Factors of Long-lasting Insecticidal Net Use among Mothers of Children Under Five in Southern Mozambique: A Mixed-method Study

Background: Malaria remains a major public health problem in Mozambique, disproportionately affecting children under five years of age and pregnant women. Despite wide distribution of long-lasting insecticide-treated nets (LLINs), their use remains inconsistent in several regions. The study aims to analyze the sociocultural, behavioral, and institutional factors influencing LLIN use among mothers of children under five years of age in Bilene District, Gaza Province. Methods: A cross-sectional qualitative study was conducted at the Macia Health Center between November and December 2022, involving 35 mothers of children under five selected through purposive sampling. Data were collected through semi-structured interviews, transcribed verbatim, and analyzed using content analysis with the support of MAXQDA software. Analytical categories included knowledge and perceptions of malaria, LLIN use practices, barriers, facilitators, and institutional factors. Results: Among the 35 mothers, most were aged 18–28 years, cohabiting, housewives, with primary education, living near the health center, and identified as Christian. Most participants were aware of malaria transmission and recognized LLINs as an important preventive measure. However, net use was often selective and seasonal, prioritizing children and influenced by factors such as heat, discomfort, insecticide odor, net deterioration, and insufficient nets per household. Health services played a central role in net distribution and health education, although gaps in coverage and replacement persisted. Sociocultural practices and alternative uses of nets further limited their availability for prevention. Conclusion: LLIN use is shaped by the interaction of individual, sociocultural, and institutional factors. Malaria control strategies should adopt integrated approaches that combine equitable distribution, context-sensitive health education, and continuous community follow-up to reduce the gap between knowledge and practice and strengthen malaria prevention among children under five.