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Does exposure to malaria prevention messages influence insecticide-treated net use through knowledge of malaria? Evidence from a causal mediation analysis among women in Uganda

Year: 2026

Type: article

Abstract: Exposure to malaria prevention messages is associated with increased use of insecticide-treated nets, but the mechanisms remain unclear. This study assessed whether comprehensive malaria knowledge mediates the relationship between exposure to malaria prevention messages and insecticide-treated net (ITN) use among women of reproductive age in Uganda. We analyzed data from women aged 15–49 years from the 2018/2019 Uganda Malaria Indicator Survey (UMIS). Using a counterfactual causal mediation framework, the study decomposed the total effect (TE) of exposure to malaria prevention messages into the natural direct effect (NDE) and the natural indirect effect (NIE), adjusting for socio-demographic confounders to identify whether malaria knowledge mediated the effect of exposure to malaria prevention messages on ITN use. Among 8,868 participants (8,231 non-refugee women, 637 refugee women), 6,143 (69.3%) reported using an ITN on the night before the survey, 3,334 (37.6%) had been exposed to malaria prevention messages, and 5,427 (61.2%) had comprehensive knowledge of malaria. Exposure to malaria prevention messages significantly increased ITN use by 6.5 percentage points TE = 0.065, 95% confidence interval [CI]: 0.034, 0.094, p < 0.001. The NDE of malaria prevention message exposure on ITN use remained significant [0.064, 95% CI: 0.034, 0.092, p < 0.001], while the NIE of malaria prevention messages through comprehensive malaria knowledge was not statistically significant [0.001, 95% CI: −0.002, 0.005, p = 0.462], accounting for approximately 1.5% of the total effect. Exposure to malaria prevention messages is associated with increased ITN use primarily through direct behavioral pathways rather than through knowledge acquisition. Communication strategies should therefore integrate motivational and behavioral reinforcement components alongside informational content to maximize public health impact.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1948476