Department of Community Medicine and Primary Care, College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
Received date: November 16, 2011; Accepted date: February 18, 2012; Published date: February 20, 2012
Citation: Amoran OE, Lawal KM, Jeminusi OA, Alabi AA, Oluwole FA (2012) Determinants of Uptake of Insecticide Treated Nets among Pregnant Women in Ado-Odo Local Government Area of Ogun State, Nigeria. J Community Med Health Edu 2:126. doi: 10.4172/jcmhe.1000126
Copyright: © 2012 Amoran OE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Introduction: Two-fifth of the World population is at risk of malaria in 90 countries across the World with 1.5 million deaths attributable to malaria each year. This study was therefore designed to determine factors associated with the uptake of insecticide treated net among pregnant women Ado –Odo local government area of Ogun State, Nigeria.
Methods: This is an analytical cross-sectional study. A Cluster sampling technique was used to obtain a representative sample of the study population. An interviewer administered structured questionnaire was administered to respondents by trained health workers.
Results: A total of 300 pregnant women were recruited into the study. Majority (72.7%) of the respondents could correctly identify the organism responsible for the cause of Malaria. The prevalence of ever use of ITN was 29.7% and 18.3% are currently using the net. Only 17.7% of the respondents had the correct knowledge of treatment of ITN and majority of the respondents that use ITN treated their fever in pregnancy properly. ITN use among the pregnant women was statistically significantly associated with correct knowledge of causative organism [OR=4.58, C.I=1.67-13.62] and if given free during previous ANC [OR = 31.32, C.I=12.56-81.62].
Conclusion: The study concludes that the use of ITN in the study population is low. A major factor determining the use of ITN among these pregnant women is price and correct knowledge of causative organism. It shows that local knowledge of causative organism is highly relevant for social marketing strategies of ITNs. Uptake of ITN can be significantly improved in low income areas if the nets are made affordable for the pregnant women and backed up with appropriate health education intervention.
Determinants; ITN uptake; Pregnant women; Nigeria
In Nigeria, 1 in 5 children suffers from one episode of severe malaria before the age of 5 years, more than one-third of paediatric admission and one-third of hospital deaths are due to malaria infection [1-3]. In Africa, there are about 300-500 million clinical cases every year and about 1 million deaths are due to Malaria infection . The 2008 World Malaria Report recommended universal coverage targets of 80% by 2010 and its maintenance at this level . This shift from targeted population to universal coverage i.e. whole population emphasizes the current shift of emphasis in control from children and pregnant women alone to whole population in the use of Insecticide-treated nets (ITN) and longlasting insecticidal treated nets (LLIN) as important means of malaria prevention. Furthermore, the Africa Malaria Report shows that many countries including Nigeria are quite far from reaching the target of 60% ITNs coverage in sub-Saharan African countries by the year 2005, which was set in Abuja by the African Heads of State for the provision of ITNs to children under five and to pregnant women . Insecticidetreated nets (ITN) and long-lasting insecticidal treated nets (LLIN) are important means of malaria prevention. Although there is consensus regarding their importance, there is uncertainty as to which delivery strategies are optimal for dispensing these life saving interventions. Bed nets have been used for protection against insect bites long before the discovery that mosquitoes transmitted malaria . Efficacy of ITN in the prevention of Malaria has already been proven beyond a reasonable doubt [7-9]. Malaria is a major public health problem in Nigeria and through malaria prevention; ITNs will reduce the need for treatment and the pressure on health services . The use of ITNs in areas with stable malaria reduced the incidence of uncomplicated episodes by 50% compared to areas where nets were not used and 39% compared to areas were the nets were untreated. ITNs also impacted on severe malaria, parasite prevalence, high parasitaemia, splenomegaly and improvement in haemoglobin levels of children. ITN use is one of the major malaria control policy prevention method in Nigeria and the government wishes to scale-up the use of ITNs. Therefore one of the urgent challenges that are facing many sub-Saharan African countries like Nigeria is how to achieve widespread distribution and use of insecticide-treated nets (ITNs) for the control of malaria.
However this study was carried out to describe factors that determine ITN use among pregnant women. The determination of factors that will assure high coverage with the ITNs remains a topical issue in Nigeria and in many sub-Saharan African countries. This study will provide information on the use of ITN in Ogun state, Nigeria. This can be used to develop health promotional goals and activities in order to enhance the use of ITN among the vulnerable population such as the study population.
Background of the study area
The study was conducted in Ado-Odo local government area Ogun state, which is located in the South Western part of Nigeria. Ado-Odo local government area is one of the 20 local government area in Ogun state. It was created in 1991 and has a total land area of 80.03 km2. It shares boundaries with Lagos state, Yewa south, Ifo and Obafemi Owode local government areas.
Ado-Odo local government area Ogun state is situated in a tropical rain forest zone with a warm dry season, a rainy season and a cold dusty harmattan season. The area belongs to the holo-endemic region of malaria infection. According to the 2006 census, the area has a population of 328,926 inhabitants with an annual growth rate of 4%. Other ethnic groups apart from the Yorubas like the Hausas, Igbos and the Benue people are well represented. Most of the towns are rural. The local government area has many facilities that offer wide range of health care services. It has 27 primary health care centers, a secondary health facility- State hospital Ota. There are also privately owned clinics and hospitals in the LGA. The Sango Ota ward has 3 health centers that offer wide range of health care services and are well patronized. The health services include child health care, maternity services and treatment of minor ailments. It provides to people living in Sango, Ota, Ijoko and its environs. All the 3 PHC in Sango Ota ward namely Sango, Ota and Ijoko health centers were used for the study. All the pregnant women attending ANC at these centers were recruited into the study.
This was a comparative cross-sectional study that quantitatively explored the awareness, knowledge and utilization of ITN by pregnant women. All consenting pregnant women who attended the PHC centres during the study period were recruited into the study.
The minimum sample size required for the study was estimated to be 138 using the formula
n = Zα2pq/d2,
where n is the sample size,
Zα is the standard normal deviate, set at 1.96 (for 95% confidence interval),
d =is the desired degree of accuracy (taken as 0.050)
p= is the estimate of our target population having that particular characteristics.
ITN use constitute about 10% (i.e. 0.1) burden (FM, 2005).
Adjustment for a 10% rate of non-responses and invalid responses yielded a sample size of 152, which was doubled to 300 for greater accuracy.
Participants in the study were pregnant women who accessed antenatal care at the primary antenatal care facilities in the Ado-Odo local government area of Ogun state. All women visiting the three designated primary health care facility during the study period were recruited into the study.
A cluster of all the pregnant women attending Ante-natal care [ANC] at the three PHC offering ANC in the Sango Ota ward of were recruited into the study. This cluster sampling was done to represent the total population of pregnant women attending ANC in Ado-Odo local government area.
The medical officer of Health/Director of Primary Health care at Ado-Odo local government secretariat was approached and permission was obtained to conduct the study. Women who consented to take part in the study were interviewed using a structured questionnaire, which was administered by a trained interviewer. The interviewers were all health care workers working at the facilities. The data were collected on antenatal clinic days by the interviewers at the respective PHC centres. Completed questionnaires were scrutinized on the spot and at the end of the daily field sessions for immediate correction of erroneous entry.
During the antenatal visit consenting pregnant women were interviewed individually over a 10 to 15minute period in a language they can understand before they were given any health talk. Data were collected over 8 weeks period from 20th of January to 17th March 2007.
The instrument was a structured questionnaire consisting of 3 parts namely:
Section A: include information on socio-demographic data such as age, marital status, religion, employment status, ethnic group and educational status.
Section B: consist of Malaria in pregnancy related knowledge of prevention and treatment.
Section C: is made up of knowledge and utilization of ITN.
Current use of ITN was ascertained by asking about the description of its use. Treatment of ITN was ascertained by the description of the interval and process of treatment of ITN and knowledge of causative organism was ascertained by correctly mentioning the vector of the disease i.e. female anopheles mosquito [efon in native language].
The questionnaire was pretested among 20 women in their first pregnancies receiving antenatal care at primary health care facilities in Olabisi Onabanjo University teaching hospital Sagamu. Appropriate adjustments were then made to the questionnaire to improve its internal validity.
Criteria for inclusion
• Subject must reside within Ado- Odo local government area of Ogun state.
Criteria for exclusion
• Subjects resident outside Ado-Odo LGA of Ogun state
• Subjects with disabilities that disallowed responses to questionnaire
• Subjects refusing to take part in the study
Ethical clearance was obtained from the Olabisi Onabanjo Teaching Hospital Ethics Board. Confidentiality on candidate’s information was maintained. Permission of the State Ministry of Health was obtained before the commencement of the study.
At each of the selected study site, the matron and medical officer in-charge were informed for consent and antenatal clinic day(s) before the commencement of the study. The purpose, general content and nature of the study were explained to each respondent. A verbal and written consent was obtained from each participant before inclusion into the study.
Percentages or means and standard deviation were computed for baseline characteristics of women interviewed. The data analysis focused on univariate frequency table and bivariate cross tabulations that identify important relationships between variables. The relationships between socio-demographic characteristics of the pregnant women and their knowledge and utilization ITNs were examined through bivariate analysis, by computing odds ratio at 95% confidence level and chi squared where appropriate.
Socio-demographic characteristics of the pregnant women
A total of 300 pregnant women were recruited into the study. The age of the respondents ranged from 18 to 44 years. Majority 183 [55.2%] of the respondents were between 25yrs-34 yrs, 71 [10.8%] were between 18-24yrs and 46 [26.0%] were between 35-46yrs. Majority [95.3%] of the respondents were married and 8 [2.7%] were never married and 6 [2.0%] were separated. Most of the respondents 200 [66.7%] were Christians, 96 [32.0%] Muslims and 4[1.3%] were from other religions. About one third [39.0%] of the respondents were traders, 34 [11.3%] were housewives, 44 [14.7%] had white collar jobs and 105 [35%] were artisans. Only 2 [0.7%] were primigravida, 189 [63.0%] had 1-2 children, 95 [31.7%] had 3-4 children and 14 [4.7%] had 5 or more children. 24 [8.0%] of the respondents had their last delivery at TBA’s home, 29 [9.7%] at home, 49 [16.3%] religious homes, 114 [38.0%] at PHC centers, while 84 [28.0%] at the secondary health care facility (Table 1).
|Level of Education|
|White collar job||44||14.7|
|5 or more||14||4.7|
Table 1: Social-dermographic Characteristics of the respondents
The knowledge of malaria prevention and ITN use
Majority (72.7%) of the respondents could correctly identify the organism responsible for the cause of Malaria. Only 123 [41.0%] of these pregnant women report at the health facilities when they have fever in pregnancy, 157 [52.4%] do self medication [anti-malarias and other drugs] while 20 [6.6%] use herbs and other traditional means. Major methods of Malaria prevention employed by the youth include the use of drugs (21.7%), Screening nets (19.0%), ITN (25.0%) Insecticides spray (8.7%), environmental care (24.0%) and other methods such as the use of mosquito traps, protective clothing, herbs and spiritual means (1.7%) (Table 2).
|Knowledge of Causative organism|
|How do you treat Malaria|
|Treated in Health facilities||123||41.0|
|Method of Malaria Prevention|
|Use of drugs||65||21.7|
|Use of Screening nets||57||19.0|
|Use of ITN||75||25.0|
|Use of Insecticide spray||26||8.7|
|Place of last delivery|
|Secondary health facilities||84||28.0|
Table 2: The Knowledge of Malaria Prevention and ITN use by Respondents.
However all (100%) have heard about ITN before but 29.3% have it at home. Only 29.7% of the pregnant women had ever used ITN before but 55 [18.3%] of the respondents are currently using it. Only 17.7% of the respondents had the correct knowledge of treatment of ITN and majority of the respondents that use ITN treated their fever in pregnancy properly. Over half [64.0%] of the pregnant women that had ever used ITN believe that it is expensive and 87.3% of the current users have been given ITN free during previous ANC. Only (45.0%) of the pregnant women believe that it is a very effective means of Malaria prevention.
Determinants of ITN use
There was no statistically significant association between current use of ITN and age (X2=2.80, p = 0.247), Place of ANC at last delivery (X2=0.287, p = 0.356) and education (X2=5.27, p = 0.153).
ITN use among the pregnant women was statistically significantly associated with correct knowledge of causative organism [OR=4.58, C.I=1.67-13.62] and if given free during previous ANC [OR=31.32, C.I=12.56-81.62] (Table 3 and Table 4).
|ITN ever use|
|Current use of ITN|
|Current using ITN||55||18.3|
|Not currently using ITN||245||81.7|
|Knowledge of treatment of ITN|
|Effectiveness of ITN|
|Price of ITN|
Table 3: The use of ITN by Respondents.
|ITN current use No [%]||Nil use No [%]||Total No [%]||Odds Ratio [C.I]|
|18-24 yrs||10 [18.2]||61 [24.9]||71 [23.7]||1.00|
|25-34 yrs||39 [70.9]||144 [58.8]||183 [61.0]||1.65 [0.74-3.79]|
|35-44 yrs||6 [10.9]||40 [16.3]||46 [15.3]||0.91 [0.27-3.03]|
|Knowledge of Causative organism|
|Correct knowledge||50 [90.9]||168 [68.6]||218 [72.7]||4.58 [1.67-13.62]|
|Not correct||5 [9.1]||77 [31.4]||82 [27.3]||1.00|
|Place of last delivery|
|Health facility||38 [69.1]||160 [65.3]||198 [66.0]||1.19 [0.61-2.34]|
|Others||17 [30.9]||85 [34.7]||102 [34.0]||1.00|
|Level of Education|
|Nil||1 [1.8]||7 [2.9]||8 [2.7]||1.00|
|Primary||9 [16.4]||69 [28.2]||78 [26.0]||0.11 [0.09-22.02]|
|Secondary||34 [61.8]||141 [57.6]||175 [58.3]||1.69 [0.20-37.72]|
|Post -Secondary||11 [20.0]||28 [11.4]||39 [13.0]||2.75 [0.27-66.52]|
|Given ITN free at previous ANC|
|Yes||48 [87.3]||44 [18.0]||92 [30.7]||31.32 [12.56-81.62]|
|No||7 [12.7]||201 [82.0]||208 [69.3]||1.00|
Table 4: Factors associated with ITN use among the Respondents.
The study shows that only 18.3% of the pregnant women currently use ITN while 29.7% have ever used it. This shows that majority of this pregnant women are not using ITN regularly despite a lot of emphasis being placed on its use and free distribution to pregnant women and children at primary health care centers since 2005 through the National Roll Back Malaria Programme. The results of this study are comparable to several surveys in Africa, where ITN use varies from 5% to 70% depending on the population studied [11-14].
The most important method of malaria prevention among the pregnant women is ITN, followed by environmental engineering, use of anti-malarias and screening nets. Over half of the pregnant women do self medication during pregnancy despite a lot of warning against this during pregnancy. This is similar to several other studies among the study population [15,16]. This implies that health education should be intensified against inappropriate use of drugs during pregnancy especially during health talks at ANC visits.
This study shows that correct knowledge of cause of malaria is a significant factor in the use of ITN. This finding has been confirmed by several other studies [3,20] that correct knowledge of source of infection is a significant predictor of ITN use. It shows that local knowledge and practice is highly relevant for social marketing strategies of ITNs. The fact that only (45.0%) of the pregnant women believe that it is a very effective means of Malaria prevention. It is not unexpected to find that majority of those who have never used ITN do not believe in its effectiveness [2,17-19]. This indicates that programs that will be geared towards increasing the knowledge and awareness of ITN effectiveness against Malaria prevention should be introduced among the vulnerable population.
The fact that the pregnant women [87.3%] that had been given ITN free in previous ANC are currently using these nets and over half [64.0%] of the pregnant women that had ever used ITN believe that it is expensive shows that adoption of ITNs will therefore probably require a subsidy. This is similar to findings in several studies which have suggested similar remedy [20-21]. This has been found to help the distribution of ITNs especially among the malaria prone population such as the study population.
Given the cross-sectional nature of the results, interpretation of study results should be done with caution. The study might also have been faced with recall bias and the accuracy of the information volunteered; however the findings might represent the actual situation since we dealt with pregnant women who are currently pregnant such experience as ITN use are still fresh. Future research with a longitudinal approach would be valuable.
The study concludes that the use of ITN in the study population is low. A major factor determining the use of ITN among these pregnant women is price and correct knowledge of causative organism. It shows that local knowledge of causative organism is highly relevant for social marketing strategies of ITNs. Uptake of ITN can be significantly improved in low income areas if the nets are made affordable for the pregnant women and backed up with appropriate health education intervention.
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