BACKGROUND Malaria is one of the top-five contributors to under-5 deaths in Myanmar. Use of insecticide-treated nets (ITN) and receiving early appropriate care in case of fever are the core interventions to prevent malaria and its complications and thereby deaths. This study aimed to assess among the under-five children, (a) utilization of ITNs and its associated factors, (b) care-seeking behaviour among their caregivers and its associated factors and uptake of malaria testing among those with fever in the last 2 weeks. METHODS This was a cross sectional study using secondary analysis of Myanmar Demographic and Health Survey (MDHS) conducted in 2015-2016. Multivariable logistic regression was used to explore the factors associated with non-utilization of ITNs and not seeking care for fever. Effect sizes have been presented using odds ratios with 95% confidence intervals. Data analysis was done using svyset command in STATA to account for the multi-stage sampling design of the survey. RESULTS Of 4597 alive under-five children, 80.5% did not sleep under an ITN last night. The factors significantly associated with non-utilization of ITNs were residing in malaria elimination regions (aOR = 2.0, 1.3-3.2), urban residence (aOR = 1.8, 1.2-2.9), staying in delta region (aOR = 8.7, 4.7-12.2), hilly region (aOR = 3.0, 2.0-4.6, and having highest wealth quintile (aOR = 1.8, 1.1-3.0). Around 16% had fever in the last 2 weeks, of whom 66.7% sought care for fever and 3% got tested for malaria. Nearly half (50.9%) of the caregivers sought care from a government health facility, followed by private hospital/doctor (27.8%), shop (8.0%), village health worker (4.4%) and pharmacy (3.1%). The factors associated with not seeking care for fever were residing in specific geographical locations (hilly, delta and central plains compared to coastal region) and having lowest wealth quintile (aOR = 2.3, 1.1-5.7). CONCLUSIONS This study highlighted that ownership and utilization of ITNs was very poor among under-5children. Care-seeking behaviour of the caregivers of under-5 children in case of fever was dismal with two-thirds not seeking care. The programme should seriously consider addressing these barriers if Myanmar is to achieve zero malaria deaths by 2030.

中文翻译：

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在不同地区五岁以下儿童中使用经杀虫剂处理的蚊帐并寻求发烧及其相关的社会人口统计学和地理因素：缅甸人口与健康调查（2015-2016年）的证据。

背景技术疟疾是缅甸五岁以下儿童死亡的前五位贡献者之一。使用经杀虫剂处理的蚊帐（ITN）并在发烧的情况下及早接受适当的护理，是预防疟疾及其并发症并因此导致死亡的核心干预措施。这项研究旨在评估五岁以下儿童中的（a）ITN及其相关因素的利用情况，（b）他们的看护者及其相关因素中的看护行为以及最近2例发烧患者中疟疾检测的摄取周。方法这是一项横断面研究，使用了2015年至2016年进行的缅甸人口与健康调查（MDHS）的二级分析。多变量logistic回归用于探讨与未利用ITN且不寻求发烧相关的因素。使用具有95％置信区间的比值比表示了效应大小。使用STATA中的svyset命令进行数据分析，以说明调查的多阶段抽样设计。结果在4597个5岁以下活着的孩子中，有80.5％的人昨晚没有在ITN下睡觉。与未利用ITN显着相关的因素主要是消灭疟疾的地区（aOR = 2.0，1.3-3.2），城市居民（aOR = 1.8，1.2-2.9），留在三角洲地区（aOR = 8.7，4.7-12.2） ），丘陵地区（aOR = 3.0，2.0-4.6，财富最高的五分之一人群（aOR = 1.8，1.1-3.0）。最近2周内约有16％的人发烧，其中66.7％寻求发烧的人和3％的人进行了疟疾检测。将近一半（50.9％）的护理人员从政府医疗机构寻求护理，其次是私家医院/医生（27.8％），商店（8.0％），乡村卫生工作者（4.4％）和药房（3.1％）。与不寻求发烧相关的因素是居住在特定地理位置（与沿海地区相比，丘陵，三角洲和中部平原），财富五分位数最低（aOR = 2.3，1.1-5.7）。结论这项研究强调了5岁以下儿童中ITN的所有权和使用率非常低。5岁以下儿童在发烧的情况下的看护行为令人沮丧，三分之二的人不寻求治疗。如果缅甸到2030年实现零疟疾死亡，该计划应认真考虑解决这些障碍。三角洲和中部平原（相比沿海地区），财富五分位数最低（aOR = 2.3，1.1-5.7）。结论这项研究强调了5岁以下儿童中ITN的所有权和使用率非常低。5岁以下儿童在发烧的情况下的看护行为令人沮丧，三分之二的人不寻求治疗。如果缅甸到2030年实现零疟疾死亡，该计划应认真考虑解决这些障碍。三角洲和中部平原（相比沿海地区），财富五分位数最低（aOR = 2.3，1.1-5.7）。结论这项研究强调了5岁以下儿童中ITN的所有权和使用率非常低。5岁以下儿童在发烧的情况下的看护行为令人沮丧，三分之二的人不寻求治疗。如果缅甸到2030年实现零疟疾死亡，该计划应认真考虑解决这些障碍。