Rural–urban variation in insecticide-treated net utilization among pregnant women: evidence from 2018 Nigeria Demographic and Health Survey

Abstract

Background In 2018, Nigeria accounted for the highest prevalence of malaria worldwide. Pregnant women and children under five years bear the highest risk of malaria. Geographical factors affect utilization of insecticide-treated nets (ITN), yet existing literature have paid little attention to the rural–urban dimension of ITN utilization in Nigeria. This study aimed at investigating the rural–urban variation in ITN utilization among pregnant women in Nigeria using data from the 2018 Demographic and Health Survey. Methods A total of 2909 pregnant women were included in the study. The prevalence of ITN utilization for rural and urban pregnant women of Nigeria were presented with descriptive statistics. Chi-square test was employed to assess the association between residence, socio-demographic characteristics and ITN utilization at 95% level of significance. Subsequently, binary logistic regression was used to assess the influence of residence on ITN utilization. Results Eight out of ten of the rural residents utilized ITN (86.1%) compared with 74.1% among urban residents. Relative to urban pregnant women, those in rural Nigeria had higher odds of utilizing ITNs both in the crude [cOR = 2.17, CI = 1.66–2.84] and adjusted models [aOR = 1.18, CI = 1.05–1.24]. Pregnant women aged 40–44 had lower odds of ITN utilization compared to those aged 15–19 [aOR = 0.63, CI = 0.44–0.92]. Poorer pregnant women had higher odds of ITN utilization compared with poorest pregnant women [aOR = 1.09, CI = 1.04–1.32]. Across regions, those in the south [aOR = 0.26, CI = 0.14–0.49] and south-west [aOR = 0.29, CI = 0.16–0.54] had lower odds of ITN use compared to their counterparts in the north-west region. Conclusion The high use of ITNs among pregnant women in Nigeria may be due to the prioritization of rural communities by previous interventions. This is a dimension worth considering to enhance the attainment of the national anti-malarial initiatives. Since possession of ITN is not a guarantee for utilization, women in urban locations need constant reminder of ITN use through messages delivered at ANC and radio advertisements. Moreover, subsequent mass ITN campaigns ought to take cognizance of variations ITN use across regions and pragmatic steps be taken to increase the availability of ITN in households since there is a moderately high use in households with at least one ITN in Nigeria.

Rural–urban dimensions of the perception of malaria severity and practice of malaria preventive measures: insight from the 2018 Nigeria Demographic and Health Survey

“…This suggests that adolescent and younger adult women in urban areas were more likely to use LLINs. This finding supports those of similar previous studies on the age-LLIN use association (Ameyaw et al, 2020) but contradicts the findings of others (Singh et al, 2013). Most young women (15-24 years) in urban areas may be in higher education institutions and may require LLINs to protect themselves from mosquito bites in their rented accommodation (Kudom & Mensah, 2010).…”

“…Furthermore, as intimated in the SDH framework, people's health practices and health literacies are influenced by where they live and work (World Health Organization, 2010; Committee on Educating Health Professionals to Address the Social Determinants of Health et al, 2016). Therefore, this rural-urban difference would have been lost if the study did not account for it, which has been a frequent practice in similar public health publications, in addition to their lack of control for the severity of malaria (Ameyaw et al, 2020). Thus, the results also have lessons for data analysts using nationally representative data.…”

“…through immunization and antenatal care services) was devised by the NMEP (Andrada et al, 2019). Nigeria's NMEP resulted in LLIN use increasing from 8% in 2008 to 61% in 2018 (Ameyaw et al, 2020).…”

“…In Nigeria, socio-demographic and economic factors play key roles in the uptake of malaria prevention and control measures. These vary by region, place of residence, education and other maternal demographic characteristics (Ameyaw et al, 2020). Malaria is reported to mainly affect vulnerable communities (Gómez et al, 2017).…”

Mosquito bed net use and associated factors among pregnant women in Rwanda: a nationwide survey

“…Likewise, as previously determined by Wagbatsoma et al and Dun-Dery et al, more married than unmarried women slept under ITNs [37,41]. Household wealth index has also previously been identi ed as a positive predictor of ITN usage among pregnant women in Nigeria [42]. This suggests that previous pregnancy (a proxy for older age), spousal support, and a stable nancial status may all play important roles in bed net use.…”