Higher temperatures and being an ethnic minority reduce mosquito net use in Lao PDR: an analysis of Lao PDR's Multiple Indicator Cluster Survey and Earth observation satellite data.

Background: Malaria remains the leading cause of under-five morbidity and mortality in low- and middle-income countries. Sleeping under mosquito nets, especially insecticide-treated nets (ITNs), is one of the best ways to prevent malaria as they form a physical and chemical barrier against mosquitoes. Therefore, the present study aimed to assess not only mosquito net use, but also how environmental factors, specifically land surface temperature, contribute to malaria prevention among households with children under 5 years of age in Lao PDR.

Methods: The most recent Multiple Indicator Cluster Survey datasets of Lao PDR 2017 and the Japan Aerospace Exploration Agency (JAXA) Public Health Monitoring and Analysis Platform (JPMAP) were used. Data from 51,948 households were used in the analysis. A bivariate logistic regression analysis was followed by a multivariate logistic regression analysis to determine the factors influencing mosquito net use with children under five.

Results: In this study, 77.8% of all households with children under 5 years of age slept under mosquito nets. Of these, 80.5% were ITNs (Olyset, Permanent, and other brands). Multivariate logistic regression analysis revealed that mosquito net use was significantly associated with the land surface temperature, ethno-linguistic group (Lao-Tai, Mon-Khmer, Hmong-Mien, Chinese-Tibetan, and other), education level of the household head, and wealth index quintile.

Conclusions: The analysis of the present study suggested measures to intensify the use of mosquito nets with an emphasis on ethnic minorities living in hot areas to bring Lao PDR closer to the day that mosquito-borne infections such as malaria can be eliminated.