Dec. 2014. Vol. 4, No.8

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

AWARENESS, OWNERSHIP AND UTILIZATION OF LONG LASTING INSECTICIDE-TREATED NET (LLIN) AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN IMO STATE UNIVERSITY TEACHING HOSPITAL, ORLU, IMO STATE OZIMS S.J and Eberendu I.F Department of Public Health, Imo State University,PMB, 2000 Owerri

ABSTRACT This is a descriptive cross sectional study designed to assess the level of awareness, ownership and utilization of long lasting insecticide-treated nets (LLIN) by pregnant women attending antenatal clinics at the Imo State University Teaching hospital Orlu, Imo state. Objective is to determine the level of awareness, ownership and utilization of long lasting insecticide treated nets (LLIN) among pregnant women attending antenatal (ANC) in a tertiary health institution in Imo state of Nigeria. A structured questionnaire was administered to three hundred and seventy five (375) pregnant women aged 15 to above 45 years that consented to the study during their routine antenatal care sessions at the hospital. Data entry and analysis was done on a computer using frequency tables, cross tabulations of important variables, percentages and charts. Chi-square test was used for the test of significance. Result revealed that a total of 375 pregnant women were interviewed. Their ages ranged between 15 and 45 years. Amongst the 375 women used in this study, 52.8% are within the age of 25-34years, 29.6% are between 15-24years of age, 12.8% are between 35-44years while 4.8% are more than 45years old. Only 38.8% have acquired university education, 49.3% of them have acquired secondary level of education, 9.3% have primary level of education while 2.6% have no formal education. Nearly all the respondents (92%) were aware of LLIN in malaria prevention in pregnancy, 76% of them owned at least a LLIN in their household, 52.7% had ever used it and only 28% were currently using it. About 70.8% of the respondents obtained their LLIN during national LLIN distribution campaign, 16.2% of them received it free of charge from the ANC clinic, 8.4% purchased it while 4.6% of them acquired from other sources. Amongst the population of women that did not own a net, 44.5% of them reported that they were using other means other than LLIN to prevent mosquito bite, 33.3% of them said there was no net distribution, 6.7% of them gave the cost of purchasing a net as their reason while 15.5% of them said it is for other reasons other than the ones stated above. Fifty four percent (54%) of the respondents have never used LLIN for reasons ranging from perceived discomfort with use of LLIN (69.2), perceived chemical in the net (14.5%). There was no statistical significance between age and level of education with awareness, ownership and utilization of nets among respondents. Conclusion is that the level of awareness of pregnant women concerning the use of ITNs was high while its utilization was low despite federal government of Nigeria’s policy of free LLIN for vulnerable groups and subsidized nets for other people. Public health education needs to be intensified to create more awareness and demand for LLINs through all available health information media.

Keywords: long lasting insecticide-treated nets (LLIN), pregnant women Falade, 2008). The morbidity and mortality toll due to Malaria in pregnancy remains significantly high in Nigeria. Malaria during pregnancy results in increased risk of maternal mortality, low birth weight, infant mortality and childhood mortality. For instance, its contribution to high morbidity and mortality accounts for 25% of infant and 30%

INTRODUCTION Malaria remains a major public health problem that is causing significant maternal and child morbidity and mortality annually in sub-Saharan Africa especially in pregnant women (Yusuf, Dada-Adegbola, Ajayi&

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Dec. 2014. Vol. 4, No.8

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

childhood mortality and 11% maternal mortality in Nigeria. (Okoye & Isara, 2011)

The use of LLIN in some research carried out shows that when compared with a situation when no net was used, there was increase in mean birth weight; reduced miscarriage, still births and placental parasitaemia. (Mbonye, Neema, & Magnussen, 2006). World health organization has been at the forefront of sponsoring the distribution of insecticide treated nets in malaria endemic areas as one of ways of combating malaria and achieving Millennium Development Goals by 2015.

The burden of Malaria is largely borne by Africa where 91% of death occurs with pregnant women and children under five years of age most at risk of infection and adverse outcomes(Adeyemi, Adekande and Akinola, 2007). Each year, there are an estimated 8.7 million pregnancies in Nigeria at risk of malaria, the consequences of which can be serious for both mother and fetus in terms of morbidity and mortality (Okwa, 2004). Consequences of malaria in pregnancy include maternal anemia, stillbirths, low birth weight and intrauterine growth restriction. These babies are too small for their age and are usually at a higher risk of dying from infant and childhood diseases. African countries with stable malaria transmission, infection during pregnancy is estimated to cause as many as 10,000 maternal deaths each year, 8 - 14% of all low birth weight babies and 3 - 8% of all infants' deaths. Despite the high impact of malaria on maternal and child health, the problem of malaria has long been neglected such that less than 5% of pregnant women have access to effective intervention. (Marchant, Schellenberg, Edgar, Nathan & Abdulla, 2002)

Nigeria and many African countries have made significant effort in subsidizing the provision of LLINs to target population including pregnant women but the success of malaria control is weighed down by problems of delivery, distribution, usage, and even acceptance of this method. The awareness and utilization of LLIN vary among individuals and communities, hence the need to ascertain the level of awareness and use of LLIN among susceptible population of pregnant women attending ante-natal clinic at IMSUTH, Orlu Imo State Malaria is a major public health problem in Nigeria and it is associated with miscarriages, low birth weight, fetal still-birth and other pregnancy related outcomes. LLIN is one of the viable ways of preventing malaria occurrences in pregnant women and their babies thereby reducing maternal and child mortality and morbidity rates in Nigeria. The awareness, ownership and 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.

One of the major breakthroughs of recent years is the realization that mosquito nets treated with insecticide give a much higher degree of protection against malaria. When properly used, Insecticide Treated Nets (ITNs) can reduce malaria transmission by at least 60% and child deaths by 20% (Wagbasoma & Aigbe, 2010). Long Lasting Insecticide treated bed Nets (LLIN) was introduced in Nigeria as an effective means of preventing mosquito bites and malaria transmission following the meeting of African Heads of States in Abuja, Nigeria in the year 2000. Malaria is the major cause of maternal and child morbidity and mortality annually especially in subSaharan Africa. Pregnant women are frequently exposed to malaria resulting from the bite of female Anopheles mosquito which is the vector of malaria. Some adverse effects associated with malaria in pregnant women include amongst others spontaneous abortion, low birth weight, stillbirth and anemia. Malaria control with the use of long lasting insecticidal net (LLIN) has been recommended at all levels as an important component of ante-natal clinic(Kuti, Owalabi & Makinde, 2006)

In the last few years malaria has become an international and domestic priority. African countries have allocated over 80million US dollars for malaria control with a commitment to implement strategies agreed by the Roll Back Malaria (RBM) partners. The global commitment of RBM was to halve malaria disease and associated death by 2010; and this target was re-affirmed by leaders of 44 African nations who met in Abuja, Nigeria in April 2000. The specific targets of malaria control under the RBM initiative are: at least 60% of people at risk of malaria, (especially young children and pregnant

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Dec. 2014. Vol. 4, No.8

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

women) benefit from ITN and minimum of 60% of pregnant women would have access to effective preventive treatment. As at 2003, only about 15% of children and 10% of women sleep under any net and less than 5% of Africa's children sleep under ITNs.

The figures obtained were substituted in the formula for calculation of sample size. Informed consent was obtained from them and due permission was sought for and obtained from the Heads of the concerned unit heads.

It is therefore obvious that attainment of the RBM set targets would require extra effort. In response to this, many African countries including Nigeria are providing free LLIN to children and pregnant women and subsidizing the cost also for other people. In Nigeria there are on-going efforts to bring prices of LLIN down by encouraging local production and reduction of taxes and tariffs on LLIN.

INSTRUMENT COLLECTION

OF

DATA

Data collection was achieved with the use of a structured questionnaire administered to pregnant women attending antenatal clinic at IMSUTH Orlu. Structured interview schedule was used to elicit information on socio-demographic characteristics, ITN knowledge, ownership, use, behavior and practices. Data captured were that of age, marital status, level of education, religious inclination, knowledge of LLINs, ownership of LLINs, usage of LLINs, family approval of use of net, observable reactions to usage. Upon collection of data, I carried out the data entry on a micro computer.

This study was conducted to determine the awareness, ownership and use of LLIN by pregnant women who constitute a fairly large vulnerable group for malaria; and who as mothers, also play a major role in the prevention of infant and childhood morbidity and mortality resulting from malaria infection.

DATA PRESENTATION REASEARCH METHODOLOGY The design of the study was descriptive cross sectional. This is a hospital-based study. The study was conducted at Imo State university teaching hospital, Orlu, Imo State. This tertiary institution provides basic and tertiary health care to Orlu suburban area and towns around it, as well as some neighboring towns in Abia, Anambra and Ebonyi states

Figure 1: Population and percentage distribution of age pregnant women attending antenatal clinic (ANC) at IMSUTH, Orlu

Age (years) 15-24 25-34 35-44 Over 45 TOTAL

The target populations for this study consist of pregnant women attending antenatal clinic between July 2013 and December 2013 at Imo State University Teaching hospital Orlu. The population is estimated at 6000

Population 111 198 48 18 375

Percentage (%) 29.6 52.8 12.8 4.8 100

375 volunteer pregnant women aged 17 to 45 years were recruited for the study between January, 2012 and March, 2013. To arrive at the sample size, the Yamane’s formula was used, and it is stated thus:

Figure 1 reveals that amongst the 375 women used in this study, 198 (52.8%) are within the age of 25-34years, 29.6% are between 15-24years of age, 12.8% are between 35-44years while 4.8% are more than 45years old.

Where n = Sample size, N = Population size, e = Level of precision or Sampling of Error which is ±5%

Table 2: Population and percentage distribution of level of education of pregnant women attending ANC at IMSUTH Orlu

SAMPLE TECHNIQUE

AND

SAMPLING

*n 

N 1  N ( e) 2 16

Dec. 2014. Vol. 4, No.8

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

Level of Education Primary Secondary University Non-formal Education TOTAL

Population

Percentage

35 185 145 10

9.3 49.3 38.8 2.6

number without LLIN TOTAL

375

Figure 2 shows that amongst the 375 women used for this study, 185 (49.3%) of them have acquired secondary level of education, 38.8% have attained university education, 9.3% have primary level of education while 2.6% have no formal education.

Figure 5: Population and percentage distribution of means of acquiring LLIN among pregnant women attending ANC at IMSUTH Orlu

Means of acquiring LLIN ANC National distribution campaigns Purchased it Other sources TOTAL

Figure 3: Population and percentage distribution of level of awareness of LLIN use among pregnant women attending ANC at IMSUTH Orlu

Level of Awareness of LLIN use in pregnancy Total number aware of use Number not aware of use TOTAL

Population

Percentage (%)

345

92

30

8

Population

Percentage (%)

46 202

16.2 70.8

24 13 285

8.4 4.6

Figure 5 reveals that amongst those that own a LLIN, 70.8% of them obtained it from the national LLIN distribution campaign, 16.2% of them received from the ANC clinic, 8.4% purchased it while 4.6% of them acquired from other sources.

375

Figure 3 reveals that 92% of women attending ANC at IMSUTH Orlu are aware of the use of LLIN in pregnancy while only 8% are not aware.

Figure 6: Population and percentage distribution of reasons for not owning a LLIN among pregnant women attending ANC at IMSUTH Orlu. Reasons for population Percentage not owning a (%) LLIN No net 30 33.3 distribution Cost of 6 6.7 buying Using other 40 44.5 methods to

Figure 4: Population and percentage distribution of level of ownership of LLIN among pregnant women attending ANC at IMSUTH Orlu Level of Population ownership Total 285 number with LLIN Total 90

375

Figure 4 reveals that amongst the women that attended ANC at IMSUTH Orlu, 76% of them owned atleast a LLIN in their household while 24% do not own a net.

Percentage (%) 76

24 17

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ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

fight mosquito Other reasons TOTAL

14 90

methods to prevent mosquito bite Other reasons 7 55 TOTAL

15.5

Figure 6 reveals that amongst the population of women that did not own a net, 44.5% of them reported that they were using other means other than LLIN to prevent mosquito bite, 33.3% of them said there was no net distribution, 6.7% of them gave the cost of purchasing a net as their reason while 15.5% of them said it is for other reasons other than the ones stated above

Figure 8: shows that amongst the population of pregnant who are not sleeping under their LLIN, 69.2% said it is because of discomfort associated with net use, 3.6% is because of chemical in the net, 14.5% of them reported that they have no need of net as they have other methods while 12.7% reported other reasons other than the ones that have been given.

Figure 7: Population and percentage distribution of level of utilization of LLIN among pregnant women attending ANC at IMSUTH Orlu Level of utilization of LLIN Always Sometimes Never TOTAL

TEST OF HYPOTHESIS

Hypothesis I Ha (alternative hypothesis)

Population Percentagebetween (%) maternal age There is relationship 80 28 and awareness, ownership and utilization of 150 LLIN 52.7 55 19.3 285 Ho (null hypothesis) 100 There is no relationship between maternal age and awareness, ownership and utilization of LLIN

Figure 7 reveals that amongst women attending ANC at IMSUTH Orlu and who also owns a net, 52.7% of them use sleep under nets sometimes, 28% sleeps always while 19.3% of those that own a net have never slept under their net.

Table 9: Relationship between Maternal Age and awareness, ownership and utilization of net

Figure 8: Population and percentage distribution of reasons for not using a LLIN among pregnant women attending ANC at IMSUTH Orlu.

Reason for not using net Due to discomfort Due to chemical in net Using other

Population

12.7

38

Percentage (%) 69.2

2

3.6

8

14.5 18

Mater nal Age 15-24

Awaren Owners ess hip

Utilizat ion

100

92

90

25-34

192

154

156

35-44

41

29

31

Above 45year

12

10

8

28 2 50 2 10 1 30

Dec. 2014. Vol. 4, No.8

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

s TOTA L

345

285

285

there is no significant relationship between maternal age and awareness, ownership and utilization of net. Therefore, the null hypothesis is accepted and the alternative hypothesis rejected.

91 5

Table reveals that X2 = 1.315, degree of freedom is 6 and the table value of 4.46 at 0.05 level. With X2 of 1.315 which is less than 4.46, which means that there is no significant relationship between maternal age and awareness, ownership and utilization of net. Therefore, the null hypothesis is accepted and the alternative hypothesis rejected.

Respondents' age and educational level have no significant influence on LLIN awareness, ownership and utilization of LLIN. (P > 0.05)

DISCUSSION The awareness level of 92% observed in the present study shows that most of the pregnant women attending antenatal clinics at IMSUTH Orlu, Imo State were adequately informed about the use of LLIN during pregnancy. This suggests that a lot of health education has actually taken place. Reports from previous studies in Nigeria and other African countries put the awareness level at between 36 and 91% (Onwujekwe, Hanson & Fox-Rushby, 2004)

Hypothesis II Ha (alternative hypothesis) There is a relationship between Maternal level of education and awareness, ownership and utilization of LLIN Ho (null hypothesis) There is no relationship between Maternal level of education and awareness, ownership and utilization of LLIN

The present study thus shows an improvement in awareness level over the previous reports. In south western Nigeria, the awareness was reported at 64% in Oshogbo, Osun State (Osero, Otieno & Orago, 2005), and 91% in Lagos State (Umeh, Obi, Onah, Ugwu, Ajah & Umeh, 2012).

Table 10: Relationship between Maternal Level of education and awareness, ownership and utilization of net Matern al Level of Educati on Nonformal Primary Seconda ry Universi ty TOTAL

Awa re

Owners hip

Utilizati on

7

5

7

19

28 170

20 140

18 142

140

120

118

345

285

285

66 45 2 37 8 91 5

In the South-South zone of Nigeria, an awareness level of 88.6% was reported (Onwujekwu, Uzochukwu, Ezumah & Shu, 2005), whereas the awareness level in the Northern zone of the country was reported at between 36% (Runsewe- Abiodun, Inyanwura & Sotimehin, 2012), and 91% (Sangare, Weis, Brentlinger, Richardson, Staekete, Kiwuwa & Stergachis, 2012). In other African countries, studies have reported an improvement in the awareness and use of LLINs over the years. (Steketee, Nahlen, Parise & Menendez, 2001) However despite high awareness amongst the pregnant women, this study demonstrated that 52% of the women used net sometimes, and only 28% used it always. This figure is rather too poor considering that this strategy has been shown to hold the key to malaria prevention in pregnancy. The implication of this low LLIN use by pregnant women in Orlu is that the uptake of this evidence based global strategy aimed at eradicating malaria is still poor in our population, and thus the possibility of achieving the malaria related MDGs (4, 5, 6) is very remote in our environment. What is even more

Table 4:10 reveals that X2 = 1.513, degree of freedom is 6 and the table value of 4.46 at 0.05 level. With X2 of 1.513 which is less than 4.46, which means that

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International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

worrisome is the level of ignorance and misconception obtained in this study among our women regarding the safety of LLIN use in pregnancy. Despite the strong evidence on the safety of LLIN in pregnancy, a good proportion of our women still have reservations in its use because of unfounded fear of deleterious effects on their unborn babies. This is a cause for public health concern considering the proven preventive ability of net in protecting pregnant women from the scourge of malaria especially during pregnancy. This finding does not also confer government effort and strategies to eliminate malaria burden in the country.

RECOMMENDATIONS Based on the findings from this study, the following recommendations were made:  Government should consider making a policy on LLIN use  Government should focus on creating demand for LLINs through all available health information channels including social marketing  Public health workers should intensive public enlightenment to dispel misconception about fear of the chemical used in treating the net and excessive heat among pregnant women  The major challenges of low usage such as fear of chemicals and excessive heat should be seriously addressed to encourage the use of LLIN by pregnant women to prevent malaria during pregnancy.

Previous studies revealed low level of ownership and use of ITNs varying from 20 to 72% (Umeh, Obi, Onah, Ugwu, Ajah & Umeh (2012). The low level of ownership could be attributed to failure to collect free samples from government agencies (Salaudeen & Jimoh, 2009), inability to purchase from the open market due to high cost, or ignorance of the importance of sleeping under LLINs during pregnancy, bearing in mind that a percentage of the women had no formal education. Oftentimes, free nets distribution by government agencies is concentrated at the primary health centers at the local governments where some local women who may not value the nets collect them only to dump them at home for one reason or another.

REFERENCES

Huge populations of pregnant women patronizing hospitals situated in major urban areas are often left out. This study did not find age and level of education of pregnant women as a factor responsible for the levels of awareness, ownership and use of LLINs among this group.

1.

Adeyemi, A.S, Adekande, D.A, & Akinola, S.E.(2007). Use and Prevalence of Insecticide treated mosquito bednets among pregnant population in Oshogbo Nigeria. Nigeria Medical Practice 52(2):2932

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CONCLUSION The present study concludes that though the level of awareness concerning the use of LLINs by pregnant women in Orlu Imo state was high, the actual ownership and use was poor justifying the high prevalence of malaria burden that has been reported in the state. The public health implication is that more work needs to be done by both the government and health workers in the state to further raise the level of use of LLIN through health education so as to motivate more pregnant women to use them

4.

5.

20

Okoye, C.A. & Isara, A.R (2011). Awareness on the use of Insecticide treated nets among women attending

Dec. 2014. Vol. 4, No.8

ISSN 2307-2083

International Journal of Research In Medical and Health Sciences © 2013-2014 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

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