Insecticide-treated nets utilization and determinants in Southeast Asia toward malaria elimination: a systematic review and meta-analysis

Malaria remains a major public health burden in Southeast Asia, where elimination depends on consistent community-level use of insecticide-treated nets (ITNs) and residual spraying, despite limited regional evidence on ITN utilization. To address this gap, a systematic review and meta-analysis were conducted to assess ITN utilization in Southeast Asia. A comprehensive search was performed across PubMed, Web of Science, and ScienceDirect, followed by PRISMA guidelines. Of 450 records screened, 28 studies published between 2003 and 2023 met the inclusion criteria for qualitative synthesis, with 20 included in quantitative analyses, comprising 14,556 households and 122,258 individuals. Meta-analysis results indicated a consistent disparity between insecticide-treated net ownership or access and their actual use across different population groups. Substantial heterogeneity was observed across studies, reflecting pronounced variability between settings. The risk factor meta-analysis indicated that geographic region was the strongest determinant of ITN non-use, with higher odds in coastal areas than in delta regions (pooled OR = 4.73, 95% CI: 1.59−14.06), followed by socioeconomic status, with higher non-use in the poorest than in the richest (pooled OR = 1.70, 95% CI: 1.01−2.86). These findings highlight the predominance of contextual and structural determinants, particularly geographic settings and socioeconomic status, over demographic factors alone. Effective malaria prevention requires area-specific risk assessment that accounts for spatial and population-level heterogeneity to optimize the coverage and impact of preventive interventions. Toward elimination of malaria in Southeast Asia, targeted efforts to improve consistent ITN utilization remain essential, and these findings can guide population-specific control strategies and evidence-based policy decisions.