East African Journal of Public Health East African Public Health Association ISSN: 0856-8960 Vol. 3, Num. 2, 2006, pp. 31-34

East African Journal of Public Heath, Vol. 3, No. 2, October 2006, pp. 31-34

DETERMINANTS OF UTILISATION OF MOSQUITO BEDNETS FOR MALARIA PREVENTION AMONG PREGNANT WOMEN IN KIGOMA URBAN DISTRICT, WESTERN TANZANIA

Kagoma S. Mnyika¹, Titus K. Kabalimu² and Godfrey Mbaruku³

Correspondence to: Kagoma S. Mnyika,  P.O.Box 65015, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. E-mail: kmnyika@muchs.ac.tz

¹Dept. of Epidemiology and Biostatistics, School of Public Health & Social Sciences 
²Cmmission for Science and Technology Dar es Salaam, Tanzania
³Department of Obstetrics and Gynaecology Maweni Regional Hospital Kigoma, Tanzania.

Code Number: lp06014

Abstract

Objectives: To determine factors influencing utilisation of mosquito bednets for malaria prevention among pregnant women in Kigoma urban district in western Tanzania.
Setting: Kigoma urban MCH clinics
Methodology: Pregnant women attending antenatal care clinic in Kigoma municility were interviewed using a structured questionnaire. The questionnaire originally developed in the English language was translated into Swahili language and pre-tested before use. A trained team administered the questionnaire as part of a larger baseline study involving several malaria chemoprophylaxis strategies among pregnant women. Informed consent was obtained from each pregnant woman before questionnaire administration. The project was reviewed and cleared by the ethical clearance committee of the Muhimbili University College of Health Sciences.
Results: A total of 729 pregnant women participated in the interview. The age of the participating women ranged from 14-45 years with mean age of 26.7 years and standard deviation (SD) of 5.4. Of the 729 pregnant women interviewed, 61.0% (445) knew about malaria and of these 69.4% (309) stated that they knew how to protect themselves against malaria. About 47% (N=728) of the pregnant women interviewed reported being current users of bednets. Reported use of bednets appeared to increase with increasing age of the pregnant women. Single and divorced pregnant women were less likely to report being users of bednets as compared to married or cohabiting pregnant women (49.2% versus 18.6%, odds ratio (OR) = 0.24, 95% confidence interval (95%CI) = 0.12 – 0.46). Similarly, reported use of bednets significantly increased with increasing level of education. Employed and those engaged in business were significantly more likely to be bednet users than housewives or peasants.
Conclusion: We conclude that factors influencing use of bednets among pregnant women in Kigoma urban district include marital status, educational level and occupational status.

Introduction

It has been shown that malaria is associated with high morbidity and mortality among pregnant women particularly primigravidae women (1-7). Malaria in pregnancy is a common cause of maternal anaemia, low birth weight babies and even abortions (3-13). It has also been shown that low birth weight babies are at an increased risk of perinatal mortality as compared with other babies (11). Therefore, prevention of malaria during pregnancy is extremely important for the health of the pregnant woman and her unborn baby. Currently preventive strategies recommended for malaria prevention in pregnancy include malaria chemoprophylaxis and use of bednets (14-18). However, in the advent of the widespread malaria drug resistant parasites in many malaria endemic countries in Africa, chemoprophylaxis alone may not be the best option to protect pregnant women against malaria. Moreover studies have shown that poor compliance to effective chemoprophylactic drugs among pregnant women poses a challenge (16,19). At the present time an effective malaria vaccine has not been developed and it might take many years before it becomes available to pregnant women in sub-Saharan Africa. Hence effective use of other proven malaria preventive strategies particularly self-protection against mosquito bites using mosquito bednets (especially those impregnated with synthetic pyrethroids), mosquito coils, repellents, window and door screening with mosquito gauze are recommended (17-19). The purpose of the present study was to investigate factors influencing utilisation of bednets among pregnant women in Kigoma municipality, western Tanzania.

In this paper we present socio-demographic factors associated with utilisation of bednets in Kigoma.

Participants and Methods

The study was conducted in Kigoma municility located along the Lake Tanganyika in western Tanzania. The study was part of a larger study involving assessment of the efficacy of various malaria chemoprophylaxis regimens among pregnant women as described in our previous communication (20). A local research team was constituted in Kigoma and trained on various procedures involved in the study. The research team consisted of two experienced senior nurse midwives, one senior laboratory technologist and one public health specialist. The training workshop consisted of methods of questionnaire administration and how to obtain informed consent from the participants. Informed consent was obtained from each pregnant woman before interview. All consenting women who came for antenatal care for the first time at the Kigoma urban antenatal care clinics were interviewed. The questionnaire was translated in Kiswahili language before use. The questionnaire was pre-tested for content validity and feasibility for use during data collection. The questions had acceptable scale score (Cronbach’s alpha = 0.7). The project was reviewed and issued with an ethical clearance certificate from the Muhimbili University College of Health Sciences.

Data management and analysis

All questionnaire forms were reviewed on daily basis for completeness, inconsistencies and out of range entries. Computer data entry was performed at the Muhimbili University College of Health Sciences using the statistical package for social sciences (SPSS/PC+) and data cleaning was performed before data analysis. Statistical data analysis was conducted using SPSS/PC+ for windows version 12.0 (21). Descriptive statistics were used to compute mean and median ages of the study population. Odds ratios (OR) were computed to assess the associations between awareness of malaria, self-protection against malaria, use of mosquito bednets and other socio-demographic characteristics. We computed 95% confidence intervals for odds ratios in order to determine significant predictors of malaria awareness, self-protection against malaria and utilisation of mosquito bednets among the study population.

Results

A total of 729 pregnant women were interviewed with age ranging from 14 to 45 years with a mean age of 26.7 years (standard deviation [SD]= 5.4) and the median age was 23.0 years. The mean number of pregnancies was 3.0 (SD=2.2) ranging from 1-12 while parity ranged from 0-10 with a mean of 2.0 (SD = 2.0). Table 1 summarises the distribution of the women by age, gravidity, parity, marital status, educational level and occupational status. As can be seen in the table, overall 61% (N=729) of the pregnant women interviewed knew about malaria while 39% did not know what malaria was. Women in the age group 21-30 were significantly more likely to know about malaria as compared to women in other age groups. Similarly, women carrying their third or more pregnancies were more likely to know about malaria than those carrying their first or second pregnancies. Women who reported having no child alive were significantly less likely to know about malaria than those who had living children. Regarding marital status, married and cohabiting women were more likely to be aware of malaria disease than unmarried or divorced women. Awareness of malaria increased significantly with increasing educational status. Housewives and peasants were less likely to be aware of malaria disease than those who were employed or engaged in business.

Table 2 presents information on women who reported knowing how to protect themselves against malaria. The table shows that of the 445 women who reported being aware of malaria, 69.4% stated that they knew how to protect themselves against malaria. Furthermore, of the 445 pregnant women who admitted being aware of how to protect themselves against malaria, 26% reported that they were using malaria chemoprophylaxis (not shown in the table). Analysis by age group indicated that women in the age group 14-20 were significantly less likely to report being aware of malaria self-protection. Self-reported awareness of malaria protection was not significantly associated with gravidity, parity, number of children alive, and marital status. However, women with no formal education were significantly less likely to know about self-protection against malaria as compared with those with primary and secondary education. Similarly, housewives and peasants were significantly less likely to know about malaria self-protection than those who were employed or engaged in business.

Table 3 summarises self-reported utilisation of bednets among pregnant women interviewed. Overall 46.7% (N=728) of the women reported being current users of bednets at their homes. Women in the age group 15-20 were significantly less likely to report use of bednets at home as compared with women in other age groups. However, there was no significant association between reported use of bednets at home and gravidity, parity and number of living children. Married and cohabiting women were significantly more likely to report use of bednets than unmarried and divorced women. Concerning educational status, women with no formal education were less likely to report use of bednets compared to women with primary and secondary education. Likewise, housewives and peasants were significantly less likely to report use of bednets as compared with women who were in employment or engaged in business.

Discussion

The present study demonstrated that a large majority of the pregnant women in Kigoma urban district of western Tanzania new about malaria although there were some women who did not know anything about malaria. This was a surprising observation because since malaria is a common illness we expected malaria awareness to be high particularly among pregnant women attending antenatal care clinics which routinely provide health education messages as part of antenatal care services in Tanzania. Information concerning the association between awareness of malaria in relation to age indicated that older women were more likely to know about malaria as compared to young pregnant women. This was probably related to past experience with malaria illness as older women are more likely to have suffered from malaria in previous pregnancies than younger women particularly those carrying their first pregnancies. This observation may indicate that health education messages given at antenatal care clinics do not focus on common health problems affecting pregnant women and therefore suggesting the need for focusing on malaria in routine health education messages given to pregnant women at antenatal clinics.

As self-protection against malaria is important in malaria prevention among pregnant women, we assessed to what extent pregnant women knew about how to protect themselves. The results suggest that the majority of the women knew how to protect themselves against malaria in pregnancy but only 47% of the women reported using bednets at home. This low utilisation of bednets may be related to socio-economic status of the pregnant women. Bednets might be expensive to the pregnant women and therefore affordability becoming an issue. Introduction of subsidies on the bednets might be helpful. Recently, the government introduced an insurance scheme for discounted vouchers (Hati Punguzo) for insecticides treated bednets in some areas and should it be useful, wider dissemination of the project will be warranted (22). On the other hand, use of bednets may be influenced by other socio-cultural factors that might be operating in the community. It is felt that although the present study did not investigate the factors, the socio-cultural factors influencing utilisation of bednets might include attitudes and beliefs about bednets. If the local communities have negative attitudes towards bednets, the likelihood of using them may be low although affordability might not be an issue. Therefore, studies designed to investigate socio-cultural factors influencing use of bednets for malaria prevention may be important.

Acknowledgement:

We wish to thank Mrs Rachel Masissila and Mrs Anna Fute for data collection. We are also grateful to Mr. Rukinisha Kondo for handling laboratory work and the late Mr. J. Mtui for computer data entry as well as the District Medical Officer for supporting the project. The project was funded by the Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa, Tanzania.

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