Universal coverage with long-lasting insecticidal nets (LLINs) is an essential component of malaria control programmes. Three-yearly mass distribution of LLINs in Papua New Guinea (PNG) has been successful in reducing infection transmission since 2009, but malaria prevalence ramped up from 2015 onwards. Although LLIN universal coverage is mostly achieved during these campaigns, it may not be related with net use over time. Uses given to LLINs and non-compliance of this strategy were evaluated. A knowledge, attitude and practice (KAP) cross-sectional study was conducted in Lihir Islands, PNG, 2–2.5 years after the last LLIN mass distribution campaign. Data on bed net ownership, use and maintenance behaviour was collected using a household questionnaire administered by trained community volunteers. Logistic regression models were used to identify factors associated with owning at least one LLIN and sleeping under a LLIN the previous night. Among 2694 households surveyed, 27.4 % (95 % CI: 25.8–29.2) owned at least one LLIN and 8.7 % (95 % CI: 7.6–9.8) had an adequate LLIN coverage (at least one LLIN for every two people). Out of 13,595 individuals in the surveyed households, 13.6 % (95 % CI: 13.0-–4.2) reported having slept under a LLIN the preceding night. Determinants for sleeping under LLIN included living in a household with adequate LLIN coverage [adjusted OR (aOR) = 5.82 (95 % CI: 3.23–10.49)], household heads knowledge about LLINs [aOR = 16.44 (95 % CI: 8.29–32.58)], and female gender [aOR = 1.92 (95 % CI: 1.53–2.40)] (all p-values < 0.001). LLIN use decreased with older age [aOR = 0.29 (95 % CI: 0.21–0.40) for ≥ 15 year-olds, aOR = 0.38 (95 % CI: 0.27–0.55) for 5–14 year-olds] compared to < 5 year-olds (p-value < 0.001). Knowledge on the use of LLIN was good in 37.0 % of the household heads. Repurposed nets were reported serving as fishing nets (30.4 %), fruits and seedlings protection (26.6 %), covering up food (19.0 %) and bed linen (11.5 %). Two years after mass distribution, LLIN coverage and use in Lihir Islands is extremely low. Three yearly distribution campaigns may not suffice to maintain an acceptable LLIN coverage unless knowledge on maintenance and use is promoted trough educational campaigns.

中文翻译：

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长效杀虫蚊帐在巴布亚新几内亚利希尔群岛大规模分发两年后的覆盖率、使用决定因素和重新利用：一项横断面研究

长效杀虫蚊帐 (LLIN) 的普遍覆盖是疟疾控制计划的重要组成部分。自 2009 年以来，巴布亚新几内亚 (PNG) 每年大规模分发 LLIN 已成功减少了感染传播，但疟疾流行率从 2015 年开始上升。尽管 LLIN 普遍覆盖在这些活动中大部分实现，但随着时间的推移，它可能与净使用无关。对 LLIN 的使用和不遵守该策略的情况进行了评估。在上次 LLIN 大规模分发活动后 2-2.5 年，在巴布亚新几内亚利希尔群岛进行了一项知识、态度和实践 (KAP) 横断面研究。使用由经过培训的社区志愿者管理的家庭问卷收集有关蚊帐所有权、使用和维护行为的数据。Logistic 回归模型用于识别与拥有至少一个 LLIN 并在前一天晚上睡在 LLIN 下相关的因素。在接受调查的 2694 户家庭中，27.4%（95% CI：25.8-29.2）拥有至少一个 LLIN，8.7%（95% CI：7.6-9.8）有足够的 LLIN 覆盖（每两个人至少一个 LLIN）。在接受调查的家庭中的 13,595 个人中，13.6%（95% CI：13.0-–4.2）报告说前一天晚上睡在 LLIN 下。在 LLIN 下睡眠的决定因素包括居住在具有足够 LLIN 覆盖范围的家庭中 [调整后的 OR (aOR) = 5.82 (95 % CI: 3.23–10.49)]、户主对 LLIN 的了解 [aOR = 16.44 (95 % CI: 8.29–32.58) )] 和女性 [aOR = 1.92 (95% CI: 1.53–2.40)]（所有 p 值 < 0.001）。LLIN 的使用随着年龄的增长而减少 [aOR = 0.29 (95 % CI: 0.21–0.40) ≥ 15 岁，aOR = 0.38（95 % CI：0.27-0.55）对于 5-14 岁] 与 < 5 岁（p 值 < 0.001）。37.0% 的户主熟悉 LLIN 的使用。据报道，改造过的网可用作渔网 (30.4%)、水果和幼苗保护 (26.6%)、覆盖食物 (19.0%) 和床上用品 (11.5%)。大规模分发两年后，LLIN 在利希尔群岛的覆盖率和使用率极低。除非通过教育活动推广有关维护和使用的知识，否则三年一次的分发活动可能不足以维持可接受的 LLIN 覆盖范围。水果和幼苗保护 (26.6 %)，覆盖食物 (19.0 %) 和床上用品 (11.5 %)。大规模分发两年后，LLIN 在利希尔群岛的覆盖率和使用率极低。除非通过教育活动推广有关维护和使用的知识，否则三年一次的分发活动可能不足以维持可接受的 LLIN 覆盖范围。水果和幼苗保护 (26.6 %)，覆盖食物 (19.0 %) 和床上用品 (11.5 %)。大规模分发两年后，LLIN 在利希尔群岛的覆盖率和使用率极低。除非通过教育活动推广有关维护和使用的知识，否则三年一次的分发活动可能不足以维持可接受的 LLIN 覆盖范围。