Use of Insecticide Treated Nets by Pregnant Women and Associated Factors in a Predominantly Rural Population in Northern Ethiopia

This 11-page article, published in Tropical Medicine and International Health, describes the use of insecticide treated nets (ITNs) among pregnant women in northern Ethiopia and examines factors associated with ITN access and use. The methodology consisted of a community-based cross-sectional study of 815 pregnant women in eight malarious areas in northern Ethiopia based on a two-stage cluster design. Knowledge of malaria, its cause and preventive measures, treatment seeking behaviour, and possession and use of ITNs by pregnant women and under-five children were ascertained through interview and observation. According to the article, household ownership of ITNs and their use by pregnant women is promising with the current efforts to scale-up ITNs implementation, but the gap between ownership and use remains high.

The study found that knowledge about the cause, transmission, and preventive measures of malaria was relatively good; 90.2% of women associated malaria with mosquito bites and 94.2% with living near water ponds. 10% reported malaria illness within the 14 days before the survey and sought treatment mainly from public health facilities (56.5%) and community health workers (37.6%). Of 815 households surveyed, 59% owned at least one non-long lasting or long-lasting ITN (59.5% rural vs. 54.5% urban). Lack of access to ITNs (68.3%) and the perception that nets could not prevent malaria (27%) were the main reasons for non-ownership of nets. A total of 58.4% of 481 pregnant women from households owning at least one ITN had slept under it during the previous night. Fewer rural (56.7%) than urban women (76.2%) used ITNs. In 57.6% of households with at least one ITN, under-five children had used it the night before.

According to the article, higher educational attainment was an important predictor of ITN use. This association was expected because people with a high educational status are likely to have more knowledge about the use and benefits of a mosquito net. Higher education may also be correlated with higher socioeconomic status, as people with higher educational attainment generally occupy higher levels of socioeconomic categories. The article also proposes that the social marketing and commercial sectors were assumed to be an important source of ITNs in urban areas of Ethiopia. A study from Malawi found that coverage of ITNs ownership by households after a social marketing campaign increased to 29% in urban areas compared to 6.4% in rural areas.

Most women in the study area associated malaria with mosquito bites. A considerable proportion also associated malaria with physical contact with a malaria patient,
eating maize or sorghum stalk, exposure to cold air or working in the sun. The authors state that the correction of such misconceptions about the relationship between mosquito bites and malaria through health education messages is very critical for the success of malaria prevention and control using ITNs.

According to authors, these findings suggest that household ownership of ITNs and their use by the intended groups can be improved through intensive health education programmes on the benefits of ITNs. Messages should persuade people that ITNs are important tools for malaria prevention and control. The availability of ITNs through government and NGOs must also improve, especially for larger households, which should be supplied with two or more ITNs. Only a third of net-owning housholds had long-lasting insecticidal nets (LLINs), and more attention should be given to replacing non-LLINs with LLINs.