Utilization Of Insecticide Treated Nets Research Articles

Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria.

Introduction. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women and under-five children, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Insecticide Treated Nets (ITN) by community members. Therefore, this study assessed the knowledge of malaria prevention among caregivers of under-five children and pregnant women in a rural community in Southwest Nigeria.Methodology. This is part of a larger malaria prevention study in rural Southwest Nigeria. A descriptive cross-sectional survey was conducted among pregnant women and caregivers of under-five children in Igbo-Ora, a rural town in Southwest Nigeria using a semi-structured, interviewer-administered questionnaire. Information was obtained on knowledge of malaria prevention, and overall composite scores were computed for knowledge of malaria prevention and ITN use. Data were analyzed using SPSS version 16. Associations between variables were tested using a Chi-square with the level of statistical significance set at 5%.Results. Of the 631 respondents, 84.9% were caregivers of under-five children and 67.7% were married. Mean age was 27.7 ± 6.3 years with 53.4% aged between 20 and 29 years. Majority (91.1%) had at least primary school education and 60.2% were traders. Overall, 57.7% had poor knowledge of malaria prevention. A good proportion (83.5%) were aware of the use of ITN for malaria prevention while 30.6% had poor knowledge of its use. Respondents who were younger (<30 years), had at least primary education and earn <10,000/per month had significantly poor knowledge of ITN use in malaria prevention. Majority (60.0%) respondents had poor attitude regarding use of ITNs.Conclusion. This study showed that the knowledge of malaria prevention is still low among under-five caregivers and pregnant women in rural Southwest Nigeria despite current control measures. There is a need for concerted health education intervention to improve the knowledge of rural dwellers regarding malaria prevention, including the use of ITN. This will go a long way to improving the reported low level of ownership and utilization of ITN in the rural areas.

Ownership and utilization of insecticide-treated nets (ITNs) for malaria control in Harari National Regional State, Eastern Ethiopia.

IntroductionInsecticide-treated nets (ITNs) stood at center in the current efforts to prevent and control malaria at community and individual levels. Though ITNs are the most prominent measure for large-scale deployment in highly endemic areas their compliance in terms of ownership and usage needs attention. The aim of this study was therefore to determine the ownership and utilization pattern of ITNs in Harari Peoples National Regional state, Ethiopia.MethodsA community based cross-sectional study was conducted in Harari National Regional State from September to October, 2012. A total of 784 households were included from malarious areas. Data were collected by using structured questionnaires and observational checklist.ResultsAbout 57.9% of participants had at least one ITNs. The utilization of ITNs based on history of sleeping under net in the previous night was 73.3%. Regarding proper use of ITNs, 57.9% of respondents demonstrated proper hanging and tucking. Those households with secondary school education (AOR: 1.775(1.047, 3.009)), knowledge about ITNs use (AOR: 2.400(1.593, 3.615)) and knowledge of malaria transmission by bite of mosquito (AOR: 1.653(1.156, 2.365)) have more likely hood to own ITNs.ConclusionITNs Ownership was low as compared to the target by Federal ministry of Health of Ethiopia. Though utilization of ITNs was promising, there are still significant number of participants who demonstrate hanging and tucking improperly. Therefore, health bureau need to work towards increasing the distribution of ITNs per household and also provide health information through health extension workers to enhance regular and proper usage of the ITNs.

Education attainment of head of households associated with insecticide-treated net utilization among five to nineteen-year old individuals: evidence from the malaria indicator survey 2010 in Zambia.

BackgroundEducation attainment may be a factor potentially influencing health-seeking behaviour of individuals. The effect of the level of education attainment of head of households of five to nineteen year old individuals in Zambia on ITN utilization was investigated.MethodsData stem from the 2010 Malaria Indicator Survey, which covered the entire Zambia, was used in this study. Of the total number of five to 19-year olds (n = 7,429), only 65% (4, 810) met the inclusion criteria for this study. The education level of the head of households was taken as a household variable and was categorized as "never been to school" for those who had never enrolled in school, Primary for Grades 1 to 7, Secondary for Grades 8 to 12 and Tertiary for beyond Grade 12. Multivariate Logistic regression was used to determine adjusted odds ratios that estimated the effect of education on ITN utilization after controlling for residence, sex, age group and other background factors.ResultsOverall (n = 4,810), 48.5% were males and 51.5% were females with the median age of 10 years and 11 years respectively. The ITN utilization among the five to 19 year old individuals from households with the head having Primary and Secondary education were not statistically significant from those who came from households where the head had never been to school. However, those who came from households with the head having tertiary education attainment were 1.7 times more likely to have slept under an ITN a night before the survey than those from households headed by individuals who never attended school or had primary education. (AOR, 1.69; 95% CI, 1.19-2.41). Of the eligible population, 35% were excluded from the study due to incomplete records.ConclusionThe findings suggest that tertiary education of the head of head of the household might be important in influencing health behaviour of the members of households. Therefore, health education messages focussing on strategies that aim to increase ITN utilization need to account for these differential variations associated with education attainment in communities.

Insecticide-treated nets ownership and utilization among under-five children following the 2010 mass distribution in Burkina Faso.

BackgroundPeriodic mass distributions contribute significantly to universal access to insecticide-treated nets (ITNs). However, due to the limited number of nets distributed, needs remain unsatisfied, particularly in large households.MethodsThis study was conducted in Kaya health district following the 2010 mass distribution of ITNs in Burkina Faso. Data were collected on the socio-economic and geo-spatial characteristics and ITN possession and utilization levels of 2,004 households. The study explored: 1) ITN access, in terms of intra-household saturation with ITNs (households with at least one ITN for every two members) correctly installed and in very good physical condition; and 2) factors influencing the decision to place under-five children under a net. Particular attention was given to vector control activities undertaken by mothers.ResultsOf the 2,004 households, 90% possessed at least one ITN. However, intra-household saturation with ITNs was below 60% in small households and below 20% in large ones (>6 members). Crude proportion ratios comparing possession and levels of intra-household saturation with ITNs varied between 1.5 (small households) and 7.8 (large households). The proportions of households with ITNs for every two members that were correctly hung or in very good physical condition ranged from 0% to 6.5% in large households and 27.8% to 40.7% in small ones. ITN use to protect under-five children was lower in large households; it was significantly higher when there was at least one ITN for every two members. In large households, it was significantly higher when a child had experienced an episode of any illness in the previous two weeks and when the mother had taken actions to control vector proliferation. In small households, ITN use was significantly higher in families with agricultural land and children aged 12–23 months.ConclusionOwnership rates were high, but real access to bed nets remained limited. The allocation process disadvantages large families. Real access to bed nets implies they are available, properly installed, and in good condition. More post-campaign awareness-raising activities targeting preventive practices in households could foster more effective ITN use.

Challenges in universal coverage and utilization of insecticide-treated bed nets in migrant plantation workers in Myanmar.

BackgroundHigh coverage of the bed nets can reduce mortality and morbidity of mosquito-borne diseases including malaria. Although the migrant workers are at high risk of malaria, there are many hidden challenges in universal coverage and utilization of the insecticide-treated nets (ITNs) in this populations.MethodsCross sectional study was conducted in 170 migrant workers in palm oil plantation sites in Tanintharyi Region and 175 in rubber plantation sites in Mon State. A multistage stratified cluster sampling was applied to select the participants. During household visit, face-to-face interviews using structured pre-coded, pre tested questionnaires and direct observation on installation of the bed nets was conducted. Two focus group discussions in each site were done by sample stratified purposive sampling method mainly focused on effective utilization of bed nets.ResultsAmong them, 332 (96.2%) had a bed net and 284 (82.3%) had an ITN, while 204 (59.1%) had unused extranets. Among the ITNs users, 28.9% reported problems including insecticide smell (56.9%), dizziness (20.2%), headache (12.8%) and itchiness (9.2%). More than 75% received ITNs from health authorities and NGOs free-of-charge. More than 70% wanted to buy a net but they were unaffordable for 64% of them. On observation, only five families could show no bed net, but 80% showed 1–3 ITNs. Consistent utilization in all seasons was noted in 189 (53.1%), that was higher in palm oil plantation than rubber plantation workers (p = 0.0001) due to the nature of the work at night. Perceived malaria risk was also significantly higher ITNs consistent users than non-users (p = 0.0004) and better willingness to buy an ITN by themselves (p = 0.0005). They said that effectiveness of the ITNs was reduced after 6 months and 2–3 times washing. They wished to receive more durable smooth nets with small holes in lace. Misuses of the ITNs such as use the nets for animals and fishing, were also noted.ConclusionThere should be efforts to improve effective utilization of ITNs by continuous mass free distribution, durability monitoring, surveillance of insecticide resistance of the vector and behaviour change interventions in migrant plantation workers.

Towards making efficient use of household resources for appropriate prevention of malaria: investigating households’ ownership, use and expenditures on ITNs and other preventive tools in Southeast Nigeria

BackgroundMany households own, use and spend money on many malaria preventive tools, some of which are inappropriate and ineffective in preventing malaria. This is despite the promotion of use of effective preventive methods such as Insecticide treated nets (ITNs) and indoor residual house spraying (IRHS). The use of these ineffective methods imposes some economic burden on households with no resultant reduction in the risk of developing malaria. Hence, global and national targets in use of various effective malaria preventive toools are yet to be achieved in Nigeria. This paper presents new evidence on the differential use and expenditures on effective and non-effective malaria preventive methods in Nigeria.MethodsSemi-structured interviewer administered pre-tested questionnaire were used to collect data from 500 households from two communities in Enugu state, Nigeria. The two study communities were selected randomly while the households were selected systematically. Information was collected on demography, malaria status of children under 5 within the past month, types of malaria preventive tools used by households and how much was spent on these, the per capita household food expenditure and assets ownership of respondents to determine their socio-economic status.ResultsThere was high level of ownership of ITNs (73%) and utilization (71.2%), with 40% utilization by children under 5. There were also appreciable high levels of use of other malaria preventive tools such as window and door nets, indoor spray, aerosol spray and cleaning the environment. No significant inequity was found in ownership and utilization of ITNs and in use of other preventive methods across socioeconomic groups. However, households spent a lot of money on other preventive tools and average expenditures were between N0.83-N172 ($0.005-$1.2) The richest households spent the most on window and door nets (P = 0.04).ConclusionHigh levels of use and expenditure on ITNs and other malaria preventive tools exist. A programmatic challenge will involve designing ways and means of converting some of the inefficient and inappropriate expenditures on many ineffective malaria preventive tools to proven cost-effective methods such as ITNs and IRHS. This will help to achieve universal coverage with malaria preventive tools.

Malaria indicator survey 2009, South Sudan: baseline results at household level

BackgroundSouth Sudan has borne the brunt of years of chronic warfare and probably has the highest malaria burden in sub-Saharan Africa. Malaria is the leading cause of morbidity and mortality in the country. This nationally representative survey aimed to provide data on malaria indicators at household level across the country.MethodsIn 2009, data were collected using a two-stage random cluster sample of 2,797 households in 150 census enumeration areas during a Malaria Indicator Survey (MIS) in South Sudan. The survey determined parasite and anaemia prevalence in vulnerable population groups and evaluated coverage, use and access to malaria control services. Standardized Roll Back Malaria Monitoring and Evaluation Reference Group (RBM-MERG) MIS household and women’s questionnaires were adapted to the local situation and used for collection of data that were analysed and summarized using descriptive statistics.ResultsThe results of this survey showed that 59.3% (95% CI: 57.5-61.1) of households owned at least one mosquito net. The proportion of the population with access to an ITN in their household was 49.7% (95% CI: 48.2-51.2). The utilization of insecticide-treated nets was low; 25.3% (95% CI: 23.9-26.7) for children under five (U5) and 35.9% (95% CI: 31.9-40.2) of pregnant women (OR: 1.66 (1.36-2.01); P =0.175). Prevalence of infection was 24.5% (95% CI: 23.0-26.1) in children U5 and 9.9% (95% CI: 7.4-13.1) in pregnant women. About two thirds (64%) of children U5 and 46% of pregnant women were anaemic. Only 2% of households were covered by indoor residual spraying (IRS) the previous year. Data shows that 58% reported that malaria is transmitted by mosquitoes, 34% mentioned that the use of mosquito nets could prevent malaria, 41% knew the correct treatment for malaria, and 52% of the children received treatment at a health facility.ConclusionThe observed high malaria prevalence could be due to low levels of coverage and utilization of interventions coupled with low knowledge levels. Therefore, access and utilization of malaria control tools should be increased through scaling up coverage and improving behaviour change communication.

Utilization of insecticide treated nets (ITNs) among male students of a tertiary institution in Lagos State, Nigeria

Background: Malaria is an eminently preventable, treatable and curable disease. Proven effective options to reduce morbidity and mortality include early diagnosis, combined with prompt effective therapy and malaria prevention through reduction of human-vector contact, emphasizing the use of insecticide-treated nets (ITNs). The aim of this study was to determine the knowledge, attitude and utilization of malaria preventive methods among the students residing in Mariere Hostel of the University of Lagos, Akoka. Materials and Methods: The study design was a cross-sectional descriptive study. Simple random sampling method was used to select the respondents. Pre-tested, structured, open and close-ended self administered questionnaires were used for data collection. Data analysis was done using Epi info version 3.5.1 statistical software package. The study was carried out in February 2012. Results: A total of 221 out of the administered 250 questionnaires were retrieved and analyzed giving a response rate of 88.4%. All the respondents were males with a mean age of 20 ± 2.8 years. The mean knowledge score (%) of the respondents was 76.5 ± 3.19. Although, 91.0% of the respondents recommended the use of ITNs to all students, only 31.6% use ITNs. The major reason given for non-usage of ITNs being that it is uncomfortable (45.3%). There was no statistically significant relationship between socio-demographic characteristics and utilization of ITN. Conclusion: This study has demonstrated high level of knowledge of malaria and positive attitude towards malaria prevention but poor malaria prevention practice as evidenced by poor usage of insecticide-treated nets. There is therefore need for more enlightenment campaigns to improve and sustain the knowledge and attitude towards malaria prevention as well as improve utilization of ITNs.

Prevalence and barriers to the use of insecticide treated nets among pregnant women attending ante-natal clinic at Specialist Hospital Sokoto, Nigeria

Malaria is endemic and a major public health problem in Nigeria. In most malaria endemic areas, pregnant women are the main adult group at risk for the severe form of the disease.In the absence of effective vaccine for malaria prevention and development of unacceptable levels of resistance to one drug after another by the malaria parasite, prevention of mosquitoes bite through use of insecticide treated nets (ITNs) remains a very important strategy for malaria control. This study aimed to assess the prevalence and barriers to use of insecticide treated nets among pregnant women in Sokoto. This was a cross sectional descriptive study among 185 randomly selected pregnant women attending antenatal clinic (ANC) at Specialist Hospital Sokoto, in October, 2010. Data collection was done using a set of pretested, semi-structured questionnaires; descriptive statistics was used for analysis. Among the 179 (96.8%) respondents that were aware of ITNs out of the 185 participants, 154 (86.0%) had accurate knowledge of ITNs, 50 (27.6%) use ITNs (but this constitutes 74.6% of the 67 respondents that own an ITN). One hundred and eleven (84.7%) of the 131 respondents who did not sleep under an ITN the night before the survey, gave lack of ITNs as reason for not sleeping under the net. Utilization of ITNs was low despite high knowledge of the commodity among the respondents. Lack of ownership was the major barrier to its utilization. Educational level was statistically significantly associated with ownership and use of ITNs (p < 0.001). Women empowerment (through education and employment) and monitoring of ITNs distribution by the relevant government agencies were suggested as important interventions in improving availability, affordability and use of ITNs. Key words: Insecticide treated nets, prevalence, barriers, pregnancy.

Universal coverage with insecticide-treated nets – applying the revised indicators for ownership and use to the Nigeria 2010 malaria indicator survey data

BackgroundUntil recently only two indicators were used to evaluate malaria prevention with insecticide-treated nets (ITN): “proportion of households with any ITN” and “proportion of the population using an ITN last night”. This study explores the potential of the expanded set of indicators recommended by the Roll Back Malaria Monitoring and Evaluation Reference Group (MERG) for comprehensive analysis of universal coverage with ITN by applying them to the Nigeria 2010 Malaria Indicator Survey data.MethodsThe two additional indicators of “proportion of households with at least one ITN for every two people” and “proportion of population with access to an ITN within the household” were calculated as recommended by MERG. Based on the estimates for each of the four ITN indicators three gaps were calculated: i) households with no ITN, ii) households with any but not enough ITN, iii) population with access to ITN not using it. In addition, coverage with at least one ITN at community level was explored by applying Lot Quality Assurance Sampling (LQAS) decision rules to the cluster level of the data. All outcomes were analysed by household background characteristics and whether an ITN campaign had recently been done.ResultsWhile the proportion of households with any ITN was only 42% overall, it was 75% in areas with a recent mass campaign and in these areas 66% of communities had coverage of 80% or better. However, the campaigns left a considerable intra-household ownership gap with 66% of households with any ITN not having enough for every family member. In contrast, the analysis comparing actual against potential use showed that ITN utilization was good overall with only 19% of people with access not using the ITN, but with a significant difference between the North, where use was excellent (use gap 11%), and the South (use gap 36%) indicating the need for enhanced behaviour change communication.ConclusionsThe expanded ITN indicators to assess universal coverage provide strong tools for a comprehensive system effectiveness analysis that produces clear, actionable evidence of progress as well as the need for specific additional interventions clearly differentiating between gaps in ownership and use.

Factors Affecting Utilization of Insecticide Treated Nets among People Living with HIV/Aids in Bahir Dar City, Northwest Ethiopia

Introduction: Malaria and HIV are among the two most important global health problems of this time. All HIV-positive persons (PLHAs) in the household were encouraged to sleep under insecticide treated nets (ITNs) at all times of year. However, the information on utilization and associated factors on these groups have been limited. Objective: the aim of the study was to assess utilization of ITN and associated factors among PLHA, who are members of the three PLHA associations in Bahir City Administration, northwest Ethiopia. Methods: A community based cross-sectional study was conducted from March to May, 2013. A simple random sampling technique was used to select the study participants. Pre-tested and structured questionnaire and observation check list was used to collect the data. Each variable were analyzed by using bi variate logistic regression to know their significance and to assess the separate effects and multi variate analysis was done using backward stepwise logistic regression to control the possible confounding effect for variables with p-value <0.2 in bi variate analysis. Result: Three hundred four304 (76.8%) of PLHA utilized ITNs properly. The main reasons for those who had not have ITN and not utilized ITN were, they did not know where obtained the ITNs 20 (41.7%), ITNs were expensive 16 (33.3%), and no fear of mosquito bite at this time 60(65.2%). Knowledge about malaria risks and ITNs importance (AOR= 2.3; 95% CI 1.23- 4.40), formal education (AOR= 2.39; 95% CI 1.40- 4.08) and better income was significantly associated with ITN utilizations (AOR= 1.83; 95%CI 1.05- 3.20) Conclusion: The PLHA needs special attention on the utilization of ITN. Free provision of ITNs, awareness creation on the utilization of ITN and participate in Income generating activities are supreme important.

Utilization of insecticide treated nets during pregnancy among postpartum women in Ibadan, Nigeria: a cross-sectional study

BackgroundPregnant women are susceptible to symptomatic malaria due to invasion of the placenta by plasmodium. Malaria increases the risk of adverse pregnancy outcomes for mothers, the foetuses and newborns. The effective use of Insecticide Treated Nets (ITNs) would be of benefit to these vulnerable women. Previous studies have focused on prenatal-women but this study sought to explore the actual trend of utilization of the proven strategy across all the pregnancy stages among postpartum women in Ibadan.MethodsThis cross-sectional survey utilized a validated structured questionnaire for data collection. A calculated sample of 335 postpartum women was proportionately recruited from three fee-paying facilities within Ibadan, Nigeria using a simple random sampling technique. These hospitals have high client flow for maternity cases and are known for provision of care under traditional ANC model. The data collected were analyzed using descriptive and inferential statistics by means of Statistical Package of Social Sciences (SPSS) version 15. The level of significance was set at = 0.05.ResultsThe women's age ranged between 18 and 47 years, mean age was 29.4 ± 0.8 years. Various irregularities marked the traditional model of ANC provided at the settings and no exposure to preconception care. Also, 276 (82.4%) had heard of ITNs. Antenatal clinics formed the major source of information. Low utilization and compliance rates were observed. One hundred and twenty-seven (37.9%) of the women had high knowledge of Malaria in Pregnancy (MIP) but only 70 (20.9%) demonstrated positive attitude towards the use of ITNs. Participants' educational status, family types, employment and residential areas significantly influenced ITNs utilization.ConclusionsThe women knew and learned about ITNs from ANC visits. Majority of the women did not own ITNs because of lack of access to free distribution. The existing traditional model of ANC was marked by irregularities and none of the women was exposed to preconception care. In addition, negative attitude in spite of increased knowledge of MIP was observed among the women. Therefore, evaluation of free distribution of ITNs is recommended. Integration of focused ANC and preconception care are advocated to promote early access to health information.

Factors Associated with Utilization of Insecticide-Treated Nets in Children Seeking Health Care at a Ugandan Hospital: Perspective of Child Caregivers

In Uganda malaria causes more morbidity and mortality than any other disease and children below 5 years contribute the biggest percentage of malaria related mortality. Insecticide treated nets (ITNs) are currently one of the most cost effective option for reducing malaria-related morbidity and mortality, however the factors affecting their utilization in Uganda are still not well understood. This study examined the prevalence and factors associated with ITN utilization among children of age 0-12 years seeking health care from a Ugandan hospital using caregiver's reports. A cross sectional design was used to collect data using a semi-structured questionnaire from 418 participants. Binary logistic regression was employed to determine predictors of ITN utilization. Results show that the prevalence of ITN utilization among children seeking health care was 34.2%. ITN utilization was higher among children of age <5 years [37.0, 95% CI 31.81-42.21] as compared to children aged ≥5 years [22.9, 95% CI 13.77-32.01]. Source of mosquito net (OR = 13.53, 95% CI = 6.47-28.27), formal employment by head of household (OR = 6.00, 95% CI = 1.95-18.48), sharing a bed with parent (s) (OR = 2.61, 95% CI = 1.21-5.63) and number of children below 12 years in a household (OR = 0.80, 95% CI = 0.65-0.99), were significant predictors of utilization. ITN utilization among children was below the set national target. The predictors identified by this study reveal opportunities that can be taken advantage of by malaria control programs to achieve the desired rates of utilization and subsequently malaria prevention in children.

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania.

BackgroundResearch evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs).MethodsThis study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics.ResultsThe survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14).ConclusionsImproving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.

Knowledge and practice concerning malaria, insecticide-treated net (ITN) utilization and antimalarial treatment among pregnant women attending specialist antenatal clinics

This study was conducted to determine the knowledge and practice of pregnant women attending specialist antenatal clinics (ANCs) concerning malaria, ITN (insecticide-treated net) utilization and antimalarial treatment. The study recruited 225 women who voluntarily presented at ANCs in Jimma town, Ethiopia. A pre-tested questionnaire was administered. A great majority (98.2%; 221/225) of the respondents were aware of malaria. Among them, 77.4% (174/225) indicated mosquito bites as a mode of malaria transmission. Overall, 94.3% (212/225) and 98.3% (221/225) of pregnant women had knowledge about ITNs and antimalarials, respectively. Overall, 76.8% (173/225) and 57.4% (129/225) of the study participants erroneously indicated mosquito bites and stagnant water as causes of malaria, respectively. In general, the majority of pregnant women were unable to distinguish between malaria transmission and cause. Chi-square analysis revealed a strong association between the educational status of the pregnant women and their daily usage of ITNs (P = 0.001; χ2 = 22.9; df = 8). The results clearly suggest that although the majority of the pregnant women had ample awareness of malaria, ITN usage and antimalarial treatment, a sizable faction still had misconceptions and misunderstandings. Therefore, appropriate communication strategies should be designed and implemented among the marginalized and most vulnerable section of society, especially through health education campaigns, in order to have a constructive outcome in the near future.

Use of insecticide treated nets among caregivers of children under five years in Makueni District, Kenya

Insecticide treated nets (ITNs) have been identified as a key strategy in addressing malaria problem among young children and pregnant women. Their utilisation among under fives, however, have been found to be low in some areas. To identify factors affecting net utilisation (sleeping under insecticide treated net) among caregivers of under fives in Makueni District in Kenya. A cross-sectional, descriptive study. Eight sub-locations in Wote division Makueni district. Four hundred caregivers of children aged five years and below. The results indicated that 88.5% of caregivers were aware of ITNs. The proportion of households with children below five years that owned mosquito net were found to be 46.2%, and only 32.0% had at least a treated net. Slightly more than half of treated nets were used by under fives (52.2%) compared to 47.8% used by children over five years including adults. The main reason cited by majority of caregivers as a hindrance to net utilisation was lack of treated nets in households (72.3%). Utilisation of ITNs by under five children was found to be positively associated with knowledge of ITNs (p = 0.024), marital status (p = 0.018) and occupation (p = 0.043). Utilisation of ITNs by under fives was low despite high level of awareness among caregivers. Factors such as awareness of ITNs, marital status and occupation significantly affected ITNs utilisation. Although the government with support from other stakeholders has recently embarked on large scale distribution of nets in high risky districts, more interventions from various stakeholders are needed to increase availability and accessibility of subsidised permanently treated nets, including interventions to address non-compliance to proper utilisation of nets. There is also need for intensive education emphasising on their proper and consistent use. Scaling up proper use of ITNs along with other initiatives can contribute significantly in reducing malaria.

Utilization of insecticide treated nets in Arbaminch Town and the malarious villages of Arbaminch Zuria District, Southern Ethiopia

Introduction: Malaria causes an overwhelmingly large number of cases and deaths round the globe every year. Insecticide treated nets (ITNs) have become important tools that provide a simple, but effective means of preventing malaria in highly endemic areas. Methods: A community-based cross-sectional study design was used to investigate possession, utilization, and factors affecting possession and utilization of ITNs in Arbaminch Town and the malarious villages of Arbaminch Zuria District, southern Ethiopia from 22nd January to 1st February 2007 on a sample of 454 households. Data were collected using structured, pretested, interviewer-administered questionnaire. Data entry and analysis was performed using SPSS 11.0 for windows. Univariate, bivariate and multivariate analyses were carried out. Results: The coverage for any net and ITN was 75.1% and 58.8% respectively; the utilization rate for any net and ITN by any member of the household the night prior to the study was 71% and 73% respectively. Both coverage and utilization were higher in rural areas than in urban areas. The proportion of pregnant women and children under five years who slept under ITNs the night preceding the study was 35% and 40.3% respectively. Education and income of head of households, place of residence of households and presence of high risk groups in the household were found to be predictors of net possession. Sex and income of head of households, and presence of radio in the households were predictors of utilization of nets by any household member. Education of head of households and place of residence ofhouseholds were predictors of utilization of nets by high risk groups.Conclusions: A wide gap exists between coverage and utilization of ITNs. Use of ITNs by high risk groups is far below the Abuja target. Appropriate BCC interventions are required to narrow the gap between coverage andutilization of ITNs and to escalate use of ITNs by high-risk groups.

Knowledge, attitudes and practices of local inhabitants about insecticide treated nets (itns) for malaria control in an endemic area of Ethiopia

The present study was conducted to assess the knowledge, attitudes and practices of local residents about insecticide treated nets (ITNs) for malaria control in an endemic area of Ethiopia. A descriptive cross-survey was conducted from July 2008 to September 2008. A structured questionnaire collecting sociodemographic, ITNs and malaria-related KAP information was administered to the representatives of households. Azendabo town, Ethiopia. 84% of the inhabitants had awareness about malaria transmission; mosquito bites were identified correctly as the cause of malaria. 85.2% respondents indicated that mosquitoes bite at night. ITNs awareness level of inhabitants was 92.4%; however, just 57.8% of them own ITNs. 96.2% and 91.5% of the inhabitants indicated the foremost reasons for nonpossession of ITNs were due to unaffordability and nonavailability. Inhabitants average monthly income significantly associated with the ITNs ownership at p<0.05 and, however educational status of the respondents and ITNs ownership was not significant (p=0.1). Indeed, respondents had adequate knowledge regarding ITNs and malaria related information. However, inhabitants had poor attitude and practice towards the ITNs utilization due to lack of availability and affordability. Therefore, besides health education campaign, distribution and promotion of ITNs to entire rural residents at free of charge may possibly bring constructive outcome in the near future.

Integration of insecticide‐treated net distribution into routine immunization services in Malawi: a pilot study

To determine the feasibility of distributing insecticide-treated nets (ITNs) through routine immunization services, to increase ownership and use of ITNs among high-risk groups, whereas maintaining or improving timely completion of routine vaccinations. Free ITNs were provided with timely completion of routine vaccinations in two intervention districts in southern Malawi for 15 months. Cross-sectional baseline and follow-up household surveys were conducted in the two intervention districts and one control district. Insecticide-treated nets utilization among children aged 12-23 months roughly doubled in the two intervention districts and did not change in the control district. Timely vaccination coverage increased in all three districts. The percentage of children aged 12-23 months who were both fully vaccinated by 12 months and slept under an ITN the night prior to the interview increased from 10-14% at baseline to 40-44% at follow-up in the intervention districts (P < 0.001), but did not change significantly in the control district. This study is the first to evaluate the provision of free ITNs at completion of a child's primary vaccination series, demonstrating that such a linkage is both feasible and can result in improved coverage with the combined services. Additional studies are needed to determine whether such a model is effective in other countries, and whether integration of other health services with immunization delivery could also be synergistic.

Knowledge and utilization of insecticide treated mosquito nets among freely supplied households in Wonago Woreda, Souther Ethiopia

Abstract Background: Free distribution of Insecticide Treated Nets (ITNs) for households in malarious areas is currently underway in Ethiopia to prevent malaria. Adequate follow-up of its utilization and status is lacking. Objectives: To assess utilization of ITNs by households and under-five children, and the factors affecting its utilization among freely supplied households. Methods: A community-based cross-sectional study was conducted in Wonago Woreda, Southern Ethiopia, in June and July 2006. Malarious kebeles of the study area were stratified into three strata based on their distance from Dilla Town (one of the towns in the Woreda), and 650 households freely supplied with at least one ITN were randomly selected using proportional allocation to size. Results: Of the 944 freely supplied ITNs to 638 households, 649 (68.8%) were reported as being used by households. The use of at least one ITN was reported by 482 (75.5%) households, and under-five children who slept under ITN in the previous night were 452 (58.0%). Availability of separate bedroom significantly increased the use of ITN by households. In addition, possession of two or more ITNs and perception that ITN prevents from mosquito bite were significantly associated with utilization of ITNs by households and under-five children. Conclusion: Not all ITNs supplied to households were used. Its utilization was affected by the unavailability of separate bedroom, less number of ITNs supplied and less perception of ITNs as main preventive measures of malaria. A strong health education program is needed for promoting the proper utilization of this newly adopted malaria control strategy. [ Ethiop.J.Health Dev. 2008;22(1):34-41]