| dc.description.abstract | Malaria remains one of the leading public health challenges globally, affecting approximately 263 million people and causing an estimated 597,000 deaths annually. Sub-Saharan Africa bears the greatest burden, accounting for 94% of global cases. In Kenya, malaria continues to pose a significant threat, with an estimated six million cases reported annually. This study examined behavioral determinants of insecticide-treated net (ITN) utilization among caregivers of children under five years in Butere Sub-County, Kakamega County, Kenya, using the Health Belief Model (HBM) as a guiding framework. A community-based cross-sectional study design was employed, involving 422 caregivers selected through multistage cluster sampling. Quantitative data were collected using structured, interviewer-administered questionnaires, while qualitative data were obtained through 22 focus group discussions (FGDs) and 12 key informant interviews (KIIs) with caregivers and community health promoters. Quantitative data were analyzed using chi-square and logistic regression at a 95% confidence level (p < 0.05), and qualitative data were thematically analyzed using NVivo 12. The dependent variable was ITN utilization, while the independent variables—perceived vulnerability, severity, benefits, and barriers—captured caregivers’ beliefs regarding malaria risk and prevention. Results indicated that 74.6% of caregivers perceived children under five as vulnerable to malaria, and 88.6% believed they were at greater risk than adults. Caregivers who perceived malaria as a serious illness were 2.5 times more likely to use ITNs [AOR = 2.517; 95% CI: 1.175–5.391; p = 0.002], while those associating malaria with anemia were less likely to use them. A significant association was found between perceived vulnerability and ITN utilization (χ² = 4.219; p = 0.040; OR = 0.343; 95% CI: 0.119–0.995). Qualitative findings revealed that although caregivers acknowledged the effectiveness of ITNs, consistent use was hindered by discomfort from heat, torn nets, limited supply, and cultural beliefs such as the ―bad eye.‖ These insights highlight a paradox within the HBM: despite high awareness of malaria’s severity and children’s vulnerability, consistent ITN use remains suboptimal due to behavioral and contextual barriers. The study concludes that targeted, culturally sensitive interventions—integrating health education, improved ITN access, and community engagement—are essential to strengthen caregivers’ perceived benefits and reduce practical and cultural barriers. Addressing these factors will enhance ITN utilization and contribute to sustainable malaria prevention among children under five in endemic regions. | en_US |
