INFLUENCE OF HEALTH EDUCATION ON UPTAKE AND USE OF FREELY DISTRIBUTED INSECTICIDE TREATED NETS AMONG PREGNANT WOMEN IN AKINYELE LOCAL GOVERNMENT AREA, NIGERIA

Abstract

ln Nigeria, malaria remains a threat to pregnancy outcomes, Despite the demonstrated effectiveness of Insecticide Treated Nets (ITN) in reducing malaria burden in pregnancy, its use among Nigerian pregnant women is still low. This study was designed to assess the effect of free ITN distribution and health education on its uptake and use among pregnant women attending Primary Health Care (PHC) centres in Akinyele Local Government Area (LGA), Oyo state. A quasi-experimental study was carried out among pregnant women attending the four urban PHC centres in Akinyele LGA, Ibadan. A pretested semi-structured questionnaire was administered pre- and post-intervention to seek information on knowledge of malaria, willingness to own and use ITN from 364 consenting pregnant women out of the 416 attending antenatal care in the PHC centres between May and August 2009. Knowledge of malaria was scored on a 18-point scale; a score of ≥ 9 was classified as good and lesser score as poor. Respondents willing to own ITN were given collection slips. Four sessions of health education talks were held with respondents at the health facilities.in order to ascertain hanging and actual use. 142 respondents (calculated based on the NDHS 2008 ITN use prevalence of 1.3% among pregnant women in southwest zone) were selected by balloting and observed at home twice over a period of three months, using an observational checklist. Post-intervention, Focus Group Discussions (FGDs) were also held to explore perceived benefits and limitations of ITN use, Data analysis was done using descriptive statistics, Chi-square and logistic regression. Thematic approach was used for FGD analysis. Mean age of respondents was 27.0 ± 5.1years, 58.8% had secondary education and 44,8% were engaged in business/trading, Mean gestational age at first antenatal care visit was 15.7 ± weeks. All the respondents signified willingness to own and they collected ITN (100% uptake). Before intervention, 68.0% of the respondents had good knowledge of malaria and 87.9%, post-intervention. The number of pregnant women that used ITN increased significantly from 3.6% at baseline to 83,2% post-intervention (p<0.05) while 0.3% used untreated bednet pre and post-intervention, Being civil servant (OR: 5.56, 95% CL: 1.30, 23.72) and in third trimester of pregnancy (OR: I.15, 95% CI: 1.00. 1.24) were significantly associated with the use of ITN pre and post-intervention respectively, Pre-intervention 11(84.6%) out of 13 respondents who owned ITN mentioned they slept under the net prior to survey. while 303 (83,2%) out 364 did so post-intervention. At first observation visit 50,0% hung and 4.2% slept under their net, while at second visit 45.8% and 22.5% did so respectively. Perceived benefit of ITN mentioned during FGD included, reduction of mosquito bites and episodes of malaria. Limitations to ITN use included the heat experienced while sleeping under the net, inadequate space for hanging and movement during sleep. Uptake of insecticide treated net was high among pregnant women. However, free distribution did not influence use as only a few slept under the net. Health education and production of less heat conserving nets stand to improve use.