Determinants of insecticide treated bed-nets use by women for malaria control: a comparison of ndavaya and Kinango divisions, Kinango district, Kenya
Globally malaria results in 300 to 500 million clinical episodes and one million deaths annually. Malaria is caused by a protozoa of the genus Plasmodium. The disease is transmitted by the bite of an infected female Anopheles mosquito. In Kenya the disease leads to morbidity and mortality contributing to 30% of outpatient cases, 20% of admissions and 15 to 35% of hospital deaths. Kinango District records over 41% outpatient morbidity due to malaria. Malaria control measures include environmental hygiene practices, application of insecticides, intermittent presumptive treatment and prompt and effective case management. Use of Insecticide Treated Bed-Nets (ITNs) protects against mosquito bites including Anopheles gambiae and An. Funestus that harbour and spread the protozoa. The aim of the study was to investigate and compare the factors that influenced use of ITNs by women for malaria control in Ndavaya and Kinango Divisions of Kinango District. A cross-sectional survey design using systematic sampling was applied to collect data from 204 women selected randomly from the two divisions. Semi structured questionnaires, Key informant Interviews and Focused Group Discussions were used to gather data. Data for variables such as age, education level, incomes and source of nets were summarized in tables and figures. Chi-square test was applied to test whether the deviations (differences between observed and expected) were a result of chance or due to other factors. About 57% of women in Kinango slept under ITNs compared with only 32% in Ndavaya. Use of ITNs was significantly influenced by source (x2 = 79.01; P < 0.001). Over 51% of the respondents who had obtained ITNs from government health facilities did not use them. About 85% and 80% of the respondents in Ndavaya and Kinango respectively earning >Ksh. 12,000 used ITNs. Over 70% of women in both divisions who knew that malaria was transmitted through mosquito bites used ITNs. Kinango had approximately 30% of respondents' husbands supporting use of ITNs compared with only 13% for Ndavaya. More respondents (73%) in Kinango than Ndavaya (61%) who had been trained on use of ITNs indeed used them. Results indicated that the use of ITNs increased with the level of education and income. Shorter distances to health facilities were also associated with use of ITNs. The government should develop a communication package for malaria endemic areas. Community health workers should facilitate massive and systematic awareness creation on malaria transmission and ITNs use. Men should participate in interventions to scale up use of ITNs. Further research is required to establish the factors that influence use of ITNs by men and also determine the efficacy of indigenous malaria control mechanisms.