Purpose . In the year 2015, the Ghana Health Service launched a free mass insecticide-treated net (ITN) distribution campaign in the Sunyani West district of Ghana with the aim of improving household ownership to increase usage. This study determined the level of ownership and usage of ITNs and associated factors among households in the Sunyani West district two years after the mass distribution campaign. Methods . Study participants were identified using the systematic approach in all five subdistricts of the Sunyani West district and interviewed, and data were collected on household ITN ownership. Data were also collected on the source of the ITN and whether the respondent slept under an ITN the previous night. Data on individual and community factors associated with ITN ownership and usage were also collected. Pearson chi-square tests and logistic regression were performed to determine factors significantly associated with ITN ownership and usage. Results . The level of ITN ownership was 78.93% and usage was 55.93%. Most of the participants (73.62%) received their nets during the 2015 mass distribution campaign, 39 (11.96%) received their ITNs during antenatal care visits, whilst 27 (8.28%) bought the nets from the store. People who experience irritation ( χ ² = 23.32; p < 0.001) and respondents who did not perceive themselves as likely to be beaten by mosquitoes or get malaria ( χ ² = 26.61; p < 0.001) were less likely to use ITNs. Respondents who used other malaria/mosquito bite prevention methods were also less likely to use the ITNs ( χ ² = 206.26; p = 0.001), but individuals who received free nets were likely to use them. Conclusion . ITN ownership was high, but usage was low and far below the national target. Intense health education emphasizing the fact that everybody is susceptible to malaria may help improve usage.