Use of insecticide treated nets among women in Ghana: a multilevel modelling of the 2016 malaria indicator survey

Abstract

Background Malaria is among the leading causes of morbidity and mortality particularly among women and children in sub-Saharan Africa and remains a public health challenge. Over the years, provision of insecticide mosquito nets (ITNs) for individuals and households have been on the forefront of various organizations. Focus has been on proportion of population with access to ITNs at the expense of usage proportion. This study examined the factors associated with the use of ITNs among women in Ghana. Methods This study used a cross-sectional data obtained from the 2016 Ghana Malaria Indicator Survey (GMIS). A sample of 4,267 women aged 15–49 who possessed at least one mosquito net was included in this study. Use of ITNs was the outcome variable. Descriptive statistics and multilevel binary logistic regression were employed. Results were provided in tables with a significance level set at P < 0.05. Results Out of the 4,267 total sample, more than half (55.9%) were users of ITNs. Women aged 15–24 were less likely (aOR = 0.680 Crl:0.576–0.803) to use ITNs compared to women aged 35 years and above. Women with no education were more likely (aOR = 1.282 Crl:1.047–1.570) to use ITNs compared to women with secondary or higher educational level. Poor women also had significantly higher odds (aOR = 2.005 Crl:1.612–2.495) of using ITNs than similar women who were rich. Women who lived in least disadvantaged communities had higher odds (aOR = 1.358 CrI:1.055–1.748) of using ITNs compared to women in most disadvantaged communities. Conclusions Low socio-economic status was a key predictor of ITN usage in Ghana. Having no education, being poor, living in rural areas, chances of getting malaria, coverage of malaria under NHIS and being least socio-economically disadvantaged increased the likelihood of using ITNs. Interventions aimed at improving socio-economic statuses are needed to increase ITN usage in Ghana.

Inequalities in the use of insecticide-treated nets by pregnant women in Ghana, 2011 and 2017

“…Concerning the education dimension, it was revealed that ITNs utilization was higher among women who had no formal education compared to those who had formal education across both survey points. Similar findings have been reported by a related study from Ghana [30]. A plausible explanation for this could be that, women with no formal education often perceive themselves to be highly vulnerable to malaria infection, possibly receiving encouragement to utilize ITNs as compared to those with formal education.…”

“…Contrary to findings from previous studies that found higher ITNs utilization among women in urban areas [27,28], the study found that rural dwelling pregnant women had higher ITNs utilization in both 2011 and 2017 as compared to their counterparts in rural areas. The result is, however, consistent with the findings from studies conducted in Ghana [29,30] and Myanmar [31]. The reasons for this finding is unclear, however, it could be that rural dwelling women struggle to afford malaria treatment and, therefore, prioritize preventive measures such as ITNs use, far more than their counterparts residing in urban areas [32].…”

“…However, it is possible that the low ITNs utilization in the Greater Accra region may be due to the characteristics of the region. Women in the Greater Accra region tend to be urbanites and also have higher formal education; all of these factors have been found to be associated with lower utilization of ITNs [27][28][29][30]. Another possible explanation could be that, Ghana's ITNs programme has generally be pro-poor and pro-rural in nature, hence, explaining the low utilization of ITNs in the Greater Accra region.…”

“…A plausible explanation for this could be that, women with no formal education often perceive themselves to be highly vulnerable to malaria infection, possibly receiving encouragement to utilize ITNs as compared to those with formal education. Dadzie et al [30] also argue that women with formal or higher education have greater access to information about alternative malaria prevention methods. Consequently, they tend to practice better environmental hygiene and/or adopt alternatives to ITNs, hence, explaining the lower ITNs utilization among women with no formal education, and the corresponding higher ITNs utilization among those with formal education.…”

Using the Ghana malaria indicator survey to understand the difference between female and male-headed households and their prevention and testing for malaria among children under 5

“…This percentage looks small but requires attention since malaria infection is said to claim the live of one child under 5 years of age in every 2 mins in the country [ 6 ]. By the first quarter of 2020, Ghana had recorded more than 1 million malaria cases, with 54 children under the age of 5 losing their lives to malaria [ 7 ].…”