.17\u201322.2; p = 0.03). Any reported non-adherence over the prior two months was associated with a 15-fold increase in the odds of having malaria (OR 15.0, 95% CI: 1.95 to 114.9; p = 0.009). Knowledge about LLIN use was high, and the most frequently reported barriers to use included heat and low perceived risk of malaria. Children, particularly school-aged, participants exposed to fewer mosquitoes, and those from poorer households, were less likely to use LLINs. Non-adherence to LLINs was associated with an increased risk of malaria. Strategies, such as behavior change communications, should be prioritized to ensure consistent LLIN use even when malaria transmission has been greatly reduced.<\/jats:p>","DOI":"10.1371\/journal.pone.0243303","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T14:15:45Z","timestamp":1607004945000},"page":"e0243303","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":36,"title":["Non-adherence to long-lasting insecticide treated bednet use following successful malaria control in Tororo, Uganda"],"prefix":"10.1371","volume":"15","author":[{"given":"John","family":"Rek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Musiime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maato","family":"Zedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Otto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Kyagamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Asiimwe Rwatooro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Arinaitwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaniter","family":"Nankabirwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah G.","family":"Staedke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Drakeley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Dorsey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5376-5336","authenticated-orcid":true,"given":"Paul J.","family":"Krezanoski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,3]]},"reference":[{"key":"pone.0243303.ref001","author":"WHO","year":"2007"},{"key":"pone.0243303.ref002","author":"World Malaria Report 2019","year":"2019"},{"key":"pone.0243303.ref003","first-page":"CD012688","article-title":"Indoor residual spraying for preventing malaria in communities using insecticide\u2010treated nets","volume":"5","author":"L Choi","year":"2019","journal-title":"Cochrane Database Syst. Rev"},{"issue":"9976","key":"pone.0243303.ref004","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1016\/S0140-6736(14)61007-2","article-title":"Efficacy of indoor residual spraying with dichlorodiphenyltrichloroethane against malaria in Gambian communities with high usage of long-lasting insecticidal mosquito nets: a cluster-randomised controlled trial","volume":"385","author":"M Pinder","year":"2015","journal-title":"Lancet"},{"issue":"8","key":"pone.0243303.ref005","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/S1473-3099(12)70081-6","article-title":"Combination of malaria vector control interventions in pyrethroid resistance area in Benin: a cluster randomised controlled trial","volume":"12","author":"V Corbel","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pone.0243303.ref006","doi-asserted-by":"crossref","first-page":"010401","DOI":"10.7189\/jogh.04.010401","article-title":"Household malaria knowledge and its association with bednet ownership in settings without large-scale distribution programs: Evidence from rural Madagascar","volume":"4","author":"PJ Krezanoski","year":"2014","journal-title":"J Glob Health"},{"key":"pone.0243303.ref007","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/1475-2875-10-83","article-title":"Reported reasons for not using a mosquito net when one is available: a review of the published literature","volume":"10","author":"J Pulford","year":"2011","journal-title":"Malar J"},{"issue":"2","key":"pone.0243303.ref008","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1177\/101053959400700203","article-title":"Observations of human behavior influencing the use of insecticide-impregnated bednets to control malaria in Sabah, Malaysia","volume":"7","author":"DW Leake","year":"1994","journal-title":"Asia Pac J Public Health"},{"issue":"12","key":"pone.0243303.ref009","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.trstmh.2008.10.018","article-title":"Sleeping arrangements under long-lasting impregnated mosquito nets: differences during low and high malaria transmission seasons","volume":"103","author":"SD Fernando","year":"2009","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pone.0243303.ref010","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1186\/s12936-017-1918-5","article-title":"Multiple entries and exits and other complex human patterns of insecticide-treated net use: a possible contributor to residual malaria transmission?","volume":"16","author":"SA Harvey","year":"2017","journal-title":"Malar J"},{"key":"pone.0243303.ref011","article-title":"Malaria Transmission, Infection, and Disease following Sustained Indoor Residual Spraying of Insecticide in Tororo, Uganda","author":"JI Nankabirwa","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"2","key":"pone.0243303.ref012","doi-asserted-by":"crossref","first-page":"e1002234","DOI":"10.1371\/journal.pmed.1002234","article-title":"Housing Improvements and Malaria Risk in Sub-Saharan Africa: A Multi-Country Analysis of Survey Data","volume":"14","author":"LS Tusting","year":"2017","journal-title":"PLOS Medicine"},{"key":"pone.0243303.ref013","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1186\/1471-2458-9-369","article-title":"The use of insecticide treated nets by age: implications for universal coverage in Africa","volume":"9","author":"AM Noor","year":"2009","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0243303.ref014","doi-asserted-by":"crossref","first-page":"e0154808","DOI":"10.1371\/journal.pone.0154808","article-title":"A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution","volume":"11","author":"IHACC Research Team","year":"2016","journal-title":"PloS one"},{"issue":"1","key":"pone.0243303.ref015","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1186\/s12879-017-2822-x","article-title":"Trends in bednet ownership and usage, and the effect of bednets on malaria hospitalization in the Kilifi Health and Demographic Surveillance System (KHDSS): 2008\u20132015","volume":"17","author":"A Kamau","year":"2017","journal-title":"BMC Infect. Dis"},{"issue":"9592","key":"pone.0243303.ref016","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/S0140-6736(07)61477-9","article-title":"Effect of expanded insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study","volume":"370","author":"GW Fegan","year":"2007","journal-title":"Lancet"},{"key":"pone.0243303.ref017","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1186\/1475-2875-10-179","article-title":"Determinants of bed net use in children under five and household bed net ownership on Bioko Island, Equatorial Guinea","volume":"10","author":"AL Garc\u00eda-Basteiro","year":"2011","journal-title":"Malar J"},{"issue":"1","key":"pone.0243303.ref018","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1186\/s12889-019-7692-2","article-title":"Barriers of persistent long-lasting insecticidal nets utilization in villages around Lake Tana, Northwest Ethiopia: a qualitative study","volume":"19","author":"A Malede","year":"2019","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0243303.ref019","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4314\/mmj.v30i2.9","article-title":"Community health priorities: Lessons for malaria prevention from Balaka district, Malawi","volume":"30","author":"W Parker","year":"2018","journal-title":"Malawi Med J"},{"key":"pone.0243303.ref020","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1016\/S0140-6736(18)30427-6","article-title":"Effectiveness of a long-lasting piperonyl butoxide-treated insecticidal net and indoor residual spray interventions, separately and together, against malaria transmitted by pyrethroid-resistant mosquitoes: a cluster, randomised controlled, two-by-two fact","volume":"391","author":"N Protopopoff","year":"2018","journal-title":"Lancet"},{"issue":"3","key":"pone.0243303.ref021","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/cid\/cix251","article-title":"Resurgence of Malaria Following Discontinuation of Indoor Residual Spraying of Insecticide in an Area of Uganda With Previously High-Transmission Intensity","volume":"65","author":"S Raouf","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"10232","key":"pone.0243303.ref022","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/S0140-6736(20)30214-2","article-title":"Effect of long-lasting insecticidal nets with and without piperonyl butoxide on malaria indicators in Uganda (LLINEUP): a pragmatic, cluster-randomised trial embedded in a national LLIN distribution campaign","volume":"395","author":"SG Staedke","year":"2020","journal-title":"Lancet"},{"issue":"1","key":"pone.0243303.ref023","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1186\/s12936-018-2571-3","article-title":"LLIN Evaluation in Uganda Project (LLINEUP): factors associated with ownership and use of long-lasting insecticidal nets in Uganda: a cross-sectional survey of 48 districts","volume":"17","author":"S Gonahasa","year":"2018","journal-title":"Malar J"},{"key":"pone.0243303.ref024","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12936-016-1178-9","article-title":"Bed net use among school-aged children after a universal bed net campaign in Malawi","volume":"15","author":"AG Buchwald","year":"2016","journal-title":"Malar J"},{"key":"pone.0243303.ref025","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1475-2875-7-60","article-title":"Socio-economic status is inversely related to bed net use in Gabon","volume":"7","author":"JN Goesch","year":"2008","journal-title":"Malar J"},{"key":"pone.0243303.ref026","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/1475-2875-8-132","article-title":"Determinants of household demand for bed nets in a rural area of southern Mozambique","volume":"8","author":"C Chase","year":"2009","journal-title":"Malar J"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243303","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T14:16:10Z","timestamp":1607004970000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243303"}},"subtitle":[],"editor":[{"given":"Luzia Helena","family":"Carvalho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,3]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0243303","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,3]]}}}