Background: Myanmar accounts for the greatest number of malaria cases among the Greater Mekong Sub-regions and 60% of the total populations are residing in malaria endemic area. The Myanmar National Malaria Strategic Plan (2016 to 2020) has recommended universal coverage and use of long-lasting insecticide-treated net (LLIN) as a key vector control measure in all malaria transmission areas.

Objective: The present study aimed to identify LLIN use and associated factors in the high, moderate, and low transmission areas of Myawaddy District, which is a high malaria morbidity and mortality area.

Materials and Methods: A cross sectional study using multistage stratified sampling was performed on 423 households in the high, moderate, and low malaria transmission areas of Myawaddy District. Structured interviews and observations of LLIN use were conducted between April and May 2017. Bivariate and multivariate logistic regressions were performed to find predictors of effective LLIN use the night before the survey.

Results: Household ownership of at least one LLIN was 91.0%, 87.2%, and 96.5% in high, moderate, and low transmission areas, respectively. Among these households, those in which all household members sleeping under effective LLIN the night before the survey was lowest in high transmission area (37.8%), followed by moderate transmission area (72.4%), and low transmission area (83.8%). Knowledge of malaria was poor in high and moderate transmission areas, while perceptions towards malaria and receiving malaria information were lowest in high transmission area. Multivariate analysis showed that knowledge of malaria, perceived susceptibility and seriousness on malaria, exposure to malaria information, ethnicity of household head, family size, and number of LLIN available in the household were the important predictors of the household in which all household members sleeping under LLIN the night before the survey.

Conclusion: The present study indicated that 100% use of LLIN should be achieved through effective behavioral change communication to improve malaria knowledge and perceptions. Moreover, the National Malaria Control Program should focus on households with Kayin ethnicity, low income, and large family size in high malaria transmission area.

Keywords: Long lasting Insecticide-treated net, Malaria, Thai Myanmar Border