Effectiveness of a health education intervention on the use of long-lasting insecticidal nets for the prevention of malaria in pregnant women of Pakistan: a quasi-experimental study

Abstract

Background: About one quarter of pregnant women in the population of Pakistan are using long-lasting insecticidetreated bed nets (LLINs) for prevention of malaria. Past research reported that adequate information and education would act as mediator to change behaviour among patients for prevention of malaria infection. The effective use of LLINs would contribute to reduction of disease burden caused by malaria. The aim of this study was to determine the effectiveness of health education on the adoption of LLINs among pregnant women living in Tharparkar, a remote district in Sindh Province, Pakistan. Methods: A quasi-experimental study design with control and intervention groups was conducted with 200 pregnant women (100 in each group). Women in the intervention group were provided with health education sessions on malaria for 12 weeks, while those in the control group obtained routine information from lady health workers (LHWs). Pre-and post-intervention assessment was done of knowledge about malaria and use of LLIN, which was statistically analysed using descriptive statistics and difference in difference (DID) multivariable regression analysis to test effectiveness of the intervention. Results: Baseline was conducted with 200 pregnant women. Demographic characteristics were similar in both groups with slight differences in age, education, income, type of latrine, and source of drinking water. There were no significant differences between mean knowledge and use of LLINs scores between groups at baseline. However, the estimated DID value after the intervention was 4.170 (p < 0.01) and represents an increase in scores of knowledge in the intervention group compared to control. Similarly DID value of 3.360 (p < 0.05) showed an increase in use of LLINs score after the intervention which was significant, showing that the intervention had a positive effect. Conclusions: Results proved that health education could be an effective intervention for improving knowledge and usage of LLINs among pregnant women for the prevention of malaria. Such educational interventions have a positive

Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan

“…Conditions like low birth weight in turn cause intrauterine growth retardation and preterm birth, which are leading causes of newborn mortality in low- and middle-income countries [ 7 , 37 ]. These findings are reported from the baseline data analysed before the health education intervention for malaria prevention among pregnant women of the same rural area published elsewhere [ 12 ]. Based on the trends shown in this baseline study, comparable results are expected if the intervention is implemented at a larger scale.…”

“…Studies have also supported the findings and shows a clear link between maternal education and poverty, and incidence of malaria in pregnant women and their newborns [ 22 , 24 ]. The use of LLINs has been shown to be higher in educated mothers and those receiving regular antenatal care and counselling [ 12 , 25 ]. A study from Nigeria showed that maternal education can effectively prevent malaria in rural communities [ 26 ].…”

“…This study was part of a larger interventional study employing quasi-experimental before and after design where baseline data were analysed before a health education intervention for malaria prevention among pregnant women of a rural district in the province of Sindh in Pakistan. The detailed methodology is published elsewhere [ 12 ]. Briefly, a sample of 200 pregnant women was recruited for data collection based on the sample size calculation with 80% power and alpha error of 0.50 to determine 30% difference.…”

“…LLINs are an important preventive measure against malaria, however, they are used by one-fourth of the pregnant women in the world. Proper use of LLINs protects against malaria and transience from malaria [ 12 – 17 ]. Moreover, the frequency of malaria cases can be reduced to half among pregnant women only by using LLINs [ 14 ].…”

“…Mass distribution of LLINs is a proven and cost-effective intervention to prevent malaria. Moreover, adequate knowledge and use of LLINs is considered an important factor against prevention of malaria [ 12 , 21 ].…”