Transcript THESIS SLIDES 4 DEFENCE

TOPIC:
ASSESSING THE COVERAGE AND CONSISTENT USE OF
INSECTICIDE TREATED MOSQUITO NETS (ITNs) IN
THE PREVENTION OF MALARIA AMONG PREGNANT
WOMEN IN NKORANZA SOUTH DISTRICT IN BRONG
AHAFO REGION OF GHANA.
By:
RICHARD OTCHERE
SUPERVISOR: PROF. (MRS) E.A. ADDY
OUTLINE
 INTRODUCTION
 OBJECTIVES
 RESEARCH QUESTIONS
 PROBLEM STATEMENT
 METHODOLOGY
 RESULTS/DISCUSION
 CONCLUSION
 RECOMMENDATIONS
INTRODUCTION
 In Africa, 30 million women living in malaria-endemic
areas become pregnant each year. For these women,
malaria is a threat both to themselves and to their
babies, with up to 200 000 newborn deaths each year
as a result of malaria in pregnancy (WHO 2003)
 Twenty-five million pregnant women are currently at
risk for malaria, and according to the World Health
Organization (WHO), malaria accounts for over 10,000
maternal and 200,000 neonatal deaths per year
(WHO, website accessed July 30, 2009).
OBJECTIVES
 GENERAL OBJECTIVE
 To assess the coverage and consistent use of ITNs among pregnant women in
the Nkoranza South District.
 SPECIFIC OBJECTIVES
 To determine the extent to which pregnant women are aware of ITN and their
understanding of its use.
 To assess the availability of and accessibility to ITN
 To identify ownership and usage among pregnant women in Nkoranza south
district
 To determine the desire of pregnant women to purchase ITN
 To identify the frequency and acceptance of ITN use among pregnant women.
RESEARCH QUESTIONS
 To what extent are pregnant women aware of and
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understand ITN use in Nkoranza South District?
Are Insecticide Treated bed Nets readily available and
accessible in Nkoranza South?
What percentage of pregnant women do own and use
ITN?
To what extent are pregnant women willing to
purchase ITN?
How frequent do pregnant women accept and use ITN
in Nkoranza south district?
PROBLEM STATEMENT
 In Ghana, many programmes employed by the Ministry of Health
(MOH) and Ghana Health Service (GHS) including Roll Back Malaria
(RBM) have failed to address the malaria problem.
 Currently, at Nkoranza South District, malaria is the leading cause of
Outpatient Department (OPD) attendance of 47%, Outpatient
admissions of 16.2% and 17.4% of Hospital deaths (GHS, 2009).
 Malaria in pregnancy was 1378 of the total hospital attendance
constituting 1% of OPD attendance.
 It is believed that Insecticide treated bed net is the most effective
way of preventing malaria infections especially among pregnant
women who are most vulnerable (WHO, 2003).
PROBLEM STATEMENT
 The over all net usage among Ghanaian population was only 4.1%
(WHO/GHS, 2003).
 However, a total of 45.4% house holds use untreated bed nets,
 while 31.7% of pregnant women also use untreated bed nets
 and 19.9% of pregnant women slept under ITN the night before
the survey (GDHS 2008).
 Malaria in pregnancy was very high in the district despite high
distribution of ITN in the district and thus gives cause to worry.
 No assessment of the coverage and consistent usage has been
done in the district hence this study.
METHODOLOGY
 The study was done in Nkoranza south district. The
study was basically observational without any
interventions.
 A descriptive cross sectional design was used to collect
data from a section of the population.
 The study engaged households in selected
communities within the Nkoranza South district.
 The focus was on pregnant women in the study
households. Subjects were drawn from a number of
communities within the Nkoranza South district.
METHODOLOGY
 SAMPLING TECHNIQUE AND SIZE
 A total of 384 pregnant women were selected for the study. A mix of
sampling methods was used in selecting the 384 study subjects.
 This included cluster sampling, simple random and systematic
sampling methods.
 A simple random sampling technique was used to select twenty (20)
communities and each community then formed a cluster.
 Subjects were selected from each cluster systematically (the grid
method).
 The sample frame was the total number of houses within the study
communities. Each household constituted a sample unit.
METHODOLOGY
DATA COLLECTION TECHNIQUE AND TOOLS
 Questionnaires containing open and closed ended questions
were administered to the respondents’ between July and
October 2010.
 Pre-testing of questionnaire was done at Nkoranza North
district to test the validity and reliability of instruments.
 Data entry was done with computer software SPSS version
16.0 and exported to Stata version 10 software for analysis.
 Descriptive statistics was used in the analysis of data.
RESULTS
 RESPONDENTS’ AWARENESS AND PERCEIVED USE OF
ITN
 Awareness (N= 384):
 Have heard about ITN 243(63%)
 Have not heard at all 141(37%)
 Perceived use of ITN (N=243)
 Protection against mosquito bite was 230(95%)
 Room decoration 7(3.0%)
 Affords good sleep 6(2.0%)
SOURCEOF INFORMATION ON ITN (N=243)
 TV/FM stations 138(57%)
 Hospitals/Clinic 83(34%)
 District health education 12(5%)
 Relatives/Peers 10(4%)
 AVAILABILITY OF ITN IN COMMUNITY (N=179)
 Available in community 61(34%)
 Unavailability in community 118(66%)
RESULTS
POSSESSION OF NET (TREATED AND UNTREATED) N= 384.
 ITN ownership was 32%
 Ownership of any untreated bed net was 15%
 No net was 53%
 Ownership and usage did not show any significant association (chi square=2.47, pvalue = 0.12) parity and usage did not show any significant association (p-value =
0.63)
DESIRE TO PURCHASE ITN IN FUTURE(N=384)
 Willing to buy was 279(73%)
 Unwilling to buy was 105(27%)
FREQUENCY OF NET USAGE BY PREGNANT WOMEN (N=179)
 All year round was 59%
 Rainy season was 37%
 Others 4%
DISCUSSION
 Awareness on ITN was relatively high (63%) which contrasted
studies by Onwujekwe O.E et al (2000)in Nigeria and Alaii J.A et
al (2003) in western Kenya
 Availability of nets in the communities was very low 34%. The
pregnant women asserts that cost of nets were very expensive.
WHO 2009 asserts that cost should not be a barrier to making
them available and accessible to all people at risk.
 Coverage of ITN among pregnant women in the district was 32% far
below the Abuja target of 60% by 2010 (Net mark 2004) and that of
the global coverage of 80% by 2010 (WHO malaria report 2009).
DISCUSSION
• 53% of pregnant women in the district did not own ITN.
 73% of those with net slept under it the night before the survey.
Brown E.N.L et al (2001) a study in Northern Ghana recorded
high net usage (70%) the night before survey.
 Desire to purchase ITN was high 279(73%) – Okra J. et al
(2002) 87%.
 59% of owners used during all year round
CONCLUSIONS
 Most of the respondents’
knowledge about malaria was
very high (83% were aware that
malaria was caused through the
bite of mosquitoes).
 ITN coverage in this study was
still low (32%) compared to the
Abuja RBM target of 60% by
2010 in spite of subsidies for
pregnant women and children
under five years of age.
 Cost of ITN was found to be
expensive especially from the
commercial centres and
therefore not affordable. It was
about three times higher in
commercial sectors than in
hospitals/clinics.
 TV/FM station was the main
source of information (57%).
 Possession was 47% with 32%
owning ITNs with a very high
net usage of 131(73%) the night
before the survey among those
who possess nets.
RECOMMENDATIONS
 National education on ITN
should be intensified through
the Television and F.M stations
to increase awareness and
possession of nets so as to
enhance national coverage of
ITN.
 The ministry of health in
collaboration with the
Government should import
more conical nets for all
communities.
 The district health education
should include the need for retreatment of nets and the
provision of regular community
re-treatment services to all those
who have the net until they are
replaced with a long lasting
ones.
 Education through churches and
schools could be looked at as a
means of educating the public.
 Husbands should be very much
concerned with providing
treated nets to their pregnant
wives.
REFERENCES
 Alaii J.A et al (2003), community reactions to the introduction
of pemethrine-treated bednets for malaria control during a
randomized control trial in western Kenya. American Journal
of Tropical Medicine and hygiene. April 1, 68. (90040):pp 128136.
 Ghana Demographic and Health Survey 2008
 Ghana Health Service/World Health Organisation (2003)
annual report on malaria
 World Health Organisation Website, authors. Global Malaria
Programme: pregnant women and infants. [Accessed July 30,
2009].
http://apps.who.int/malaria/pregnantwomenandinfants.html.
ACKNOWLEDGEMENT
 To my academic supervisor – Prof. (Mrs) E.A Addy
 All lecturers in Community Health Department
KNUST
 Nkoranza south health directorate
 Nkoranza south district assembly.
THANK YOU