Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

FACTORS MILITATING AGAINST THE USE OF INSECTICIDE TREATED NETS AMONG PREGNANT WOMEN IN NIGERIA. 1

MARTINA EZEAMA, 2FELIX EZEAMAH, 3QUEENSLEY GINIKA AKOR 1

Nursing Science, Imo State University Owerri Nigeria, Private Practictioner, Ndukwu Hospital Amaifeke Orlu Imo State , Nigeria, 3 Nursing Science, Imo State University Owerri Nigeria. E- mail:[email protected] , [email protected]

2

ABSTRACT The study was carried out to determine factors militating against utilization of insecticide treated nets by pregnant women. This was based on the background of the study which reflected low usage of ITNS by pregnant women in the study setting. A total 201 pregnant women were interviewed using questionnaire. Overall results showed that majority were aware of the insecticide treated net but usage was low. Most respondents reported experiencing excessive heat under net, were afraid of the chemical used in producing the net and suffocation. Level of education, marital status and parity were also highly associated with use of ITNs . Findings suggest the need for an intensive public enlightenment campaign to dispel fear of chemicals used in treating the ITNs and heat produced by ITNs to encourage use among pregnant women. Keywords: Pregnant Women, Malaria, Insecticide Treated Net, Nigeria malaria. The use of ITNs during pregnancy reduces the risk of morbidity and mortality among pregnant women and their infants( D’A Lessandro (1996). Compliance with the use has been very difficult in sub-sahara Africa (Njama 2003). In Nigeria only 5% of women utilize (ITNs) despite government policy of free insecticide treated Nets (ITNs) for vulnerable groups. The study aimed at determining the factors militating against use of ITNs among pregnant women attending Antenatal clinics in Imo State Teaching Hospital Orlu.

INTRODUCTION Malaria infestation during pregnancy has been associated with persistent high maternal and childhood morbidity and mortality among pregnant women especially in Nigeria where malaria is highly endemic. Malaria accounts for 11% of maternal death, 70% of morbidity in pregnant women and is responsible for 63% of all clinic attendances in Nigeria. It causes 25% of infant mortality and 30% of all childhood deaths. Malaria during pregnancy accounts for up to 15% of maternal anemia and 514% of low birth weight (Safe motherhood fact sheet 19). As a result the World Health Organization (WHO) launched Roll Back Malaria (RBM) initiative in 1998 with a major focus on the prevention and management of malaria during pregnancy by using insecticide treated nets (ITNs) among other measures. Although malaria is preventable, easily treated and curable, it assumes a deadly dimension when it occurs in pregnancy and it is not promptly managed.

METHODOLOGY The study was descriptive in nature and because of its focus on the clinics within the teaching hospital, was a case study of the factors militating against the utilization of insecticide treated net among pregnant women attending antenatal care in teaching hospital Orlu, Imo State Nigeria. In the course of clinical experience at the antenatal clinics (ANC) and community postings, the researcher noticed that the usage of insecticide treated nets (ITNs) among pregnant women is still not encouraging despite awareness being created about the importance of this cost-effective and efficient method of malaria prevention and control.

Lines ,(2004) and Grand,(2005) stated that the materials necessary in making insecticide treated nets (ITNs) consist mainly of nets and insecticides. They are treated with insecticides such as pyrethroids and permethrin to protect against mosquito bites and

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Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

The study was approved by the Hospital Ethical Research Review Committee and informed consent was obtained from the respondents. The sample and sampling technique were not used in this study because the total population was small in number. The researcher decided to use the whole population . Data were collected on a pretested researcher’s administered structured questionnaire. Information collected included socio-demographic data, level of awareness and usage of ITNs, factors militating against usage and measures that could promote the use of ITNs by pregnant women. Descriptive statistics was obtained for quantitative variables while frequencies and percentages were used to present categorical variables. Chi Square statistical tests were carried out where applicable with the level of significance set at p < 0.05.

The validity and reliability of the instrument were done to ensure that questionnaire ask relevant questions that would yield data required to reach meaningful conclusion in this study. Pretest of instrument was to ensure reliability of instrument, 15 copies of questionnaires were administered to pregnant women outside the study population. The statistical analysis of the instrument at pretest recorded 0.875 indicating high reliability. .RESULTS A total of 201 pregnant women were interviewed. The majority 191(95%) were married, 150 (74.6%) had attained tertiary education,39(19.4) secondary school education and 137(68.2%) were multigravida. while 64(31.8%) primigravida.

Table 1: Socio-demographic characteristics of the respondents Variable

Frequency (N = 201)

Percent

Marital status Single Married Widowed Divorced

6 191 2 2

3.0 95.0 1.0 1.0

Level of Education None Primary Secondary Tertiary

4 8 39 150

2.0 4.0 19.4 74.6

Parity Primigravidae Multigravidae

64 137

31.8 68.2

98% were aware that insecticide treated nets (ITNs) could prevent malaria in pregnancy, while 2% of them were not(figure 1).

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Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

Figure 1: Respondents awareness and usage of ITNs

100

98%

90 80

Yes

70

64.3%

No

60 50

35.3%

40 30 20 10

2%

0

Awareness of ITNs

Usage of ITNs

71(35.3%) of pregnant women were in possession of ITNs.29(29%) were not. Constraints to the use of ITNs were 55(27.4%) experienced excessive heat under the ITNs; 46(22.9%) reported fear of the chemicals used in treating the net, 45(22.4%) indicated suffocation, 35(17.4%) non-availability of ITNs and 20(10%) lacked knowledge on how to treat the nets.

Responses

Frequencies

Percent (%)

Excessive heat

55

27.4

Fear of chemical

46

22.9

Fear of suffocation

45

22.4

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Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

Non availability of the net

35

17.3

Lack of knowledge of how to treat the net

20

10.00

201

100.0%

Measures to increase the use of ITNs by respondents included: the majority 50(24.9%) indicated the increase in ITNs awareness campaign, 45(22.4%) increase availability of nets, and 35(17.4%) indicated the need for increased education on how to treat the net,26(12.9%) free distribution of the net, 20(10%) teaching in the Church and in the market(12.4%)respectively.

Table 3: Responses

Frequencies

Percentages

Free distribution of the net

45

22.4

Increase awareness

50

24.9

Teaching on how to treat the net

35

17.4

Availability of the net

26

12.2

Going to churches

20

10.0

Teaching in the market

25

12.1

201

100.0%

Their main sources of information about ITNs were the ANC, 124(69.7%) ,and the mass media, 28(15.7%), health workers 12(6.7%), church 9(5.1%) and friends 5(2.8%). There was no statistical significance between marital status (P=0731, Parity (P=0.538), level of education (P=0.269) and usage of ITNs. Table 4:Some characteristics of respondents and their usage of ITNs Usage of ITNs Yes No

X2

p value

Married Others

87(95.6) 4(4.4)

104(94.5) 6(5.5)

0.12

0.731

Parity Primigravidae

31(48.4)

33(51.6)

0.38

0.538

Variable Marital status

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Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

Multigravidae

60(43.8)

77(56.2)

Level of education None Primary Secondary Tertiary

0(0.0) 3(37.5) 16(41.0) 71(47.3)

4(100.0) 5(62.5) 23(59.0) 79(52.7)p

4.03

0.258

studies in Kenya and Democratic Republic of Congo showed that access to free ITNs by pregnant women increase the usage to both mothers and their new born children (Guyan and Ochola 2003)

DISCUSSION The finding showed that majority was aware of the existence of ITNs, but the awareness did not reflect into utilization of the ITNs since only 35.3% of respondents were sleeping under ITNs. This low usage of ITNs is consistent with other findings from other part of the Nigeria and developing countries. It is also in line with Binka (2003) findings that current use of Malaria preventive measures such as use of ITNs by pregnant women is very low. Factors militating against the use of ITNs were identified as: Experiencing excessive heat while sleeping under the covers of ITNs 55(27.4%), fear of chemicals 46(22.9%) and fear of suffocation 45(22.4%) respectively as the main constraints in the use of ITNs by pregnant women (table 2). These could be strong reasons for low usage as they could lead to additional discomfort to pregnant women or even to death resulting from inhaling the chemicals if they are poisonous. This is in line with Chukwuocha,Dozie,Nwoga, et al (2010) findings that people perceive chemicals used in treating nets as being dangerous as they can cause death. The low usage of ITNs is unlikely to be due to nonavailability of ITNs as 71% of respondents are in possession of ITNs in Imo State teaching hospital, rather efforts should be made by relevant implementing agencies to extend the distribution of ITNs to pregnant women attending ANC in private health facilities and maternity homes. This is because

Also in this study, the use of ITNs increased with level of education of the respondents and more primigravida and married women used ITNs than their counterparts. These findings are consistent with other studies which demonstrated that the higher the education attainment (Kwuwa and Mufubenga 2008); the more they use ITNs, marital status and parity were also highly associated with use of ITNs. CONCLUSION Although there was a high level of awareness about ITNs, the use of ITNs was low. Experiences of excessive heat under the net, fear of the chemical used in treating the nets and suffocation are major constraints. Intensive public enlightenment to dispel misconception about fear of the chemical used in treating the net, excessive heat, suffocation and availability of ITNs may encourage the use of ITNs among pregnant women. It is recommended that the major challenges of low usage such as fear of chemicals, excessive heat and inadequate supply be seriously addressed to encourage the use of insecticide treated nets by pregnant women to prevent malaria during pregnancy.

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Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

100

98%

90 80

Yes

70

64.3%

60 50 40

35.3%

30 20 10 0

Awareness of ITNs

2%

Usage of ITNs

13

No

Jan. 2014. Vol. 4, No.9

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

control of malaria in Africa”. Retrieved in 2012 October 11th from http://www.mamma htm. 7. Robertson,C.(2006)”Malaria prevention and control”. Retrieved on 2012 October 12th from http//www.mh.org/malaria/ichziu.htw. 8. Rowland,M.(2009).”Effects of on malaria on Africa Nation.”Retrieved on 2012 October 15th from http//www.nibi.nm.gov/pubmed.16735163. 9. Smeltezer, S.,Bare,B.Hinkle,J.,and Cheever,K.(2008)Brunner and Suddarths.Textbook of Medical- Surgical Nursing,11th Ed.Philadelpha,LippincottWilliam and Milkins. 10. Word Health Organization(2003)Strategic frame work for Malaria control during pregnancy in WHO African Region,j 11. World Health Organization(2000)”Roll Back Malaria in insecticide Mosquito treated net”.Retrieved in2012 October 16th from http//www:rbn.who.int/cmc,0000015396. 12. World Health Organization(2000)”Roll Back Malaria in Pregnancy” Retrieved on 2012 October 20th from http://www.rbn,who.int/cmc,0000015368.S

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