Increased financial accessibility and targeted education messages could increase ownership and use of mosquito nets in Purulia District, West Bengal, India

Insecticide-treated mosquito nets are effective in reducing malaria transmission and mortality, yet they are underused for prevention. In this study, 561 households in 33 clusters were surveyed to estimate the coverage of net ownership and the frequency of use according to selected characteristics. Of the 540 participating household heads, 247 (46%) owned mosquito nets. Of 1681 individuals in households with mosquito nets, 1359 (81%) used the nets. A household monthly income ≥2000 Indian rupees (US$45) was strongly associated with mosquito net ownership (prevalence ratio = 12, 95% CI 7.8-82). Factors independently associated with net use in multivariate analysis included age < 35 years (P < 0.001), sleeping inside (P < 0.001), use of repellent (P = 0.03) as well as knowledge that mosquitoes cause malaria (P = 0.002) and that malaria is severe in children (P < 0.001). Whilst household income is the strongest determinant of mosquito net ownership, selected knowledge elements are associated with net use. It is necessary to improve financial accessibility to nets and to communicate that malaria is a disease transmitted by mosquitoes that could be fatal in children.