Abstract
BackgroundOne established means of preventing the adverse consequences of malaria during pregnancy is sleeping under an insecticide treated net (ITN) throughout pregnancy. Despite increased access to this intervention over time, consistent ITN use during pregnancy remains relatively uncommon in sub-Saharan Africa.Methodology/Principal FindingsWe sought to identify determinants of ITN use during pregnancy. Utilizing a population-based random sample, we interviewed 500 women living in Jinja, Uganda, who had been pregnant in the past year. ITN ownership at the start of pregnancy was reported by 359 women (72%) and 28 women (20%) acquired an ITN after the first trimester of pregnancy. Among 387 ITN owners, 73% reported either always sleeping under the ITN during all trimesters of pregnancy, or after acquiring their net. Owning more than 1 net was slightly associated with always sleeping under an ITN during pregnancy (RR: 1.13; 95% CI: 1.00, 1.28). Women who always slept under an ITN during pregnancy were more likely to be influenced by an advertisement on the radio/poster than being given an ITN free of charge (RR: 1.48; 95% CI: 1.24, 1.76). No differences were found between other socio-demographic factors, pregnancy history, ANC use or socio-cultural factors.Conclusions/SignificanceWhile self-reported ITN ownership and use was common throughout pregnancy, we were unable to pinpoint why a sizable fraction of Ugandan women did not always adhere to recommendations for use of an ITN during pregnancy. More data are needed on the capacity of individual households to support the installation of ITNs which may provide insight into interventions targeted at improving the convenience and adherence of daily ITN use.
Highlights
In areas with stable malaria transmission, malaria parasitaemia is commonly asymptomatic during pregnancy
The 2009 Malaria Indicator Survey in Uganda reports 53.7% of pregnant women slept under any mosquito net the night before the interview, and 43.7% slept under an insecticide treated net (ITN) [13,14]
Selection of study participants Home-based interviews were conducted between November, 2008 and January, 2009 from a population-based simple random sample of 500 female residents of Kibibi and Namizi parishes in Budondo-sub county of Jinja District, Uganda, to ascertain ownership, acquisition and use of ITNs and antimalarial use during pregnancy, as well as possible factors associated with these behaviors
Summary
In areas with stable malaria transmission, malaria parasitaemia is commonly asymptomatic during pregnancy. A meta-analysis on the effectiveness of ITNs in preventing adverse maternal and fetal outcomes in Africa among pregnant women living in areas with endemic malaria concluded that the use of ITNs during pregnancy reduced placental malaria by 23%, reduced fetal loss by 32% and improved birth weight by 33 grams [5]. Free ITN distribution campaigns and subsidized voucher programs for ITNs targeting pregnant women and children ,5 years have been successful at increasing the proportion of households that own and use an ITN [7,8,9,10,11], ITN use among currently pregnant women in many intervention areas remains low [8,10]. Despite increased access to this intervention over time, consistent ITN use during pregnancy remains relatively uncommon in sub-Saharan Africa
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