Abstract
BackgroundMalaria during pregnancy is a major public health problem in Nigeria leading to increase in the risk of maternal mortality, low birth weight and infant mortality. This paper is aimed at highlighting key predictors of the ownership of insecticide treated nets (ITNs) and its use among pregnant women in Nigeria.MethodsA total of 2348 pregnant women were selected by a multi-stage probability sampling technique. Structured interview schedule was used to elicit information on socio-demographic characteristics, ITN ownership, use, knowledge, behaviour and practices. Logistic regression was used to detect predictors of two indicators: ITN ownership, and ITN use in pregnancy among those who owned ITNs.ResultsITN ownership was low; only 28.8% owned ITNs. Key predictors of ITN ownership included women who knew that ITNs prevent malaria (OR = 3.85; p < 0001); and registration at antenatal clinics (OR = 1.34; p = 0.003). The use of ITNs was equally low with only 7.5% of all pregnant women, and 25.7% of all pregnant women who owned ITNs sleeping under a net. The predictors of ITN use in pregnancy among women who owned ITNs (N = 677) identified by logistic regression were: urban residence (OR = 1.87; p = 0.001); knowledge that ITNs prevent malaria (OR = 2.93; p < 0001) and not holding misconceptions about malaria prevention (OR = 1.56; p = 0.036). Educational level was not significantly related to any of the two outcome variables. Although registration at ANC is significantly associated with ownership of a bednet (perhaps through free ITN distribution) this does not translate to significant use of ITNs.ConclusionsITN use lagged well behind ITN ownership. This seems to suggest that the current mass distribution of ITNs at antenatal facilities and community levels may not necessarily lead to use unless it is accompanied by behaviour change interventions that address the community level perceptions, misconceptions and positively position ITN as an effective prevention device to prevent malaria
Highlights
Malaria during pregnancy is a major public health problem in Nigeria leading to increase in the risk of maternal mortality, low birth weight and infant mortality
Nigeria has promoted insecticide treated nets (ITNs) use in pregnancy along with other evidence-based interventions for malaria control since the Abuja Malaria Summit [9] but levels of ITN utilization by pregnant women and other vulnerable population groups have remained low [10,11,12]
Pregnant women who knew that ITNs prevent against malaria were nearly four times more likely to use ITNs than those who did not have such knowledge (OR = 3.9, 95% confidence interval 3.073 to 4.824; p < .0001)
Summary
Malaria during pregnancy is a major public health problem in Nigeria leading to increase in the risk of maternal mortality, low birth weight and infant mortality. Placental infections compromise foetal nutrition leading to intrauterine foetal growth retardation and low birth weight [3]. Placental infection and other deleterious effects of malaria are worse in first pregnancies than in subsequent ones [4]. Low birth weight caused by malaria in pregnancy is estimated to account for over 100,000 infant deaths in Africa annually [5]. This explains why national efforts to reduce the high maternal and infant mortality place high premium on effective control of malaria in pregnancy
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