Role of knowledge attitude and practice in influencing use of insecticide treated bed-nets among pregnant women in Kilifi district

Abstract

Malaria is one of the most serious public health problems in Kenya infecting 20 million people annually (Republic of Kenya Ministry of Health, National Malaria Strategy 2001-20 I0). Malaria is leading among the top five diseases that bring people to seek health care services in Kilifi district hospital. Pregnant women and children under five years are the groups with the highest risk of malaria. Malaria in pregnancy may cause spontaneous abortion, neonatal death, low birth weight (LB W), anaemia or maternal death. One of the main strategies of The National Malaria Control Strategy (NMS) is to ensure use of insecticide-treated nets by communities at-risk. Use of ITN is a cost-effective method of controlling malaria. Despite this, utilization of ITN in Kenya is very low. In coast province where Kilifi district is located, only 7.9 % of pregnant women slept under lTN (KDHS 2003). Coast province being an endemic malaria zone, this coverage is very low. It falls far below the target set by African leaders at Abuja Summit on Roll Back Malaria that 60% of pregnant women should sleep under ITN by the year 2006. The failure to achieve the target is a drawback in malaria control in pregnancy and the reasons to this are not clear. The objective of study was to determine knowledge, attitude and practice on the use of ITN in the prevention of malaria among pregnant women in Kilifi district. A descriptive cross-sectional study was carried out in the district between October and December 2007. This involved both qualitative and quantitative methods. The sampling frame was the district hospital and the five health centres. A structured questionnaire was administered to 220 pregnant women attending antenatal clinic (ANC). Focus group discussions were held with women groups. A key informant interview was also administered to a village elder. KAP on utilization of ITN among pregnant women in Kilifi district was determined through a scoring system (Appendix 3). Knowledge on malaria illness (transmission, symptoms, complications and prevention) and ITN was high with majority of pregnant women having adequate level of knowledge (86.9%). Adequate knowledge was also high among the young age groups, married, Christians, low parity, unsalaried and the educated pregnant women. There was significant association between level of education and adequate knowledge (p-value=O.O I0). Good attitude on ITN use was low. There was no association between good attitude and any of the socio-demographic variables (age, parity, marital status, religion, occupation and education) The majority of pregnant women attending ANC owned ITN (75.4%). ITN usage was high (70.5%). Good practice on use ITN was also high. Good practice on use of ITN was high among the young age groups, married, Christians, low parity, unsalaried and the educated pregnant women. Th~re was significant association between religion and good practice (p-value=0.050). Although adequate level of knowledge on malaria and protective role of ITN was high among the pregnant women, there was no association between knowledge with practice and attitude. Practice and attitude towards use of ITN were influenced by the cultural beliefs and traditional practices. This study recommends that before any malaria preventive intervention is implemented in an area, different socio-cultural factors must be considered when behavioral interventions for malaria control are designed and implemented. Health education about the method should be disseminated to the community. This would remove stigma and misconceptions associated with ITN. Community concerns and fears should be addressed. Further research on the role of religion in influencing utilization of ITN is recommended.