Inequalities in the use of insecticide-treated nets by pregnant women in Ghana, 2011 and 2017

Budu, Eugene, Okyere, Joshua, Mensah, Felix, Azure, Simon Agongo, Seidu, Abdul-Aziz, Ameyaw, Edward Kwabena, and Ahinkorah, Bright Opoku (2022) Inequalities in the use of insecticide-treated nets by pregnant women in Ghana, 2011 and 2017. Malaria Journal, 21. 376.

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Background: Pregnant women and children are the most vulnerable group of people usually affected by malaria. The use of insecticide-treated nets is one of the proven interventions for mitigating malaria and its associated deaths in endemic regions, including Ghana. Meanwhile, there is limited evidence on the extent of inequality in insecticide-treated nets use by pregnant women in Ghana. This study assessed the inequalities in insecticide-treated nets use by pregnant women in Ghana.

Methods: Data from the 2011 and 2017 versions of the Ghana Multiple Indicator Cluster Surveys were used. The 2019 updated World Health Organization (WHO) HEAT software (version 3.1) was used for all analyses. Four equity stratifiers were employed to disaggregate insecticide-treated nets use by pregnant women in Ghana. These are economic status, level of education, place of residence, and sub-national region. Four measures were used to compute inequality namely Difference (D), Population Attributable risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).

Results: The analyses indicated a rise in pregnant women’s insecticide-treated nets use from 32.6% in 2011 to 49.7% in 2017. Except sub-national region, all the factors showed mild inequality in insecticide-treated nets use. For instance, with respect to the economic status of pregnant women, only a slight inequality was exhibited by one of the simple measures in both 2011 (R = 0.3; 95% UI = 0.2–0.6) and 2017 (R = 0.5; 95% UI = 0.3–0.7). Marginal inequality in insecticide-treated nets use was noted in 2011 (R = 0.6; 95% UI = 0.5–0.9) and 2017 (R = 0.8; 95% UI = 0.6–0.9) for level of education. In the same vein, slight inequality was realized with respect to place of residence in 2011 (R = 0.4; 95% UI = 0.3–0.6) and 2017 (R = 0.6; 95% UI = 0.5–0.7). For sub-national region, both simple (D = 50.5; 95% UI = 30.7–70.4) and complex (PAF = 91.3; 95% UI = 72.3–110.3) measures demonstrated substantial inequality in 2011. In the case of 2017, considerable inequality in insecticide-treated nets use occurred (D = 58; 95% UI = 42.2–73.8, PAF = 51.9; 95% UI = 36.2–67.6).

Conclusion: In conclusion, insecticide-treated nets utilization by pregnant Ghanaian women increased between 2011 and 2017. The findings show that Ghana’s Ministry of Health in collaboration with anti-malarial non-governmental organizations must review patterns of insecticide-treated nets distribution and intensify advocacy among educated pregnant women, those in urban settings and the rich, to assuage the magnitude of inequality.

Item ID: 77563
Item Type: Article (Research - C1)
ISSN: 1475-2875
Keywords: Ghana, Insecticide-treated net, Multiple indicator cluster survey, Pregnant women
Copyright Information: © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver (http://creativeco applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Date Deposited: 24 Mar 2023 00:04
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420606 Social determinants of health @ 100%
SEO Codes: 20 HEALTH > 2004 Public health (excl. specific population health) > 200401 Behaviour and health @ 100%
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