Published In

Journal of Global Health

Document Type


Publication Date



Malaria -- Sub-Saharan Africa -- Prevention, Malaria -- Madagascar -- Prevention, Malaria -- Prevention -- Social aspects, Malaria -- Education

Physical Description

9 pages


Background Insecticide–treated bednets are effective at preventing malaria. This study focuses on household–level factors that are associated with bednet ownership in a rural area of Madagascar which had not been a recipient of large–scale ITN distribution.

Methods Data were gathered on individual and household characteristics, malaria knowledge, household assets and bednet ownership. Principal components analysis was used to construct both a wealth index based on household assets and a malaria knowledge index based on responses to questions about malaria. Bivariate and multivariate regressions were used to determine predictors of household bednet ownership and malaria knowledge.

Results Forty–seven of 560 households (8.4%) owned a bednet. In multivariate analysis, higher level of malaria knowledge among household members was the only variable significantly associated with bednet ownership (odds ratio 3.72, P < 0.001). Among respondents, predictors of higher malaria knowledge included higher education levels, female sex and reporting fever as the most frequent or dangerous illness in the community. Household wealth was not a significant predictor of bednet ownership or respondent malaria knowledge.

Conclusion In this setting of limited supply of affordable bednets, malaria knowledge was associated with an increased probability of household bednet ownership. Further studies should determine how such malaria knowledge evolves and if malaria–specific education programs could help overcome the barriers to bednet ownership among at–risk households living outside the reach of large–scale bednet distribution programs.


Originally appeared in the Journal of Global Health, volume 4, number 1, June 2014.

At the time of writing, David Bangsberg was affiliated with Massachusetts General Hospital and Harvard Medical School.



Persistent Identifier


Edinburgh University Global Health Society