Determinants of the use of insecticide-treated mosquito nets in pregnant women: a mixed-methods study in Ghana

• Published in: International health Vol. 14; no. 6; pp. 619 - 631
• Main Authors: Dun-Dery, F, Kuunibe, N, Meissner, P, Winkler, V, Jahn, A, Müller, O
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-11-2022
• Subjects: Original; pregnant women; insecticide-treated mosquito nets; mixed methods; malaria complications; knowledge
• ISSN: 1876-3413; 1876-3405
• DOI: 10.1093/inthealth/ihab087

Malaria in pregnancy remains a significant cause of morbidity and mortality, affecting the highly endemic countries of sub-Saharan Africa (SSA). Insecticide-treated nets (ITNs) are effective for malaria prevention. However, poor adherence in SSA remains a challenge.
We conducted a standard questionnaire survey among 710 pregnant women from 37 primary care clinics in the Upper West Region of Ghana from January through May 2019. Using a sequential explanatory design, we integrated the survey data from six focus group discussions with pregnant women.
While 67% of women had some general knowledge about malaria prevention, only 19% knew the specific risks in pregnancy. Determinants of ITN use included ITN ownership (odds ratio [OR] 2.4 [95% confidence interval {CI} 1.3 to 4.4]), good maternal knowledge of the risks of malaria in pregnancy (OR 2.4 [95% CI 1.3 to 4.3]) and more antenatal care (ANC) contacts (OR 1.3 [95% CI 1.0 to 1.5)]. Focus group discussions showed that non-use of ITNs resulted from inappropriate hanging infrastructure, a preference for other malaria prevention alternatives, allergy and heat.
Specific maternal knowledge of malaria risks in pregnancy was low and influenced the regular use of ITNs. Community and ANC-based malaria interventions should prioritize increasing knowledge of the specific risks of malaria.