Vol. 1 No. 1 (2026)

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Determinants of Utilization of Long-Lasting Insecticidal Nets ( LLINs ) for Malaria Prevention in Fashoda County, Upper Nile State, South Sudan

Lual Kur Amum Ajak, School of Public Health, AMREF International University, Nairobi, Kenya Denis Butto, School of Public Health, AMREF International University, Nairobi, Kenya Tobijo Denis Sokiri Moses, School of Public Health, Upper Nile University, South Sudan
DOI: 10.5281/zenodo.19046958
Published: December 22, 2026

Abstract

Background: Malaria remains a leading cause of morbidity and mortality in South Sudan, particularly in Fashoda County, Upper Nile State. Despite widespread distribution of Long-Lasting Insecticidal Nets (LLINs), utilization rates remain inconsistent, undermining the effectiveness of vector control interventions. Understanding the determinants influencing LLINs use is critical for improving malaria prevention in this resource-limited, conflict-affected setting. Objective: This study examined factors affecting LLINs utilization among households in Fashoda County, focusing on community knowledge, socio-economic status, cultural beliefs and practices, and accessibility to LLINs distribution mechanisms. Methods: A cross-sectional analytical design was employed among 334 household respondents selected through probability-proportional-to-size cluster sampling across four settlement clusters. Data were analysed using descriptive statistics, Spearman rank correlation, and ordinal logistic regression in SPSS v25. Results: Descriptive analysis revealed 66.5% of respondents were strongly aware of LLINs, yet only 50.3% reported consistent nightly usage. Spearman correlation indicated significant positive associations with knowledge (rₛ = 0.72, p < 0.01), socio-economic factors (rₛ = 0.68, p < 0.01), and accessibility (rₛ = 0.74, p < 0.01), while cultural beliefs had a moderate negative effect (rₛ = –0.33, p < 0.05). Ordinal regression confirmed knowledge (β = 30.63, p < 0.001), income capacity (β = 45.10, p < 0.001), and easy access (β = 6.19, p < 0.001) as significant positive predictors, whereas negative cultural beliefs (β = –1.21, p = 0.027) reduced utilization likelihood. Conclusion: LLINs utilization in Fashoda County is shaped by converging knowledge, socio-economic, cultural

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Lual Kur Amum Ajak, Denis Butto, Tobijo Denis Sokiri Moses (2026). Determinants of Utilization of Long-Lasting Insecticidal Nets ( LLINs ) for Malaria Prevention in Fashoda County, Upper Nile State, South Sudan. African Journal of Public Health and Health Systems, Vol. 1 No. 1 (2026). https://doi.org/10.5281/zenodo.19046958
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Keywords

LLINs utilizationmalaria preventionFashoda CountySouth Sudanknowledgesocio-economic factorscultural beliefs

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  • © 2025 Ajak, Butto & Sokiri Moses. Published by African Journal of Public Health and Health Systems under CC BY 4.0 License. DOI: 10.XXXXX/AJOPHA.2025.XXXXX
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