Mixed effect analysis of factors influencing the use of insecticides treated bed nets among pregnant women in Ghana: evidence from the 2019 Malaria Indicator Survey

Abstract

Background Malaria during pregnancy is a major cause of maternal morbidity globally and leads to poor birth outcomes. The World Health Organization has recommended the use of insecticide treated bed nets (ITN) as one of the effective malaria preventive strategies among pregnant women in malaria endemic areas. This study, therefore, seeks to examine the individual and household factors associated with the use of ITNs among pregnant women in Ghana. Methods Data for this study was obtained from the 2019 Ghana Malaria Indicator Survey (GMIS) conducted between September 25 and November 24, 2019. The weighted sample comprised 353 pregnant women aged 15–49 years. Data was analyzed with SPSS version 22 using both descriptive and multilevel logistics regression modelling. Statistically significant level was set at p < 0.05. Results The study found that 49.2% of pregnant women in Ghana use ITN to prevent malaria. Pregnant women aged 35–49 years (AOR = 3.403, CI: 1.191–9.725), those with no formal education (AOR = 5.585, CI = 1.315–23.716), and those who had secondary education (AOR = 3.509, CI = 1.076–11.440) had higher odds of using ITN. Similarly, higher odds of ITN usage was found among who belonged to the Akan ethnic group (AOR = 7.234, CI = 1.497–34.955), dwell in male-headed households (AOR = 2.232, CI = 1.105–4.508) and those whose household heads are aged 60–69 years (AOR = 4.303, CI = 1.160–15.966). However, pregnant women who resided in urban areas (AOR = 0.355, CI = 0.216–0.582), those whose household heads aged 40–49 years (AOR = 0.175, CI = 0.066–0.467) and those who belonged to richer (AOR =0.184, CI = 0.050–0.679) and richest (AOR = 0.107, CI = 0.021–0.552) households had lower odds of using ITN for malaria prevention. Conclusions Individual socio-demographic and household factors such as pregnant women’s age, educational level, place of residence, ethnicity, sex and age of household head, and household wealth quintile are associated with the use of ITN for malaria prevention among pregnant women. These factors ought to be considered in strengthening malaria prevention campaigns and develop new interventions to help increase ITN utilization among vulnerable population living in malaria- endemic areas.

Inequalities in the use of insecticide-treated nets by pregnant women in Ghana, 2011 and 2017

“…This figures are greater than the prevalence recorded in sub-Saharan Africa (30.6%) and Madagascar (10.1%) [17]. The results, however, corroborate an earlier study conducted in Ghana [19] which reported a prevalence of 49.2%. Probably, the increase in the utilization of ITNs between 2011 and 2017 could be attributed to the implementation of the National Malaria Control Programme (NMCP), which provides free mass and continuous distribution of ITNs in hospitals and schools [20,21].…”

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

“…However, other studies have reported older 58,59 or younger-aged pregnant women 20,60 slept more under ITNs. Though higher levels of education are associated with ITN use in pregnant women, 28,31 no such association was observed in the current study.…”

“…22 Several studies have reported 32%-80.7% uptake of ⩾3 doses of IPTp-SP. [23][24][25][26][27] and ITN utilization of 40%-95% in pregnant women 25,[28][29][30][31] in Ghana over the last decade. However, there is a paucity of data on the uptake of these interventions and a limited understanding of local factors influencing them in the Ho Municipality of the Volta Region.…”

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

“…However, it was higher than a study in Cameron (12.4%) [ 27 ], Uganda (35%) [ 28 ], Ghana 2019 malaria indicator survey (49.2%) [ 29 ], and Nigeria (43.3%) [ 30 ], and lower than the studies reported from Kenya (70.5%) [ 31 ], Multi-level analysis from SSA (74.2%) [ 32 ], and the Democratic Republic of Congo (76.4%) [ 33 ]. This could be due to differences in sociodemographic characteristics, norms, beliefs and other cultural variations across the study settings.…”