摘要
背景：國家瘧疾控制計畫(National Malaria Control Program)成功的增加了馬拉威擁有蚊帳的家戶數量。然而，其中近乎一半的蚊帳並沒有被家戶所使用。此篇研究欲探討擁有蚊帳之家戶，其使用蚊帳與否的相關因素。
方法：資料來源為馬拉威的國家人口與健康調查(DHS)，調查採結構式問卷，以面訪方式進行，調查期間為2010年6月至11月。資料以多元羅吉斯迴歸進行分析，檢視蚊帳使用情形與各種使用潛在因素的關聯性，計算各變項的OR值、P值及信賴區間後，建立解釋模型。
結果：最終模型包含12個相關因子，包括痢疾(OR=1.168，95% CI=1.034-1.319)、富有程度(OR=1.463，95% CI=1.23-1.75)、居住城鄉(OR=0.67，95% CI=0.55-0.82)、蚊帳顏色偏好(OR=1.185，95% CI=1.03-1.34)、行政區域、良好蚊帳的數目(OR=1.13，95% CI=1.01-1.27)、母親年齡(OR=1.16，95% CI=1.02-1.32)、宗教(OR=0.86，95% CI=0.76-0.97)、家庭成員數目(OR=0.71，95% CI=0.60-0.84)、母親教育程度(OR=1.30，95% CI=1.07-1.59)、其他健康促進行為(OR=2.00，95% CI=1.14-3.5)及天花板材質(OR=0.73，95% CI=0.62-0.87)。
結論：研究結果顯示多種因素會影響孩童使用蚊帳的情形，可以利用這些因素研擬新方法，增進蚊帳的使用率。公共衛生機關在訓練專業人員的同時，應該要讓他們知道防瘧疾藥物對於預防疾病感染的成效是有限的，除此之外，在宣導使用蚊帳的相關資訊時，政府當局也應該要設法讓人民有相同的機會了解使用蚊帳的重要性，並從中受益。

ABSTRACT
Background: National Malaria Control Program has been successfully in increasing the number of households that own mosquito nets in Malawi. However, as many as half of nets already in households go unused. This study examines the factors associated with use of nets owned in Malawi.
Methods: Data was collected from June to November 2010 using a structured, interviewer-administered questionnaire by the Malawi statistical service as part of a national demographic and health survey (DHS). Secondary data analysis was performed on the collected data using multivariate logistic regression to examine the relationship of net used last night with the potentially explanatory variables. Odds Ratios, p-values, and confidence intervals were calculated for each variable to develop an explanatory model.
Results: The final multivariate model consisted of 12 variables statistically associated with whether or not the net was used the prior night: Diarrhea (OR = 1.168, 95% CI: 1.034 – 1.319), wealth index (OR = 1.463, 95% CI: 1.23 – 1.75), residence (OR = 0.67, 95% CI: 0.55 – 0.82), color of net preferred (OR = 1.185, 95% CI: 1.03 – 1.34), District, number of good net (OR = 1.13, 95% CI: 1.01 – 1.27), age of mother (OR = 1.16, 95% CI: 1.02 – 1.32), religion (OR= 0.86, 95% CI: 0.76 – 0.97), number of household members (OR = 0.71, 95% CI: 0.60 – 0.84), education level of mother (OR = 1.30, 95% CI: 1.07 – 1.59), health promotion measure (OR = 2.00, 95% CI: 1.14 – 3.5) and roof material (0R = 0.73, 95% CI: 0.62 – 0.87).
Conclusion: This study showed that there are a number of factors influencing utilization of ITNs by children. These factors reveal the opportunities that could be explored to scale up ITN utilization. Therefore, public health agencies, while training field workers, probably should also make a point to educate field workers about the limited effectiveness of anti-malarial drugs in preventing infections. Also, when implementing the messages regarding net use, authorities should consider techniques which could equalize everyone in benefiting the importance of nets.

Contents pages
Acknowledgement……………………………………………………………………………................i
Acronyms ……………………………………………………………………………………...............ii
Abstract ……………………………………………………………………………………………….iv
Table of content ………………………………………………………………………………………vi
List of tables…………………………………………………………………………………………..vii
List of figures………………………………………………………………………………………...viii
CHAPTER 1: INTRODUCTION ……………………………………………………………………1
1.1 Statement of the problem …………………………………………………………………………..1
CHAPTER 2: LITERATURE REVIEW ……………………………………………………………4
2.1 Theoretical Framework ……………………………………………………………………………..4
2.2 Factors related to ITNs usage ………………………………………………………………………5
2.2.1 Need Factors ……………………………………………………………………………………...5
2.2.1.1 Fever ……………………………………………………………………………………5
2.2.2 Enabling Factor …………………………………………………………………………………...6
2.2.2.1 Wealth index ……………………………………………………………………………6
2.2.2.2 Residence ……………………………………………………………………………….7
2.2.2.3 Color of net preferred …………………………………………………………………..8
2.2.2.4 Age of net ………………………………………………………………………………8
2.2.2.5 Number of good net …………………………………………………………………….9
2.2.3 Predisposing Factor ……………………………………………………………………………..10
2.2.3.1 Religious affiliation …………………………………………………………………...10
2.2.3.2 District…………………………………………………………………………………11
2.2.3.3 Number of household members ……………………………………………………….12
2.2.3.4 Mother’s education …………………………………………………………………....13
2.2.3.5 Health Promotion measure ……………………………………………………………14
2.2.3.6 Roof material ………………………………………………………………………….14
CHAPTER 3: METHODS ………………………………………………………………………......16
3.1 Study Area ………………………………………………………………………………………...16
3.1.1 Geography and Climate …………………………………………………………………16
3.1.2 Health ……………………………………………………………………………………16
3.2 Data source and Sample size………………………………………………………………………18
3.3 Measurements ……………………………………………………………………………………..20
3.3.1 Outcome Variables ……………………………………………………………………...21
3.3.2 Explanatory Variables …………………………………………………………………..21
3.4 Analysis …………………………………………………………………………………………...26
CHAPTER 4: RESULTS ……………………………………………………………………………28
4.1 Descriptive Analysis ………………………………………………………………………………28
4.2 Bivariate Analysis …………………………………………………………………………………28
4.3 Multivariate Analysis ……………………………………………………………………………..28
CHAPTER 5: DISCUSSION ………………………………………………………………………..40
Study limitation ……………………………………………………………………………………….47
CHAPTER 6: CONCLUSION………………………………………………………………………48
CHAPTER 7: REFERENCES ……………………………………………………………………...50
Tables Page
Table 4.1 Description of the sample characteristics …………………………………………32
Table 4.2 Bivariate relationship between explanatory variables and ITNs usage …………..34
Table 4.3 Multivariate analysis of factors associated with ITNs usage …………………….36
Figure Page
Figure 1: Theoretical framework model for determinants of ITNs usage in Malawi based on selected variables from Malawi Demographic Health Survey 2010…………………………….……………………………………………………………15
Figure 3.1: Map of Malawi ………………………………………………………………....28

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