Demographic and socio-economic factors affecting bed net ownership, usage, and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities

Abstract

The most cost-effective malaria prevention and control strategy is the use of a bed net. However, several factors affect the ownership and usage of bed nets among the adult population. Hence, this study aimed to examine socio-demographic factors affecting bed net ownership, usage and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities. Structured questionnaires were administered to a total of 550 participants to ascertain their ownership and usage of the bed nets. Afterwards, finger prick blood samples were collected for malaria microscopy. Crude and adjusted prevalence ratios (PR) and their respective 95% CIs were calculated, using Poisson regression with robust standard errors, to show associated variables in bivariate and multivariate analyses respectively. About 53.3% (n = 293) of participants owned a bed net but only 21.5% (n = 118) slept under it the previous night. Those married were 2.0 (95% CI: 1.7–2.5) and 2.4 (95% CI: 1.6–3.5) times more likely to own and use a bed net respectively than those never married. Also, pregnant women were 1.3 (95% CI: 1.1–1.6) and 1.8 (95% CI: 1.3–2.5) times more likely to own and use a bed net respectively than non-pregnant. Even though income levels were not associated with bed net ownership and usage, students were 0.4 (95% CI: 0.2–0.6) and 0.2 (95% CI: 0.1–0.5) times less likely to own and use bed net respectively compared to formally employed persons. The overall malaria prevalence rate was 7.8%. Malaria-negative patients were 1.6 (95% CI: 1.2–2.0) and 2.4 (95% CI: 1.4–4.1) times more likely to own and use bed nets respectively than malaria positive. Patients with tertiary education recorded the lowest malaria prevalence (3.5%, n = 4). None of those with a monthly income >$300 recorded a case of malaria. On the contrary, majority 83%, n/N = 25/30) of the malaria-positive patients earned ≤ $150. Hence, in designing malaria control programmes for the urban adult populations, income, occupation, educational and marital status should be considered in order to improve bed net usage and decrease malaria prevalence.