Wealth, mother's education and physical access as determinants of retail sector net use in rural Kenya

Between December 2004 and January 2005, a random sample of 72 rural communities was selected across four Kenyan districts. Demographic, assets, education and net use data were collected at homestead, mother and child (aged < 5 years) levels. An assets-based wealth index was developed using principal components analysis, travel time to net sources was modelled using geographic information systems, and factors influencing the use of retail sector nets explored using a multivariable logistic regression model.Homestead heads and guardians of 3,755 children < 5 years of age were interviewed. Approximately 15% (562) of children slept under a net the night before the interview; 58% (327) of the nets used were purchased from the retail sector. Homestead wealth (adjusted OR = 10.17, 95% CI = 5.45–18.98), travel time to nearest market centres (adjusted OR = 0.51, 95% CI = 0.37–0.72) and mother's education (adjusted OR = 2.92, 95% CI = 1.93–4.41) were significantly associated with use of retail sector nets by children aged less than 5 years.Approaches to promoting access to nets through the retail sector disadvantage poor and remote communities where mothers are less well educated.Insecticide treated bed nets (ITN) have been shown to provide significant protection against early childhood mortality under a range of malaria settings in Africa [1], reduce the incidence of clinical malaria and anaemia in young children [1,2] and are regarded as a cost-effective public health intervention for low income countries [3]. African Heads of State, as part of the Roll Back Malaria (RBM) initiative, agreed that they would ensure that 60% of at-risk populations in their countries would have access to ITN by 2005 [4]. Since the Abuja summit, donor support to country national malaria control programmes or their non-governmental organisations (NGO) partners has substantially increased to support the adoption of ITN policies and programme implementation [5]. Despite the overwhelming scientific