{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:27:54Z","timestamp":1791930474925,"version":"4.3.4"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SENUPH-II","award":["59360"],"award-info":[{"award-number":["59360"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite ongoing interventions like long-lasting insecticidal nets (LLIN) distribution and indoor residual spraying, malaria is increasing in Ethiopia. LLIN ownership and utilization vary from time to time and place to place; thus, local evidence of LLIN ownership and use is required. Hence, this study aimed to investigate LLIN ownership, access within household, use, and associated factors using repeated indicators measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A community-based cross-sectional study with repeated measures was conducted in the Sidama region, southern Ethiopia. The first survey was conducted in February and March 2023, and the second was done from October to December 2023. Multi-stage cluster sampling was employed to select representative households. LLIN coverage and use were estimated per the World Health Organization\u2019s recommendations. Descriptive and multilevel logistic regression analyses were performed, and effect sizes were measured using adjusted odds ratios (AOR) with a 95% confidence interval (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1647 households with 8054 individuals were included in the study. Most households were headed by males (89%), farmers (63%), and persons who were unable to read and write (55%). The ownership of at least one LLIN per household was 85% in survey one and dropped to 69% in survey two. The sufficiency of one LLIN for every two people was 36% in survey one and decreased to 29% in survey two. Similarly, the proportion of the population with access to LLIN within households decreased from 66.5% to 54.2%. Moreover, LLIN use dropped from 30.5% to 19.9% between the two surveys. The sufficiency of one LLIN to every two household members was consistently associated with geographical residence, sex, and education of household heads. In contrast, the education of household heads, family size, and age of individuals were consistent predictors of LLIN use. Females were likely to use LLIN during first survey, but no difference was noted during second survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LLIN ownership and use were far below the conventional target (80%). LLIN ownership and utilization declined before the expected period. More than half of the population with access to LLIN within households do not use it. Thus, the malaria programs should consider more LLIN distribution and strengthen LLIN use among population with access to LLIN within their households.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0322342","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T13:45:43Z","timestamp":1745502343000},"page":"e0322342","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["A decline in the coverage and utilization of long-lasting insecticidal nets in Southern Ethiopia: A repeated cross-sectional 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Haileselassie","year":"2023","journal-title":"Int Health"},{"issue":"1","key":"pone.0322342.ref013","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1186\/s12889-024-18344-w","article-title":"Under utilization of long-lasting insecticidal nets (LLINs) is challenging malaria elimination program in Ethiopia: a systematic review and meta-analysis","volume":"24","author":"FD Bayou","year":"2024","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0322342.ref014","doi-asserted-by":"crossref","first-page":"e0210578","DOI":"10.1371\/journal.pone.0210578","article-title":"Low use of long-lasting insecticidal nets for malaria prevention in south-central Ethiopia: a community-based cohort study","volume":"14","author":"T Solomon","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0322342.ref015","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12936-023-04540-3","article-title":"Durability of long-lasting insecticidal nets (LLINs) in Ethiopia","volume":"22","author":"HN Hiruy","year":"2023","journal-title":"Malar J"},{"key":"pone.0322342.ref016","volume-title":"Annual plan of 2015 EFY","author":"Sidama Regional Health Bureau","year":"2022"},{"issue":"1","key":"pone.0322342.ref017","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12936-023-04722-z","article-title":"Prevalence and predictors of asymptomatic malaria infection in Boricha District, Sidama Region, Ethiopia: implications for elimination strategies","volume":"22","author":"D Dabaro","year":"2023","journal-title":"Malar J"},{"issue":"1","key":"pone.0322342.ref018","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s12936-020-03169-w","article-title":"Analysis of trends of malaria from 2010 to 2017 in Boricha District, Southern Ethiopia","volume":"19","author":"D Dabaro","year":"2020","journal-title":"Malar 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Program","year":"2020"},{"key":"pone.0322342.ref023","volume-title":"Creation of a wealth index","author":"L Hjelm","year":"2017"},{"issue":"8","key":"pone.0322342.ref024","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1136\/jech.2009.097956","article-title":"Impact of small group size on neighbourhood influences in multilevel models","volume":"65","author":"KP Theall","year":"2011","journal-title":"J Epidemiol Community Health"},{"key":"pone.0322342.ref025","author":"The World Bank Group","year":"2024"},{"issue":"3","key":"pone.0322342.ref026","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1017\/S0021932005007169","article-title":"A comparison of female- and male-headed households in Tanzania and poverty implications","volume":"38","author":"RS Katapa","year":"2006","journal-title":"J Biosoc Sci"},{"issue":"4","key":"pone.0322342.ref027","first-page":"e57819","article-title":"Long-lasting insecticidal net ownership and use in Mogode Health District, Cameroon","volume":"16","author":"C Buh Nkum","year":"2024","journal-title":"Cureus"},{"issue":"1","key":"pone.0322342.ref028","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1186\/s12936-017-1907-8","article-title":"Factors influencing the ownership and utilization of long-lasting insecticidal nets for malaria prevention in Ethiopia","volume":"16","author":"A Tassew","year":"2017","journal-title":"Malar J"},{"issue":"4","key":"pone.0322342.ref029","first-page":"564","article-title":"Insecticide-treated net use in sub-saharan africa: systematic review and meta-analysis","volume":"78","author":"E Defo Tamgnoa","year":"2021","journal-title":"Ig Sanita Pubbl"},{"key":"pone.0322342.ref030","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/1471-2458-14-99","article-title":"Ownership and use of long-lasting insecticidal nets for malaria prevention in Butajira area, south-central Ethiopia: complex samples data analysis","volume":"14","author":"A Woyessa","year":"2014","journal-title":"BMC Public Health"},{"key":"pone.0322342.ref031","doi-asserted-by":"crossref","first-page":"e00182","DOI":"10.1016\/j.parepi.2020.e00182","article-title":"Effect of malaria preventive education on the use of long-lasting insecticidal nets among pregnant females in a Teaching Hospital in Osun state, south-west Nigeria","volume":"11","author":"OO Sonibare","year":"2020","journal-title":"Parasite Epidemiol Control"},{"issue":"1","key":"pone.0322342.ref032","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12936-018-2178-8","article-title":"Malaria knowledge and bed net use in three transmission settings in southern Africa","volume":"17","author":"M Kanyangarara","year":"2018","journal-title":"Malar J"},{"issue":"3","key":"pone.0322342.ref033","doi-asserted-by":"crossref","first-page":"e0000724","DOI":"10.1371\/journal.pgph.0000724","article-title":"Long-lasting insecticidal nets (LLINs) use among household members for protection 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