Are pregnant women prioritized for bed nets? An assessment using survey data from 10 African countries

Ricotta, Emily; Koenker, Hannah; Kilian, Albert; Lynch, Matthew

doi:10.9745/ghsp-d-14-00021

Cited by 20 publications

(22 citation statements)

References 16 publications

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“…LLIN usage was disproportionately low for children 6–12 years old despite living in households that reported hanging a LLIN the previous night. Consistent with other studies in sub-Saharan Africa, this particular age group may be less prioritized for net usage, particularly when there are not enough nets to cover all members of the household [ 20 , 48 – 50 ]. Though in such cases, children may still receive some residual benefit from reduced vector abundance in households with LLINs hanging [ 2 , 51 , 52 ].…”

Section: Discussionsupporting

confidence: 83%

A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution

et al. 2016

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Major efforts for malaria prevention programs have gone into scaling up ownership and use of insecticidal mosquito nets, particularly in sub-Saharan Africa where the malaria burden is high. Socioeconomic inequities in access to long lasting insecticidal nets (LLINs) are reduced with free distributions of nets. However, the relationship between social factors and retention of nets after a free distribution has been less studied, particularly using a longitudinal approach. Our research aimed to estimate the ownership and use of LLINs, and examine the determinants of LLIN retention, within an Indigenous Batwa population after a free LLIN distribution. Two LLINs were given free of charge to each Batwa household in Kanungu District, Uganda in November 2012. Surveyors collected data on LLIN ownership and use through six cross-sectional surveys pre- and post-distribution. Household retention, within household access, and individual use of LLINs were assessed over an 18-month period. Socioeconomic determinants of household retention of LLINs post-distribution were modelled longitudinally using logistic regression with random effects. Direct house-to-house distribution of free LLINs did not result in sustainable increases in the ownership and use of LLINs. Three months post-distribution, only 73% of households owned at least one LLIN and this period also saw the greatest reduction in ownership compared to other study periods. Eighteen-months post distribution, only a third of households still owned a LLIN. Self-reported age-specific use of LLINs was generally higher for children under five, declined for children aged 6–12, and was highest for older adults aged over 35. In the model, household wealth was a significant predictor of LLIN retention, controlling for time and other variables. This research highlights on-going socioeconomic inequities in access to malaria prevention measures among the Batwa in southwestern Uganda, even after free distribution of LLINs, and provides critical information to inform local malaria programs on possible intervention entry-points to increase access and use among this marginalized population.

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Section: Discussionsupporting

confidence: 83%

A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution

et al. 2016

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“…These results were corroborated by a comparative study by Ricotta et al [39] and 2011 found a similar uniform situation over time-even after mass distribution of LLINs [23]. Similar results were found in a study in Indonesia, Timor-Leste [41].…”

Section: Decision-making Process For Llin Recipientssupporting

confidence: 84%

Social vulnerability of children aged 5 to 15 years to malaria in Madagascar: 3 anthropological studies LLIN use

Njatosoa

Mattern

Pourette

et al. 2020

Preprint

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BackgroundAlthough it is accepted that long lasting insecticide bed net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; malaria prevalence is highest in this age group. The purpose of this article is to summarize recent qualitative studies describing LLIN use among children aged 5–15 years and explore options to increase their use in this age group.MethodsQualitative data from three anthropological studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analyzed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.ResultsA total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN nonuse by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and therefore are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.ConclusionsPerceptions, social practices and regional beliefs regarding LLINs s and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.Trial registrationNot applicable

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“…ITN ownership has been a common factor for not using ITNs in other studies [14, 15], though ownership in itself does not guarantee the use of ITNs [21]. In this study conducted in 2010, most of the respondents (57.2%) had received free ITNs or had purchased ITNs at subsidized rates from a public health facility.…”

Section: Discussionmentioning

confidence: 76%

“…However, access does not always result in usage due to sociocultural and logistical reasons [15]. Evidence from some parts of Ghana has shown that over 40% of ITNs available in the households go unused [16].…”

Section: Introductionmentioning

confidence: 99%

Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

Manu

Boamah-Kaali

Febir

et al. 2017

Malaria Research and Treatment

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Background Malaria in pregnancy leads to low birth weight, premature birth, anaemia, and maternal and neonatal mortality. Use of insecticide-treated nets (ITNs) during pregnancy is one of the proven interventions to reduce the malaria burden. However, Ghana has not achieved its target for ITN use among pregnant women. Methods A qualitative study was conducted in seven communities purposively selected from the middle belt of Ghana. Participants who had delivered in the six months prior to this study were selected. In all, seven focus group discussions and twenty-four in-depth interviews were conducted between June and August 2010. Results Respondents knew of the importance of ITNs and other malaria-preventive strategies. Factors such as financial access and missed opportunities of free distribution denied some pregnant women the opportunity to own or use an ITN. Reasons for not using ITNs during pregnancy included discomfort resulting from heat, smell of the net, and difficulty in hanging the net. Participants maintained their ITNs by preventing holes in the nets, retreatment, and infrequent washing. Conclusion Pregnant women know about the causes and prevention of malaria. However, this knowledge is not transformed into practice due to lack of access to ITNs and sleeping discomforts among other logistical constraints.

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Are pregnant women prioritized for bed nets? An assessment using survey data from 10 African countries

Cited by 20 publications

References 16 publications

A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution

A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution

Social vulnerability of children aged 5 to 15 years to malaria in Madagascar: 3 anthropological studies LLIN use

Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

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