Factors influencing utilization of insecticide treated nets in malaria prevention and control among women in Msambweni district, Kwale County, Kenya

Abstract

Malaria remains a leading cause of morbidity and mortality in Kenya, especially in young children and pregnant women. To control the malaria problem, the use of ITNs was incorporated into the National Malaria Strategy (NMS) in April 2001 targeting at least 60% of pregnant women should be sleeping under ITNs during their confinement. Only 13% of pregnant women used a bed net during pregnancy, and only 38% of these were ITNs. The study objective was to determine the factors influencing ITNs utilization in Msambweni District among pregnant women attending antenatal care clinic. Coast Province and Msambweni District were sampled purposively.

The study was a descriptive cross-sectional survey conducted between March and April 2008, at Msambweni District hospital. Data was collected using interview schedules, from 426 pregnant women on consent. It was cleaned, coded, sorted and analyzed using SPSS version 13.0. Chi-square tests were used to compare proportions. The mean number of nets per household was 2.17. Majority (73.9%) of the study population owned a bed net, 50.5% of them were using a bed net always, 25.6% sometimes and 67.1 % were using ITNs. The main reasons given for not using a bed net always included dislike to use bed nets (52.15%) and lack of any to use (47.85%). Most bed nets had been received through health facilities (49.4%) and retail shops (45.7%) and a few from relatives (3.7%) and community aid groups (1.2%). Several factors were identified to be significantly associated· with ITN use including marital status, education level, prevention method used, prevention method qualities, side effects in preventive measures and mounting knowledge, household bed nets, reasons for inconsistent use, bed net sources, net retreatment, teaching on net use and household head net use promotion. There was significant association between the prevention measure used and ITNs use (X2=244.322, df=3, P<O.OO 1).

Among 166 respondents who used bed nets as the only preventive measure, 147 (88.6%) were using ITNs, followed by those using nets in combination with other measures 136 (85.0%) out of 160 respondents. Teaching of effective bed net use was found to be significantly associated with ITNs use (X2=11.196, df=1, P<0.005). In conclusion, the proportion of pregnant women using ITNs was 67.1%; there was no significant association between ITN use and reported pregnancy outcome among pregnant women in Msambweni district; pregnant mothers had good general knowledge of signs and symptoms, prevention and source of treatment for malaria; a significant association was noted between personal preferences such as bed net shape and colour and reported malaria episodes and factors that influence ITNs utilization included: malaria knowledge, individual practices and personal preferences. These are strong indicators of Il'Ns use among pregnant women.

The study recommends that both. public and private health stakeholders should ensure sustainable ITN availability and accessibility; increase lIN and malaria advocacy, and consider individual practices and personal preferences for bed nets such as bed net shape and colour among different communities before supplying HNs for malaria control to pregnant women in Msambweni district.