Factors Associated With Utilization of Long-lasting Insecticidal Treated Nets Among Pregnant Women in Nyando Sub-county, Kisumu County, 2022

Abstract

Introduction: In spite of the progress made in the past decades, malaria continues to be a pressing public health problem in sub-Saharan African countries. Pregnant women are particularly vulnerable to infections and adverse health outcomes for themselves and their children who are unborn. In western Kenya, utilization of long-lasting insecticide-treated bed nets (LLITNs) among pregnant women is 40%. The prevalence of malaria in this region under which Nyando Sub-County falls is 19% which exposes the pregnant women living within the vicinity at risk of malaria. The associated risks can be mitigated through the appropriate deployment of control measures such as the use of LLITNs. There is therefore a need to determine the factors associated with utilization of LLITNs and, ultimately, formulate strategies for optimizing uptake of LLITNs use in this vulnerable group. Objectives: The present study sought to determine the factors associated with the utilization of LLITNs among pregnant women in Nyando sub-county, Kisumu County, Kenya. Methodology: The study deployed a cross-sectional design. Pregnant women who were coming for the second antenatal clinics (ANC) visits or more were enrolled. Data was collected using an interviewer-administered questionnaire. Descriptive analyses were done with categorical data being described using frequencies, absolute numbers, and proportions. Continuous data were summarized using appropriate measures of central tendencies. Normally distributed continuous data were summarized using means and standard deviations while continuous data exhibiting deviation from normal distribution were summarized using medians and interquartile ranges. Bivariate analysis to assess the association between various independent variables and the dependent variable were conducted using chi-square (χ2) tests. Binary logistic regression analysis was also done to control for confounders in the test for associations. The level of significance for hypothesis testing was set at p ≤ 0.05. Results: A total of 373 pregnant women were recruited. Their age ranged from 16 to 44 years with mean age of 30.1 ± 6.85 (SD) years. Majority of the respondents were married (51.2%), Christian (92.8%), unemployed (79.4%), initiated ANC in the third trimester (60.5%) and reported having had no previous obstetric complications (79.4%). Those who reportedly slept under a LLITN in the night preceding the current study were 86.3%, 95%CI (82.5% - 89.5%) while those who always slept under an LLIN were 34.6% (95%CI 29.9% - 39.5%). The proportion of those who had suffered from malaria in the current pregnancy were 72.7% (95%CI 67.9% - 76.9%). The sociodemographic factors associated with LLITNs utilization included: Marital status AOR 2.173, 95% CI (1.065 - 4.459), and education AOR 2.067, 95%CI (1.011-3.416); for primary education. The obstetric factors associated with LLITNs utilization included previous loss of a child below 5 years (AOR 3.051, 95%CI (2.01 - 4.24), having had previous obstetric complications AOR 1.041, 95%CI (1.006-3.245), gestational age AOR 4.389, 95%CI (1.097-17.56), and AOR 16.232, 95%CI (2.46 -106.92) for second and third trimesters respectively, and number of ANC contacts AOR 2.2, 95%CI (1.059-7.68), for at least four ANC contacts) and suffered from malaria in the current pregnancy AOR 3.33, 95% CI (2.13 - 4.81). Besides, knowledge on malaria prevention and control in pregnancy was a predictor of LLITNs utilization among pregnant women AOR 3.3, 95% CI (1.36-8.06). Conclusion: A substantial proportion of the pregnant women who took part in the present survey, slept under a LLITN in the night preceding the current study. The study identified modifiable factors associated with LLITN use in the study population which if prioritized can accelerate the already high uptake found in this study. On the other hand, the high prevalence of those who, reportedly, suffered from malaria in the current pregnancy is alarming. There is a need for more research on the underlying factors associated with malaria infection during pregnancy