Socio-economic and demographic disparities in ownership and use of insecticide-treated bed nets for preventing malaria among rural reproductive-aged women in northern Ghana.

Edmund Wedam Kanmiki,James F Phillips,Ayaga A Bawah,John Koku Awoonor-Williams,Sabastian F Achana,Stephen Patrick Kachur,James Akazili,Ana Paula Arez

doi:10.1371/journal.pone.0211365

Abstract

BackgroundMalaria continues to be a leading cause of morbidity and mortality in most countries in Sub-Saharan Africa. Insecticide-treated bed nets (ITNs) is one of the cost-effective interventions for preventing malaria in endemic settings. Ghana has made tremendous efforts to ensure widespread ownership and use of ITNs. However, national coverage statistics can mask important inequities that demand targeted attention. This study assesses the disparities in ownership and utilization of ITNs among reproductive-aged women in a rural impoverished setting of Ghana.MethodsPopulation-based cross-sectional data of 3,993 women between the age of 15 and 49 years were collected in seven districts of the Upper East region of Ghana using a two-stage cluster sampling approach. Bivariate and multivariate regression models were used to assess the social, economic and demographic disparities in ownership and utilization of ITN and to compare utilization rates among women in households owning at least one ITN.ResultsAs high as 79% of respondents were found to own ITN while 62% of ITN owners used them the night preceding the survey. We identified disparities in both ownership and utilization of ITNs in wealth index, occupational status, religion, and district of residence. Respondents in the relative richest wealth quintile were 74% more likely to own ITNs compared to those in the poorest quintile (p-value< 0.001, CI = 1.29–2.34) however, they were 33% less likely to use ITNs compared to the poorest (p-value = 0.01, CI = 0.50–0.91).ConclusionInterventions aimed at preventing and controlling malaria through the use of bed nets in rural Ghana and other similar settings should give more attention to disadvantage populations such as the poor and unemployed. Tailored massages and educational campaigns are required to ensure consistent use of treated bed nets.

Highlights

In spite of global efforts aimed at controlling and preventing malaria, it is still the leading cause of ill health, death, poverty and low productivity in most developing countries [1, 2]
We identified disparities in both ownership and utilization of Insecticide-treated bed nets (ITNs) in wealth index, occupational status, religion, and district of residence
Respondents in the relative richest wealth quintile were 74% more likely to own ITNs compared to those in the poorest quintile (p-value< 0.001, CI = 1.29–2.34) they were 33% less likely to use ITNs compared to the poorest (p-value = 0.01, CI = 0.50–0.91)

Summary

Introduction

In spite of global efforts aimed at controlling and preventing malaria, it is still the leading cause of ill health, death, poverty and low productivity in most developing countries [1, 2]. The World Health Organization (WHO) estimates that in the year 2016 alone, 216 million clinical cases of malaria were recorded while 445,000 deaths occurred globally due to malaria infection [1]. Sub-Saharan Africa alone accounted for 90% of all malaria cases and 91% of deaths due to malaria infection according to the 2017 World Malaria Report [1]. Malaria continues to be a leading cause of morbidity and mortality in most countries in SubSaharan Africa. Insecticide-treated bed nets (ITNs) is one of the cost-effective interventions for preventing malaria in endemic settings.

Methods

Results

Conclusion