TOPIC: ASSESSING THE COVERAGE AND CONSISTENT USE OF INSECTICIDE TREATED MOSQUITO NETS (ITNs) IN THE PREVENTION OF MALARIA AMONG PREGNANT WOMEN IN NKORANZA SOUTH DISTRICT IN BRONG AHAFO REGION OF GHANA. By: RICHARD OTCHERE SUPERVISOR: PROF. (MRS) E.A. ADDY

OUTLINE INTRODUCTION OBJECTIVES RESEARCH QUESTIONS PROBLEM STATEMENT METHODOLOGY RESULTS/DISCUSION CONCLUSION RECOMMENDATIONS

INTRODUCTION In Africa, 30 million women living in malaria-endemic areas become pregnant each year. For these women, malaria is a threat both to themselves and to their babies, with up to 200 000 newborn deaths each year as a result of malaria in pregnancy (WHO 2003) Twenty-five million pregnant women are currently at risk for malaria, and according to the World Health Organization (WHO), malaria accounts for over 10,000 maternal and 200,000 neonatal deaths per year (WHO, website accessed July 30, 2009).

OBJECTIVES GENERAL OBJECTIVE To assess the coverage and consistent use of ITNs among pregnant women in the Nkoranza South District. SPECIFIC OBJECTIVES To determine the extent to which pregnant women are aware of ITN and their understanding of its use. To assess the availability of and accessibility to ITN To identify ownership and usage among pregnant women in Nkoranza south district To determine the desire of pregnant women to purchase ITN To identify the frequency and acceptance of ITN use among pregnant women.

RESEARCH QUESTIONS To what extent are pregnant women aware of and understand ITN use in Nkoranza South District? Are Insecticide Treated bed Nets readily available and accessible in Nkoranza South? What percentage of pregnant women do own and use ITN? To what extent are pregnant women willing to purchase ITN? How frequent do pregnant women accept and use ITN in Nkoranza south district?

PROBLEM STATEMENT In Ghana, many programmes employed by the Ministry of Health (MOH) and Ghana Health Service (GHS) including Roll Back Malaria (RBM) have failed to address the malaria problem. Currently, at Nkoranza South District, malaria is the leading cause of Outpatient Department (OPD) attendance of 47%, Outpatient admissions of 16.2% and 17.4% of Hospital deaths (GHS, 2009). Malaria in pregnancy was 1378 of the total hospital attendance constituting 1% of OPD attendance. It is believed that Insecticide treated bed net is the most effective way of preventing malaria infections especially among pregnant women who are most vulnerable (WHO, 2003).

PROBLEM STATEMENT The over all net usage among Ghanaian population was only 4.1% (WHO/GHS, 2003). However, a total of 45.4% house holds use untreated bed nets, while 31.7% of pregnant women also use untreated bed nets and 19.9% of pregnant women slept under ITN the night before the survey (GDHS 2008). Malaria in pregnancy was very high in the district despite high distribution of ITN in the district and thus gives cause to worry. No assessment of the coverage and consistent usage has been done in the district hence this study.

METHODOLOGY The study was done in Nkoranza south district. The study was basically observational without any interventions. A descriptive cross sectional design was used to collect data from a section of the population. The study engaged households in selected communities within the Nkoranza South district. The focus was on pregnant women in the study households. Subjects were drawn from a number of communities within the Nkoranza South district.

METHODOLOGY SAMPLING TECHNIQUE AND SIZE A total of 384 pregnant women were selected for the study. A mix of sampling methods was used in selecting the 384 study subjects. This included cluster sampling, simple random and systematic sampling methods. A simple random sampling technique was used to select twenty (20) communities and each community then formed a cluster. Subjects were selected from each cluster systematically (the grid method). The sample frame was the total number of houses within the study communities. Each household constituted a sample unit.

METHODOLOGY DATA COLLECTION TECHNIQUE AND TOOLS Questionnaires containing open and closed ended questions were administered to the respondents’ between July and October 2010. Pre-testing of questionnaire was done at Nkoranza North district to test the validity and reliability of instruments. Data entry was done with computer software SPSS version 16.0 and exported to Stata version 10 software for analysis. Descriptive statistics was used in the analysis of data.

RESULTS RESPONDENTS’ AWARENESS AND PERCEIVED USE OF ITN Awareness (N= 384): Have heard about ITN 243(63%) Have not heard at all 141(37%) Perceived use of ITN (N=243) Protection against mosquito bite was 230(95%) Room decoration 7(3.0%) Affords good sleep 6(2.0%)

SOURCEOF INFORMATION ON ITN (N=243) TV/FM stations 138(57%) Hospitals/Clinic 83(34%) District health education 12(5%) Relatives/Peers 10(4%) AVAILABILITY OF ITN IN COMMUNITY (N=179) Available in community 61(34%) Unavailability in community 118(66%)

RESULTS POSSESSION OF NET (TREATED AND UNTREATED) N= 384. ITN ownership was 32% Ownership of any untreated bed net was 15% No net was 53% Ownership and usage did not show any significant association (chi square=2.47, p-value = 0.12) parity and usage did not show any significant association (p-value = 0.63) DESIRE TO PURCHASE ITN IN FUTURE(N=384) Willing to buy was 279(73%) Unwilling to buy was 105(27%) FREQUENCY OF NET USAGE BY PREGNANT WOMEN (N=179) All year round was 59% Rainy season was 37% Others 4%

DISCUSSION Awareness on ITN was relatively high (63%) which contrasted studies by Onwujekwe O.E et al (2000)in Nigeria and Alaii J.A et al (2003) in western Kenya Availability of nets in the communities was very low 34%. The pregnant women asserts that cost of nets were very expensive. WHO 2009 asserts that cost should not be a barrier to making them available and accessible to all people at risk. Coverage of ITN among pregnant women in the district was 32% far below the Abuja target of 60% by 2010 (Net mark 2004) and that of the global coverage of 80% by 2010 (WHO malaria report 2009).

DISCUSSION 53% of pregnant women in the district did not own ITN. 73% of those with net slept under it the night before the survey. Brown E.N.L et al (2001) a study in Northern Ghana recorded high net usage (70%) the night before survey. Desire to purchase ITN was high 279(73%) – Okra J. et al (2002) 87%. 59% of owners used during all year round

CONCLUSIONS Most of the respondents’ knowledge about malaria was very high (83% were aware that malaria was caused through the bite of mosquitoes). ITN coverage in this study was still low (32%) compared to the Abuja RBM target of 60% by 2010 in spite of subsidies for pregnant women and children under five years of age. Cost of ITN was found to be expensive especially from the commercial centres and therefore not affordable. It was about three times higher in commercial sectors than in hospitals/clinics. TV/FM station was the main source of information (57%). Possession was 47% with 32% owning ITNs with a very high net usage of 131(73%) the night before the survey among those who possess nets.

RECOMMENDATIONS National education on ITN should be intensified through the Television and F.M stations to increase awareness and possession of nets so as to enhance national coverage of ITN. The ministry of health in collaboration with the Government should import more conical nets for all communities. The district health education should include the need for re-treatment of nets and the provision of regular community re-treatment services to all those who have the net until they are replaced with a long lasting ones. Education through churches and schools could be looked at as a means of educating the public. Husbands should be very much concerned with providing treated nets to their pregnant wives.

REFERENCES Alaii J.A et al (2003), community reactions to the introduction of pemethrine-treated bednets for malaria control during a randomized control trial in western Kenya. American Journal of Tropical Medicine and hygiene. April 1, 68. (90040):pp 128-136. Ghana Demographic and Health Survey 2008 Ghana Health Service/World Health Organisation (2003) annual report on malaria World Health Organisation Website, authors. Global Malaria Programme: pregnant women and infants. [Accessed July 30, 2009]. http://apps.who.int/malaria/pregnantwomenandinfants.html.

ACKNOWLEDGEMENT To my academic supervisor – Prof. (Mrs) E.A Addy All lecturers in Community Health Department KNUST Nkoranza south health directorate Nkoranza south district assembly.

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