Project – Utilisation of insecticide treated net among antenatal and nursing mothers

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria remains a major public health problem worldwide, particularly in sub-Saharan Africa, where it continues to be a leading cause of morbidity and mortality. The disease disproportionately affects vulnerable populations, including pregnant women, nursing mothers, and children under five, who are at higher risk of severe complications. According to the World Health Organization (WHO, 2022), approximately 95% of global malaria cases occur in Africa, highlighting the heavy disease burden in the region. The high prevalence of malaria in sub-Saharan Africa is fueled by climatic conditions favorable to mosquito breeding, limited healthcare access, and socio-economic challenges that hinder effective prevention and treatment.

Pregnant women are particularly susceptible to malaria due to immunological and physiological changes during pregnancy, which increase their vulnerability to Plasmodium infections. Malaria in pregnancy can lead to severe maternal anaemia, placental parasitization, intrauterine growth restriction, low birth weight, stillbirth, and even maternal death (Radeva-Petrova et al., 2014). These adverse outcomes not only threaten maternal health but also compromise neonatal survival and long-term child development. The risk is compounded in areas with poor antenatal care coverage or inadequate health education, where preventive interventions may not reach all pregnant women.

Nursing mothers and their infants are also at risk due to potential malaria transmission and compromised immunity. Infants born to malaria-infected mothers may have low immunity, making them more prone to malaria infections during early life. Nursing mothers may experience repeated malaria episodes that can reduce their physical strength, affect lactation, and indirectly impact infant health (Hill et al., 2013). In regions where malaria is endemic, such as many parts of Nigeria, this cycle perpetuates poor maternal and child health outcomes, contributing to high infant mortality rates.

Insecticide-treated nets (ITNs) are widely recognized as one of the most effective preventive strategies against malaria. ITNs provide both a physical barrier that prevents mosquito bites and a chemical barrier that kills or repels mosquitoes through insecticide treatment (Eisele et al., 2010). When used consistently and correctly, ITNs have been shown to significantly reduce malaria incidence, maternal anaemia, and infant mortality in endemic regions. The World Health Organization and other international health agencies advocate ITN use as a key component of malaria prevention strategies, particularly targeting vulnerable populations such as pregnant women and nursing mothers.

The distribution and utilisation of ITNs among these high-risk groups are considered cost-effective interventions for reducing malaria-related morbidity and mortality (Bhatt et al., 2015). Many countries, including Nigeria, have adopted policies to provide free or subsidized ITNs through antenatal clinics, immunization programs, and community-based health initiatives. These programs aim to ensure that pregnant and nursing women have access to ITNs and are educated on their proper use. Effective ITN distribution can also contribute to wider community protection by reducing the overall mosquito population and transmission potential.

Despite these efforts, studies indicate that ITN utilisation remains suboptimal in many regions. Factors influencing adherence include socio-economic status, educational level, cultural beliefs, awareness of malaria risks, accessibility, and perceived discomfort from heat or suffocation when sleeping under a net (Baume & Marin, 2008; Pulford et al., 2011). In Nigeria, even when ITNs are available, some mothers may not use them consistently due to misconceptions about their effectiveness, improper installation, or concerns about side effects. Such barriers highlight the gap between ITN ownership and actual utilisation, which undermines the effectiveness of malaria prevention programs.

The National Malaria Elimination Programme (NMEP) in Nigeria has made significant efforts to distribute millions of ITNs through antenatal clinics and child immunization programs (Federal Ministry of Health [FMOH], 2020). However, malaria remains endemic in many states, indicating that provision alone is insufficient without addressing behavioural, social, and cultural factors that influence ITN use. Understanding the patterns of ITN utilisation among antenatal and nursing mothers is therefore crucial for designing interventions that not only increase ownership but also promote consistent and proper use.

Identifying the barriers and facilitators to ITN use can inform public health interventions and policies aimed at increasing coverage and utilisation among high-risk groups. Evidence-based strategies, such as targeted health education, community mobilization, and culturally sensitive messaging, can enhance adherence and reduce malaria burden. By focusing on antenatal and nursing mothers, interventions can directly improve maternal and neonatal health outcomes, contributing to broader public health goals, including the Sustainable Development Goals on maternal and child mortality reduction.

1.2 Statement of the Problem

Malaria continues to be a major public health concern in Nigeria, with pregnant and nursing women among the most vulnerable groups. Despite numerous government and non-governmental efforts to scale up preventive measures such as insecticide-treated nets (ITNs), malaria-related morbidity and mortality remain high in many regions. Pregnant women are particularly at risk due to immunological changes during pregnancy, which increase susceptibility to malaria infections. Nursing mothers, on the other hand, are at risk both from recurrent infections and from the potential transmission of malaria to their infants, which can lead to poor neonatal health outcomes.

Evidence suggests that although ITNs are distributed widely across Nigeria through antenatal clinics, immunization programs, and community-based campaigns, not all recipients use them consistently or correctly (Onwujekwe et al., 2010). In some cases, antenatal and nursing mothers may possess ITNs but fail to use them due to lack of awareness, misconceptions about malaria prevention, or discomfort caused by sleeping under a net. In other instances, ITNs are repurposed for activities such as fishing, gardening, or other household uses, which undermines their intended public health benefits and reduces community protection against malaria (Adebayo et al., 2015).

This low utilisation of ITNs contributes directly to persistent malaria transmission in endemic areas. Pregnant and nursing women who do not consistently use ITNs remain susceptible to malaria, increasing the risk of adverse maternal and infant outcomes. These outcomes include maternal anaemia, low birth weight, preterm births, and infant mortality, all of which place significant strain on healthcare systems and contribute to the high maternal and child mortality rates observed in Nigeria (Menendez et al., 2007).

Several factors have been identified as contributing to the suboptimal use of ITNs among antenatal and nursing mothers. Socio-cultural beliefs and practices, knowledge gaps regarding malaria prevention, and misconceptions about ITN effectiveness influence adherence negatively. Additionally, logistical challenges such as inadequate distribution, poor follow-up, wear and tear of nets, and perceived discomfort due to heat or suffocation while sleeping under ITNs further impede effective utilisation (Pulford et al., 2011). These multifaceted barriers indicate that mere provision of ITNs is insufficient without addressing behavioral, educational, and infrastructural factors.

Given these challenges, it becomes essential to examine the extent of ITN utilisation specifically among antenatal and nursing mothers. Understanding usage patterns, identifying the factors that encourage or hinder proper ITN use, and assessing the knowledge and attitudes of these women towards malaria prevention can provide crucial insights for intervention programs. Studies focused on these high-risk populations are particularly valuable because maternal behavior directly influences neonatal health outcomes, and improvements in ITN use can significantly reduce malaria-related morbidity and mortality.

Therefore, there is a critical need for targeted research to identify strategies that can enhance ITN adherence among antenatal and nursing mothers. Evidence-based findings from such studies can inform the design of culturally sensitive educational campaigns, improve distribution strategies, and ensure sustained behavioural change. Ultimately, addressing ITN utilisation gaps will contribute to the broader goal of reducing maternal and infant mortality in Nigeria and help achieve the Sustainable Development Goals related to maternal and child health.

1.3 Objectives of the Study

The general objective of this study is to assess the utilisation of insecticide-treated nets among antenatal and nursing mothers.

The specific objectives are to:

1. Determine the level of awareness of ITNs among antenatal and nursing mothers.
2. Examine the pattern of ITN utilisation among antenatal and nursing mothers.
3. Identify socio-demographic and socio-economic factors influencing ITN utilisation.
4. Investigate challenges and barriers to consistent ITN use among antenatal and nursing mothers.

1.4 Research Questions

The research questions are buttressed below:

1. What is the level of awareness of ITNs among antenatal and nursing mothers?
2. How do antenatal and nursing mothers use ITNs in their households?
3. What socio-demographic and socio-economic factors influence ITN utilisation among antenatal and nursing mothers?
4. What challenges or barriers affect the consistent use of ITNs among antenatal and nursing mothers?

1.5 Research Hypothesis

The hypothesis is buttressed below:

H₀: There is no significant relationship between socio-demographic factors and the utilisation of insecticide-treated nets among antenatal and nursing mothers.
H₁: There is a significant relationship between socio-demographic factors and the utilisation of insecticide-treated nets among antenatal and nursing mothers.

1.6 Significance of the Study

This study is significant because it provides empirical data on the utilisation patterns of insecticide-treated nets (ITNs) among antenatal and nursing mothers. While ITNs are widely distributed in Nigeria, there is limited comprehensive data on how frequently and correctly these nets are used by the target population. By systematically examining ITN use at Federal Medical Centre (FMC), Umuahia, this research will generate evidence on actual usage patterns, filling a critical knowledge gap. Such data can help policymakers and healthcare providers understand the real-world effectiveness of ITN distribution programs.

The study also identifies the socio-demographic, socio-economic, and behavioral factors that influence ITN utilisation among antenatal and nursing mothers. Factors such as age, education, income level, cultural beliefs, and health knowledge may affect adherence to malaria prevention strategies. By uncovering these determinants, the research provides valuable insights that can guide the development of targeted educational and awareness campaigns. These campaigns can address misconceptions, enhance knowledge about malaria prevention, and ultimately improve ITN use among high-risk populations.

By highlighting barriers to ITN utilisation, this study can assist health authorities in designing practical and effective strategies to improve adherence. Barriers such as perceived discomfort, improper net maintenance, lack of knowledge on proper use, and socio-cultural practices may limit the impact of ITN distribution programs. Understanding these obstacles allows healthcare planners to implement interventions that are context-specific and culturally appropriate, ensuring that ITNs achieve their intended protective effect against malaria.

The findings of this study will contribute significantly to maternal and child health research, particularly in the area of malaria prevention. Malaria is a leading cause of maternal and neonatal morbidity in Nigeria, and improving ITN utilisation among pregnant and nursing women is a key step toward reducing adverse health outcomes. By providing evidence-based recommendations, this research supports both local and national efforts to protect vulnerable populations from malaria and improve overall maternal and infant health.

Moreover, the study has implications for broader malaria elimination efforts at both national and global levels. Nigeria is a major contributor to the global malaria burden, and improving ITN utilisation among high-risk groups is essential for achieving the targets set by the World Health Organization and the Sustainable Development Goals. By providing data-driven insights, this research supports the design of effective interventions that can be scaled up in similar healthcare settings, contributing to the overall reduction of malaria transmission.

Finally, this study serves as a foundation for future research in malaria prevention and health behavior among antenatal and nursing mothers. Researchers, public health practitioners, and policymakers can use the findings to explore related issues, such as the effectiveness of educational interventions, the impact of ITN durability and quality on use, and strategies for integrating malaria prevention into broader maternal and child health programs. In this way, the study not only addresses immediate gaps but also contributes to long-term improvements in public health outcomes.

1.7 Scope of the Study

This study focuses on antenatal and nursing mothers attending Federal Medical Centre (FMC), Umuahia, Abia State, Nigeria. It examines their awareness, utilisation patterns, and factors influencing the use of insecticide-treated nets (ITNs) for malaria prevention. The study is limited to mothers within reproductive and postnatal age groups who attend FMC Umuahia for antenatal care or postnatal services. It does not include children, non-pregnant adults, or mothers who do not attend the facility, though the findings may provide insights applicable to similar healthcare settings and inform broader malaria control strategies in the region.

1.8 Definition of Terms

Insecticide-Treated Net (ITN): A mosquito net that has been treated with insecticides to prevent mosquito bites. ITNs act both as a physical barrier and as a chemical deterrent, killing or repelling mosquitoes, thereby reducing the risk of malaria transmission (World Health Organization [WHO], 2022).

Utilisation: The actual practice of sleeping under or correctly using an ITN by antenatal and nursing mothers as a preventive measure against malaria. Utilisation includes consistent and proper use according to recommended guidelines.

Antenatal Mothers: Women who are currently pregnant and receiving care at healthcare facilities, such as antenatal clinics, to monitor pregnancy and ensure maternal and fetal health.

Nursing Mothers: Women who are actively breastfeeding or caring for infants, typically within the first six months postpartum, and who may be at increased risk of malaria.

Malaria: A potentially life-threatening disease caused by Plasmodium parasites transmitted to humans through the bites of infected female Anopheles mosquitoes. Symptoms include fever, chills, headache, and in severe cases, anemia, organ failure, or death.

Maternal Mortality: The death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy from any cause related to or aggravated by pregnancy or its management (WHO, 2019).

Infant Mortality: The death of a child before reaching one year of age. In malaria-endemic regions, malaria infection in mothers can significantly contribute to low birth weight and increased infant mortality.

Knowledge of Malaria Prevention: Awareness and understanding of strategies, including ITN use, environmental management, and prophylactic measures, aimed at preventing malaria infection among at-risk populations.

Barriers to ITN Utilisation: Factors that prevent or discourage the proper and consistent use of ITNs, such as discomfort, cultural beliefs, lack of knowledge, accessibility challenges, or repurposing of nets for non-health-related uses.

Project – Utilisation of insecticide treated net among antenatal and nursing mothers