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Background In Ethiopia, despite improvements in coverage and access, utilization of long-lasting insecticidal nets (LLINs) remains a challenge. Different household-level factors have been identified as associated with LLIN use. However, the contribution of LLIN physical integrity to their utilization is not well investigated and documented. This study aimed to assess the association between the physical integrity of LLINs and their use. Methods This study employed a nested case-control design using secondary data from the Ethiopian LLIN durability monitoring study conducted from May 2015 to June 2018. LLINs not used the night before the survey were identified as cases, while those used the previous night were categorized as controls. The physical integrity of LLINs was classified as no holes, good, acceptable, and torn using the proportionate hole index (pHI). A Generalized Estimating Equation (GEE) model was used to assess and quantify the association between LLIN physical integrity and use. The model specifications included binomial probabilistic distribution, logit link, exchangeable correlation matrix structure, and robust standard errors. The factors included in the model were selected first by fitting binary regression, and then by including all factors that showed statistical significance at P-value less than 0.25 and conceptually relevant variables into the multivariate regression model. Results A total of 5277 observations fulfilled the inclusion criteria. Out of these 1767 observations were cases while the remaining 3510 were controls. LLINs that were in torn physical condition had higher odds (AOR [95% CI] = 1.76 [1.41, 2.19]) of not being used compared to LLINs with no holes. Other factors that showed significant association included the age of the LLIN, sleeping place type, washing status of LLINs, perceptions towards net care and repair, LLIN to people ratio, economic status, and study site. Conclusion and recommendation LLINs that have some level of physical damage have a relatively higher likelihood of not being used. Community members need to be educated about proper care and prevention of LLIN damage to delay the development of holes as long as possible and use available LLINs regularly.

Cross-sectional study was conducted using panel blood films and questioner to assess detection & identification performance of laboratory professionals’ and identify factors affecting the performance of malaria microscopic diagnosis. Study participants had 91.7% (95% CI: 89.96 – 93.44) agreement for detection of malaria parasites, 67.63% (95% CI: 64.91 – 70.35) species identification agreement for Plasmodium falciparum, 5.08% false positive and 21.04% false negative results. Correct species identification percentage for Plasmodium falciparum were 60.9% (510), Plasmodium vivax 59.17% (371) and Mixed (Plasmodium falciparum and Plasmodium vivax) 25% (53) were also identified in the study. In addition, sensitivity 94.69% (95% CI: 93.02 – 96.36) and specificity of 79.71 (95% CI: 75.22 – 84.2) were calculated from panel blood film results. The most frequent type of misdiagnosis was 85(40.09%) mixed BFs diagnosed as Plasmodium vivax, 67 (31.6%) mixed BFs as Plasmodium falciparum and 218(26%) Plasmodium falciparum BFs as Plasmodium vivax. Moreover, only 18(8.5%) laboratory professionals were participated in external quality assessment. From multiple logistic regression analysis training was the major factor for species identification percent agreement performance improvement of laboratory professionals. It showed statistical significance with p-value < 0.05 and untrained laboratory professionals were 64% less likely to perform ≥ 85% agreement of species identification. Training of laboratory professionals on malaria microscopic diagnosis help to improve the accuracy and reliability of reported results. This will help to provide the right and recommended medication and patient management.