Factors of Long-lasting Insecticidal Net Use among Mothers of Children Under Five in Southern Mozambique: A Mixed-method Study
Whitney Danilo Chigoi
*
Universidade São Tomás de Moçambique-Xai-Xai, Mozambique.
Inocêncio Muchanga
Hospital Distrital de Mapai, Mozambique.
Agrácio Cumbe
Universidade São Tomás de Moçambique-Macia, Mozambique.
Emídio Dique
Núcleo Provincial de Pesquisa de Direcção Provincial de Saúde de Gaza, Mozambique and Hospital Provincial de Xai-Xai, Mozambique.
Samuel Muchanga
Hospital Provincial de Xai-Xai, Mozambique.
Alfredo Muchanga
Hospital Distrital de Jangamo, Mozambique.
Mariza Manguele
Universidade São Tomás de Moçambique-Xai-Xai, Mozambique and Universidade São Tomás de Moçambique-Macia, Mozambique.
Diadora Mariquele
Hospital Provincial de Xai-Xai, Mozambique.
Sandra Bata
Serviço Distrital de Educação, Juventude e Tecnologia de Tambara, Mozambique.
Hilário Massango
Instituto Superior Politécnico de Gaza, Mozambique.
Osvaldo Muchanga
Universidade São Tomás de Moçambique-Xai-Xai, Mozambique and Universidade São Tomás de Moçambique-Macia, Mozambique.
Virgílio Simione Cau
Escola Secundaria Eduardo Mondlane de Mahamba, Mozambique and Instituto Superior Politécnico de Quissico, Mozambique.
Benilda Mondlane
Universidade São Tomás de Moçambique-Xai-Xai, Mozambique and Universidade São Tomás de Moçambique-Macia, Mozambique.
Soares Michal
Universidade Católica de Mocambique, Mozambique.
Avelino Mazuze
Faculdade de Ciências de Saúde da Universidade Lúrio, Mozambique.
Stélia Macome
Hospital Provincial de Xai-Xai, Mozambique.
Izaidino Muchanga
Universidade São Tomás de Moçambique-Xai-Xai, Mozambique.
Amâncio Nhangave
Núcleo Provincial de Pesquisa de Direcção Provincial de Saúde de Gaza, Mozambique and Hospital Provincial de Xai-Xai, Mozambique.
*Author to whom correspondence should be addressed.
Abstract
Background: Malaria remains a major public health problem in Mozambique, disproportionately affecting children under five years of age and pregnant women. Despite wide distribution of long-lasting insecticide-treated nets (LLINs), their use remains inconsistent in several regions. The study aims to analyze the sociocultural, behavioral, and institutional factors influencing LLIN use among mothers of children under five years of age in Bilene District, Gaza Province.
Methods: A cross-sectional qualitative study was conducted at the Macia Health Center between November and December 2022, involving 35 mothers of children under five selected through purposive sampling. Data were collected through semi-structured interviews, transcribed verbatim, and analyzed using content analysis with the support of MAXQDA software. Analytical categories included knowledge and perceptions of malaria, LLIN use practices, barriers, facilitators, and institutional factors.
Results: Among the 35 mothers, most were aged 18–28 years, cohabiting, housewives, with primary education, living near the health center, and identified as Christian. Most participants were aware of malaria transmission and recognized LLINs as an important preventive measure. However, net use was often selective and seasonal, prioritizing children and influenced by factors such as heat, discomfort, insecticide odor, net deterioration, and insufficient nets per household. Health services played a central role in net distribution and health education, although gaps in coverage and replacement persisted. Sociocultural practices and alternative uses of nets further limited their availability for prevention.
Conclusion: LLIN use is shaped by the interaction of individual, sociocultural, and institutional factors. Malaria control strategies should adopt integrated approaches that combine equitable distribution, context-sensitive health education, and continuous community follow-up to reduce the gap between knowledge and practice and strengthen malaria prevention among children under five.
Keywords: Malaria, long-lasting insecticide-treated nets, prevention, sociocultural factors, maternal and child health, Mozambique