Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis

Interventions for malaria prevention in pregnancy; factors influencing uptake and their effect on pregnancy outcomes among post-natal women in a tertiary facility in the Volta Region of Ghana

Objectives

Malaria in pregnancy is associated with adverse pregnancy outcomes including maternal anaemia and low birthweight. Uptake of preventive interventions is sub-optimal in sub-Saharan Africa including Ghana. Understanding local-level factors that influence uptake of these interventions can enhance control. The study assessed uptake of intermittent preventive treatment of malaria during pregnancy using sulphadoxine-pyrimethamine (IPTp-SP) and insecticide-treated net (ITN) use, their determinants and effects on pregnancy outcomes.

Methods

A cross-sectional study involving 349 post-partum women was conducted from 25 August 2022 to 9 October 2022 at the Ho Teaching Hospital. A structured questionnaire was used to collect data on participant socio-demographics, ITN use, number of doses of sulphadoxine-pyrimethamine received, knowledge of malaria in pregnancy, haemoglobin levels and birth weight among others. Summary statistics were reported as frequencies, percentages and means. Associations between exposure and outcome variables were assessed using logistic regression methods and odds ratios reported with 95% confidence intervals. Statistical significance was concluded at p < 0.05.

Results

More than 80% (291) of respondents received ⩾3 doses of intermittent preventive treatment using sulphadoxine-pyrimethamine and 64.8% (226) slept under ITNs the night before the survey. Age >25 years, employment, good knowledge of malaria in pregnancy, parity ⩾2 and initiating antenatal care visits in the first trimester facilitated the uptake of these interventions. Receiving ⩾3 doses of sulphadoxine-pyrimethamine was associated with having normal-weight babies (adjusted odds ratio 2.80, 95% CI: 1.07, 7.34; p = 0.036) while ITN use was associated with having term babies (adjusted odds ratio 2.72, 95% CI: 1.24, 5.90; p = 0.013) and normal maternal haemoglobin concentration at term (adjusted odds ratio 1.57, 95% CI: 1.01, 2.47; p = 0.044).

Conclusions

The interventions were beneficial against low birthweight and preterm births which predispose to neonatal deaths and poor cognitive function in children. Malaria in pregnancy health campaigns should be intensified, especially among younger-aged primigravidae, to increase their knowledge of the condition as a way to further improve uptake of these preventive interventions.

Insecticide-treated bed net utilization and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Malaria infection during pregnancy endangers the pregnant woman, fetus, and newborn child. Thus, the use of an insecticide-treated net (ITN) is one of the most frequently advised methods for preventing malaria during pregnancy. Contrary findings have been reported in various studies on ITN utilization among pregnant women in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of ITN utilization and its associated factors among pregnant women in Ethiopia.

METHODS

Published articles from PubMed, Google Scholar, Science Direct, AJOL and Cochrane library were systematically searched. All cross-sectional studies on ITN utilization among pregnant women were included in this meta-analysis. To estimate the pooled prevalence and odds ratio, a random-effect model was used; and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias.

RESULTS

Ten cross-sectional studies with 7,161 participants were included. The pooled prevalence of ITN utilization among all pregnant women who had access to ITN in Ethiopia was 59.42% (95% CI 51.14, 67.69). Statistically significant heterogeneity was observed (I2 = 97.7%; p < 0.0001). Higher educational status (OR = 3.47, 95% CI   2.32, 5.2), pregnant women who had antenatal care visits (OR = 2.37, 95% CI 1.97, 2.65) and having good knowledge of malaria prevention practices (OR = 10.63, 95% CI   5.31, 21.29) were associated with ITN utilization among pregnant women.

CONCLUSION

The utilization of ITNs among pregnant women was much lower than the national target. Higher education status, attending ANC and a good level of knowledge were found to be independent predictors of ITN utilization. Improving women's understanding of ITNs will enhance their use, and the government and health sectors should encourage pregnant mothers to enroll in antenatal care.

Utilization of insecticide-treated nets and associated factors among childbearing women in Northern Nigeria

BACKGROUND

Studies have explored the correlates of insecticide-treated nets in Nigeria. The few studies that focused on Northern Nigeria mostly examined individual correlates, but largely ignored the community correlates. Also, the persistence of armed insurgencies in the region calls for more research attention. This study examines the utilization and the associated individual and community factors of insecticide-treated nets in Northern Nigeria.

METHODS

The study adopted a cross-sectional design. Data were extracted from the 2021 Nigeria Malaria Indicator Survey (NMIS). A weighted sample size of 6873 women was analysed. The outcome variable was the utilization of insecticide-treated nets. The explanatory variables selected at the individual/household level were maternal age, maternal education, parity, religion, sex of head of household, household wealth, and household size. The variables selected at the community level were the type of place of residence, geo-political zone of residence, the proportion of children under five who slept under a bed net, the proportion of women aged 15-49 who heard malaria media messages, and the community literacy level. Two variables, namely, the number of mosquito bed nets in the household, and the number of rooms used for sleeping were included for statistical control. Three multilevel mixed-effect regression models were fitted.

RESULTS

The majority of childbearing women (71.8%) utilized insecticide-treated nets. Parity and household size were the significant individual/household characteristics associated with the utilization of insecticide-treated nets. The proportion of under-five children in the community who slept under mosquito bed nets, and the geopolitical zone of residence were significant community correlates of the use of insecticide-treated nets. In addition, the number of rooms for sleeping, and the number of mosquito bed nets in the households were significantly associated with the utilization of insecticide-treated nets.

CONCLUSION

Parity, household size, number of sleeping rooms, number of treated bed nets, geo-political zone of residence, and proportion of under-five children sleeping under bed nets are important associated factors of the utilization of insecticide-treated nets in Northern Nigeria. Existing malaria preventive initiatives should be strengthened to target these characteristics.

Multilevel Modelling of Individual, Community and Regional Level Factors Associated with Insecticide-Treated Net Usage among Pregnant Women in Ethiopia

Background: Pregnant women who are infected with malaria usually have more severe symptoms and negative health outcomes than women who are not pregnant, with higher rates of miscarriage, intrauterine demise, premature delivery, low-birth-weight neonates, and neonatal death. Based on evidence from the 2016 Ethiopia Demographic and Health Survey, this study assessed the variation in insecticide-treated nets (ITNs) usage and its associated factors among pregnant women in Ethiopia. Methods: Data from a total of 1122 women who were pregnant at the time of the survey were included in the final analysis. Bivariate and multilevel analyses were conducted. Multilevel modeling with fixed and random coefficients was used to estimate the variation in pregnant women’s ITNs usage across communities (residence areas) and regions of Ethiopia. Results: Out of the total 1122 pregnant women, 58.37% slept under a net and 41.63% did not sleep under nets. Significant variations were observed in pregnant women’s ITNs usage across communities (residence areas) and regions of Ethiopia, with between variations in pregnant women’s ITNs usage across communities (residence areas) and regions. In addition, the region, place of residence, wealth index, educational level, and age of the women as well as whether they believed that mosquito bites cause malaria were significant factors in pregnant women’s usage of ITNs. Pregnant women in Ethiopia had moderate usage of ITNs with varied risk factors at the individual, community, and regional levels. Conclusion: Based on the factors identified, there is a need to implement and/or strengthen programs (e.g., regular sensitization) that intensify high coverage of ITNs for effective malaria prevention in Ethiopia, especially among pregnant women who do not use ITNs.

Insecticide-Treated Nets Utilization and Associated Factors Among Pregnant Women in Miesso Woreda, Eastern Ethiopia: Observational Study

Background

Even though most sub-Saharan Africa adopted the World Health organization guidelines for malaria prevention, the coverage of insecticide-treated nets by pregnant women is low, where 28 million pregnant women did not receive insecticide-treated nets services. Likewise, only 13–51.4% of pregnant women utilize insecticide-treated nets in Ethiopia.

Methods

A community-based cross-sectional study was conducted in Miesso woreda from April 01 to 30, 2017, among 424 pregnant women. A multi-stage cluster sampling technique was used to select the study participants. A structured interviewer-based administered questionnaire and observational checklist were used to collect the data. The collected data were entered into Epi data version 3.1 and exported to SPSS version 23 for analysis. Multiple logistic regression models were fitted to identify factors associated with insecticide-treated nets utilization. Adjusted odds ratios along 95% CI were estimated to measure the strength of the association and declared statistical significance at a p-value < 0.05.

Results

Of a total respondents, 39.9% (95% CI: 34.9–44.2%) utilize insecticide-treated nets. Pregnant women from rural (AOR = 2.05, 95% CI: 1.14, 3.38), employed women (AOR = 1.80, 95% CI: 1.13, 2.86), monthly income >1050 Ethiopian total birr (AOR = 2.02, 95% CI: 1.06, 3.84), third trimester pregnancy (AOR = 2.19, 95% CI: 1.09, 4.40), and having antenatal care for current pregnancy (AOR = 3.86, 95% CI: 1.63, 9.10) were factors significantly associated with insecticide-treated nets.

Conclusion

The utilization of insecticide-treated nets is relatively low. Residence, occupational status, monthly income, stage of pregnancy, and antenatal care status were factors significantly associated with insecticide-treated net utilization among pregnant women.

Utilization of insecticide-treated bed nets among pregnant women in Myanmar–analysis of the 2015–2016 Demographic and Health Survey

Background

Due to the effectiveness of insecticide-treated nets (ITNs), most malaria-endemic countries resort to free distributions in the population with particular attention to pregnant women, a more vulnerable group. However, the mere issuance of ITNs does not usually translate to proper utilization. This study aimed to examine the utilization of ITNs and its associated factors among pregnant women in Myanmar.

Methods

The data analyzed in this cross-sectional study were extracted from available survey datasets of the 2015–16 Myanmar Demographic Health Survey. The secondary data were presented using a chart, descriptive statistics and inferential statistics including simple and multiple logistic regression models. All analyses were performed using STATA, Version 15. A p-value <0.05 was considered statistically significant.

Results

Of 466 currently pregnant women, the majority (96%) possessed bed nets for sleeping. Among them, 15.9% slept without a bed net the night before the survey, while 65.7% slept with untreated nets. Only about 1 in 5 (18.4%) slept under ITNs. In the multivariate logistic regression analysis, pregnant women residing in delta and lowland regions [adjusted odds ratio (aOR) = 7.70, 95% confidence interval (CI): 3.62, 16.38], plains (aOR = 7.09, 95%CI: 3.09, 16.25) or hilly areas (aOR = 4.26, 95%CI: 1.91, 9.52) were more likely to report non-utilization of ITNs than those residing in coastal regions.

Conclusion

Relatively poor ITN utilization was observed among pregnant women in Myanmar. Health promotion activities for ITN utilization should be implemented especially for pregnant women residing in the delta, lowland, plain and hilly regions. Other social-behavioral factors including perceived susceptibility to malaria, knowledge of ITNs, and attitude towards ITN that might favor the non-utilization of ITNs need to be further explored.