Social Interactions and the Uptake of Long-Lasting InsecticideTreated Nets (LLINs) among Under-Five Children in Kenya: Policy Implications

Abstract

Background: Despite the availability of effective prevention measures such as long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS), malaria remains a major global health concern. In 2023, the WHO African region accounted for 95% of global malaria deaths, of which 76% occurred among children under five years. Methods: This study analyzed data from the 2020 Kenya Malaria Indicator Survey, including 6,771 eligible child caregivers. Bivariate and logistic regression analyses were employed to examine the influence of religious social interactions on LLIN use among children under five. Results: Logistic regression revealed that LLIN use among children under five was significantly influenced by child age, caregiver education, household wealth, and place of residence, with social interactions by religious affiliation amplifying these effects. Compared to infants, oneyear-olds were 13.4% more likely to use an LLIN (p<0.05), although this advantage declined with age. Caregiver education strongly predicted use, with primary schooling raising uptake by 18.6% and secondary or higher by 25.2% (p<0.01); these effects were further strengthened when caregivers belonged to active religious networks. Similarly, children in the highest wealth quintile were 22.7% more likely to use LLINs than those in the lowest (p<0.01), but peer influences within faith-based groups widened this wealth gap, especially in rural settings where uptake was otherwise 11.5% lower than in urban areas (p<0.05). Overall, social interactions shaped how education, wealth, and rural residence translated into preventive behavior, underscoring the importance of community-level peer effects in malaria prevention. Conclusion: Religious social interactions play an important role in shaping malaria prevention behaviors. Policy measures should leverage faith-based networks to strengthen community education, address rural–urban disparities, and optimize resource allocation for malaria control.