Abstract
The persistent disparity between insecticide-treated (ITN) net ownership and actual nightly utilization limits the effectiveness of malaria prevention strategies in Nigeria. This study assessed ITN coverage, the social determinants of its use, and its direct association with confirmed malaria infection among febrile patients in Osun State. A facility-based cross-sectional study enrolled 200 febrile patients across six Local Government Areas, serving as a focused sentinel investigation. Data regarding sociodemographics and net utilization were collected via a structured questionnaire. Malaria infection was confirmed using a nested polymerase chain reaction (PCR) reference standard. Data were analyzed using descriptive statistics and multivariate logistic regression, with multicollinearity assessed via Variance Inflation Factors (VIF). ITN ownership was 74.5%, while actual utilization was 52.0%, yielding a 22.5 percentage-point gap. Higher education (aOR=2.51), richest wealth quintile (aOR=3.02), and mass media exposure (aOR=1.89) independently predicted net use. PCR-confirmed malaria positivity was 23.5%. Net non-use (aOR=4.12) and open eaves (aOR=1.92) strongly predicted infection. Socioeconomic factors drive a significant utilization gap, resulting directly in higher malaria prevalence among non-users. Intervention strategies must pair distribution with targeted behavioral communication and structural improvements.