Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana

Open Access Research Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana Kunche Delali Nyavor1, Margaret Kweku2, Isaac Agbemafle2, Wisdom Takramah2, Ishmael Norman2,3, Elvis Tarkang2,4,&, Fred Binka2 1 Faculty of Education, University of Ottawa, Canada, 2School of Public Health, University of Health and Allied Sciences, Ho, Volta region, Ghana, 3Institute for Security, Disaster and Emergency Studies, Sandpiper Place, Langma, Central Region, Ghana, 4HIV/AIDS Prevention Research Network, Cameroon, Kumba, South-West region, Cameroon & Corresponding author: Elvis Tarkang, School of Public Health, University of Health and Allied Sciences, Ho, Volta region, Ghana, HIV/AIDS Prevention Research Network, Cameroon, Kumba, Southwest region, Cameroon Key words: Malaria prevention, children, ITN ownership, ITN usage, knowledge, caregivers Received: 31/05/2016 - Accepted: 14/08/2017 - Published: 22/09/2017 Abstract Introduction: Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. Methods: in August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. Results: A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). Conclusion: Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs. Pan African Medical Journal. 2017; 28:67 doi:10.11604/pamj.2017.28.67.9934 This article is available online at: http://www.panafrican-med-journal.com/content/article/28/67/full/ © Kunche Nyavor et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Page number not for citation purposes 1 Introduction Methods Malaria is a major public health problem and one of the leading causes of maternal and child deaths particularly in Africa. Globally, 198 million cases of malaria occurred in 2013 and the disease resulted in 584,000 deaths [1]. An estimated 90% of all malaria deaths occurred in Africa and 78% of these deaths occurred in children under five [1]. A consensus by the World Health Organization (WHO) in 1992 mentioned insecticide-treated nets (ITNs) as the most promising preventive measure against malaria. ITNs have been described as the best intervention that could save the lives of more children than any other single intervention apart from breast feeding and oral rehydration therapy [2, 3]. An ITN is a treated, safe net, effective in reducing human contact with mosquitoes. The distribution of ITNs has been shown to reduce malaria episodes, severe disease, and malaria-related death in endemic regions. Insecticide-treated nets have helped to reduce malaria episodes by 48-50% [4] and if universally used, could prevent an estimated 7% of global under-five mortality [2]. They are also connected with statistically significant reductions in the risk of low birth weight and foetal loss [5]. Study design and setting It appears that household ITN ownership declines within 2-3 years after mass campaigns [6]. A 37% and 13% decline in ITN ownership were recorded within three years of campaign without further net input in Sierra Leone and Togo respectively [7]. Ownership may not translate into usage as usage does not appear to be near-universal. Most studies report usage rates in the range of 60-80% [8-10], although World Malaria report documented 90%+ usage [11]. In Thailand, actual usage as determined by surprised home visits was 70-73% while reported usage was 85% [9], but in Tanzania, actual usage was 85% and reported usage was 97% [12]. Although survey methods could account for some of the differences in ITN usage across countries, current deployment initiatives are based on evidence of its cost effectiveness and the consistent and large benefits provided by ITNs in Africa as compared to Asia [4, 5, 10]. Statistics indicate that malaria is responsible for 9% of overall mortality in Ghana, accounts for 44% of outpatient attendance, 13% of all hospital deaths, and 22% of mortality among children under five years [13]. At an estimated cost of US$1.2 per person protected per year, ITNs are considered to be one of the most cost-effective health interventions in Ghana [14]. However, estimates from Africa indicate that only 3% of children under five years sleep under ITNs, while up to 22% of Ghanaian children under five sleep under any bednet [15]. Ghana as a signatory to the May 2006 Abuja declaration and as part of the objectives of the Roll Back Malaria (RBM) programme, Ghana was to increase ITN ownership to 80% and use to 60% by 2010; by 2015 there should be 100% ownership and 80% usage [15]. Factors such as the knowledge level of the people about ITNs, environmental and socio-cultural factors (such as perceptions and beliefs about causes of malaria, perceptions about the use of ITNs and family size), as well as sleeping arrangements, may facilitate participation or nonparticipation in ITN campaigns [16-18]. In Hohoe municipality, subsidized ITNs from the RBM programme have been distributed free of charge to all households with children under two years of age since the 2006 national immunization days. However, ITN usage with respect to ownership and level of effectiveness in the Hohoe (...truncated)