Caregivers’ use of insecticide-treated nets is associated with the use of ITNs by children under the age of five in Ghana

PLOS ONE RESEARCH ARTICLE Caregivers’ use of insecticide-treated nets is associated with the use of ITNs by children under the age of five in Ghana Daudi Yeboah ID*, Michael Boah ID, Martin Nyaaba Adokiya ID Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * , Abstract Background OPEN ACCESS Citation: Yeboah D, Boah M, Adokiya MN (2023) Caregivers’ use of insecticide-treated nets is associated with the use of ITNs by children under the age of five in Ghana. PLoS ONE 18(1): e0280065. https://doi.org/10.1371/journal. pone.0280065 Editor: Luzia H. Carvalho, Fundação Oswaldo Cruz Centro de Pesquisas René Rachou: Fundacao Oswaldo Cruz Instituto Rene Rachou, BRAZIL Received: July 31, 2022 Accepted: December 20, 2022 Published: January 6, 2023 Copyright: © 2023 Yeboah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data used in this study can be found at http://goo.gl/ny8T6X. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abbreviations: ANC, Antenatal Clinic; DHS, Demographic and Health Survey; EAs, Enumeration Areas; GHS, Ghana Health Service; Malaria poses a greater risk to children under the age of five years due to its high morbidity and mortality rates. The use of Insecticide-Treated Net (ITN) has been proven to be an effective preventive intervention in the control of malaria. However, its utilisation remains low. This study assessed the association of mother or caregiver’s utilisation of ITN on its use by their children under five years of age in Ghana. Methods This study used data from the 2019 Ghana Malaria Indicator Survey (GMIS). The study analysed a weighted sample of 1,876 women aged 15–49 years who had at least one child under the age of five. In this study, the outcome variable is mosquito bed net use in children under five years. We performed descriptive statistics, chi-square tests, and multinomial logistic regressions. Results Of the women studied, 58.59% [95% CI: 55.39, 61.71] slept under mosquito bed nets the previous night. The utilisation of ITN in children under five was 61.88% [95% CI: 58.43, 65.2] on the night before the study. The adjusted logistic regression revealed that mothers/caregivers who slept under a mosquito bed net were more likely to have their children under five years of age sleeping under a mosquito bed net (RRR = 2.47, 95% CI: 1.48, 4.12; p <0.001). In addition, the use of ITN in children under five was also found to be predicted by the number of ANC visits, the number of children under five in the household, and wealth status. Conclusion The study found that the use of ITN by mothers/caregivers and their children remains low in Ghana. Nevertheless, we found that when a mother uses ITN, her children under the age of five are more likely to use it as well. PLOS ONE | https://doi.org/10.1371/journal.pone.0280065 January 6, 2023 1 / 12 PLOS ONE GMIS, Ghana Malaria Indicator Survey; GSS, Ghana Statistical Service; HBM, Health Belief Model; ITN, Insecticide Treated Net; MIS, Malaria Indicator Survey; PHC, Population and Housing Census; RRR, Relative Risk Ratio. The use of ITN between children under the age of five and their caregivers Introduction Globally, malaria is a public health concern, with half of the population at risk of infection [1]. Nearly one million people die each year from malaria [2]. The Plasmodium parasites cause malaria, which is transmitted when one is bitten by anopheles mosquitoes [3, 4]. Globally, malaria cases increased from 227 million in 2019 to 241 million in 2020, with most of this increase occurring in the African region [5]. According to the World Malaria Report, malaria mortality steadily declined from 896,000 in 2000 to 558,000 in 2019. However, malaria deaths increased in 2020 as compared to 2019 (558,000), reaching an estimated figure of 627,000 [5]. WHO’s World Malaria Report for 2021 also reported that 68% (47,000) of the 69,000 extra deaths were caused by problems with service delivery during the COVID-19 pandemic [5]. Due to its high morbidity and mortality rate, malaria poses a major threat to children younger than five years of age [6]. Malaria cases increased from 213 million to 228 million in the WHO African Region between 2019 and 2020, with deaths rising from 534, 000 to 602, 000. Around 95% and 96% occurred in this region, with children under the age of five accounting for 80% of all deaths [5]. In Ghana, malaria is endemic, perennial, and follows a seasonal variation, particularly in the northern part of the country. The rate of spread of malaria differs geographically, conditional on the length of the dry season (December to March), which has little transmission [7]. Ghana is among the 15 countries with the highest malaria cases, accounting for 2% of global malaria cases and 3% of malaria mortality. However, malaria cases and deaths in Ghana decreased between 2016 and 2019. The number of cases decreased by 32% from 237 in 2016 to 161 per 1000 in 2019 [8]. Malaria deaths decreased by 7%, from 0.4 deaths per 1,000 to 0.37 deaths during the same period. Globally, 18 (58%) out of 31 countries completed the continuous distribution of insecticidetreated mosquito nets (ITNs) campaign, which resulted in 159 million (72%) ITNs being distributed in 2020 [5]. In the Ghanaian setting, both mass and continuous distribution campaigns have been employed in distributing ITN to the entire populace. The recent mass distribution campaign took place in 2018. ITNs are routinely distributed at maternity care centers, child welfare centers, and primary schools as part of the continuous distribution. ITNs are given out free to children aged 18 months or older at their second dose of the measles-rubella vaccine during child welfare visits and pregnant women during their first ANC visit as part of health facilitybased distribution [9]. Ghana has 74% of households owning at least one ITN in 2019, but a low usage rate (54%) for children under five years [10]. The global malaria elimination programme classifies Ghana as being in the control phase of malaria elimination [9]. As a result, Ghana and most sub-Saharan African countries have made an effort to attain a reduced level of malaria morbidity [11]. The country’s development and implementation of consecutive strategic action plans, policy interventions, and an enhancement in financial support over the years have contributed to reducing the burden of malaria in the country [12]. However, the National Malaria Control Programme still has a lot more to achieve. It aims at achieving (...truncated)