Women in child-bearing age who are not currently pregnant are missed opportunities for malaria control in pregnancy: Evidence from 16 Local Government Areas of Nigeria

Abstract

The health of women is not only linked to reproductive issues but also to efforts in health promotion, improved nutritional status and general well being of girls and adolescents from infancy to adulthood. The aim was to evaluate the use and non-use of long lasting insecticidal nets (LLIN) among women in child-bearing age in Nigeria. This survey employed cross-sectional survey to collect data from households on coverage and use of LLINs. The study took place in 2007, five months after the distribution of LLINs, coinciding with the second raining period of the year and a time of high malaria transmission during the wet season. In the 1,756 households sampled, the ratio of women in childbearing age to currently pregnant women was 8.2 to 1. The probability of having a woman in reproductive age in the household is 50 times more than having a pregnant woman. Overall, there was a significant difference in the proportion of pregnant women who slept under any net (χ² = 23.2; p = 0.000003; odds ratio (OR) = 1.89; confidence interval (CI) = 1.46, 2.46) or under an LLIN (χ² = 15.17; p = 0.0001; OR = 1.73; CI = 1.31, 2.28) night before survey compared to women in child-bearing age. A significant proportion of currently pregnant women took IPT1 only compared to WCBA in their last pregnancy (χ² = 524.04; p = 0.000000; OR = 35.2; CI = 22.6, 54). Use of LLINs among women in childbearing age (WCBA) in Nigeria is low. Aggressive approach is needed to increase the utilization of LLIN among WCBA to improve use among pregnant women. Eight hundred and ninety one (51%) of households sur- veyed had any net while 738 (42%) had insecticide treated nets in the form of LLINs (Figure 2). The highest percentage of the ownership and assumed usage of “any net” (88%) and of LLIN (84%) was in Owo LGA in Ondo state,southern states of the country than in the northern states. Figure 3 illustrates the percentage of households with at least 1 mosquito net of any type by wealth quintile. The ownership of LLIN ranged from 53% among the poorest to 56% among the least poor. Almost equal percentage of households had any net hanging (69%) and LLIN (68%) hanging during the survey. Ikorodu LGA in Lagos state had the lowest percentage of “any net” and of LLIN hanging while Owo in Ondo state and Gulani in Yobe state had the highest percentage (91%) of “any net” and South-west Nigeria. Ilorin West LGA in Kwara state recorded the lowest “any net” (17%) and the lowest ITN/LLIN (6%) use.of LLIN hanging (Figure 4). The percentage use of LLINs by CPW and by WCBA in different zones of the country was staggered. For example, 36% of CPW and 23% of WCBA slept under LLIN the night before survey in South-east zone, 0% CPW and 12% WCBA did so in North-Central zone. Overall, there was a significant difference in the proportion of pregnant women who slept under any net (χ² = 23.2; p = 0.000003; OR = 1.89; CI = 1.46, 2.46) or under an LLIN (χ² = 15.17; p = 0.0001; OR = 1.73; CI = 1.31, 2.28) night before survey compared to WCBA