Barriers to Access and Sustained Use of Insecticide-Treated Bed Nets for Prevention of Malaria in Pankshin LGA, Plateau State, Nigeria

Malaria remains a significant public health challenge in Pankshin LGA, Plateau State, Nigeria, requiring effective prevention through insecticide-treated bed nets (ITNs). This study utilized a mixed-methods approach to investigate the barriers to ITN access and sustained utilization across eight communities. Findings revealed a high aggregate ownership rate of 88.2%, with universal coverage achieved in four communities; however, significant gaps persist in Nungwus (63.6%) and Dimwai (70%). A critical "know-do" gap was identified, as 92.9% of respondents recognized ITNs as effective, yet only 57% reported consistent nightly use. Statistical analysis showed that while barriers were significantly associated with place of residence ($\chi^2 = 72.91, p < 0.001$), socio-demographic factors like education and occupation had no significant influence on usage frequency. The predominant deterrent was heat and physical discomfort, reaching 100% in certain communities, alongside localized cultural myths. Consequently, high ownership does not guarantee protection due to environmental and structural constraints. It is recommended that the Ministry of Health transition from simple distribution to a holistic strategy that includes providing "breathable" net designs and improving housing ventilation. Furthermore, localized behavioral change communication must address community-specific myths, while "last-mile" distribution frameworks should be strengthened to reach marginalized populations. Addressing these practical barriers is essential for translating ITN ownership into meaningful reductions in malaria morbidity and mortality within high-risk Nigerian communities..