Barriers and Determinants of Insecticide-treated Net Utilization for Malaria Prevention among Pregnant Women in Tamale Metropolis, Ghana

Introduction: Insecticide-treated mosquito nets (ITNs) are proven malaria prevention tools, particularly for pregnant women who are at increased risk of malaria-related complications. In Ghana, malaria remains a leading cause of morbidity and mortality among pregnant women, making the use of ITNs critical in reducing malaria incidence. Aim: This study aimed to assess the barriers and determinants of ITNs utilization among pregnant women in the Tamale Metropolis. Methods: A cross-sectional survey was conducted with 399 pregnant women in the Tamale Metropolis using stratified sampling. A structured questionnaire solicited responses from the participants. Data were analyzed using Stata version 18, and a p-value less than 0.05 was considered statistically significant.

Results: The study found that 98.5% of participants were aware of ITNs, with the majority gaining knowledge through mass media (81.7%) and antenatal care centers (79.1%). Despite this high level of awareness, 92.5% of participants owned at least one ITN. The main source of ITNs was free house-to-house distribution (79.7%) and ANC centers (78.6%). However, while 82.7% of participants used ITNs at home, only 22.6% reported consistent nightly use. In terms of education level, basic education (AOR=0.06, 95% CI: 0.02-0.18), secondary education (AOR=0.08, 95% CI: 0.03-0.23), and tertiary education (AOR=0.29, 95% CI: 0.09-0.95, p=0.042) had lower odds compared to those with no formal education. Respondents who were self-employed (AOR=0.04, 95% CI: 0.01-0.20) and unemployed (AOR=0.01, 95% CI: 0.005-0.32, p<0.001) had reduced odds compared to those who were employed. Additionally, household monthly income was significantly associated with those earning 500-999 (AOR=0.07, 95% CI: 0.02-0.21, p<0.001), 1000-1999 (AOR=0.10, 95% CI: 0.01-0.30, p<0.001), and ≥2000 (AOR=0.10, 95% CI: 0.03-0.21, p<0.001) had lower odds compared to the lowest income category (0-499).

Conclusions: While ownership of ITNs is high, consistent use among pregnant women remains low due to practical barriers such as discomfort and lack of proper facilities. Addressing these issues through education, infrastructural improvements, and increased access to ITNs, especially in remote areas, could enhance ITN usage.