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Impact of Insecticide-Treated Net Use during Pregnancy on Malaria Prevention among Pregnant Women in Nigeria

Abstract

Malaria remains a major public health challenge in Nigeria, with pregnant women representing a particularly vulnerable population because malaria infection during pregnancy may result in maternal anaemia, placental malaria, severe illness, miscarriage, stillbirth, preterm birth, low birth weight, and other adverse pregnancy outcomes. Insecticide-treated nets (ITNs) provide an important vector-control intervention by reducing contact between individuals and malaria-transmitting mosquitoes during sleeping hours. Consistent and correct use of ITNs during pregnancy may therefore contribute to reducing malaria infection and its associated complications. However, inadequate access to ITNs, inconsistent use, discomfort, heat, damage to nets, limited awareness, cultural practices, and environmental conditions may affect utilization among pregnant women in Nigeria. Against this background, this study investigates the impact of insecticide-treated net use during pregnancy on malaria prevention among pregnant women in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of susceptibility to malaria, perceived severity of infection, perceived benefits of ITN use, perceived barriers, and cues to action may influence consistent net utilization. The Social Ecological Model emphasizes the influence of individual, household, community, environmental, healthcare, and socioeconomic factors on malaria prevention behaviour. The Health Systems Framework emphasizes service delivery, health education, availability of malaria prevention commodities, health workforce, financing, governance, and accessibility as essential components of effective malaria prevention programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how ITN use during pregnancy may influence malaria prevention among pregnant women in Nigeria. The study will adopt a quantitative analytical cohort or cross-sectional analytical research design. The study population will comprise pregnant women receiving antenatal care in selected healthcare facilities and communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, antenatal clinics, and eligible pregnant women. ITN use during pregnancy will be assessed using indicators such as ownership of an ITN, frequency of use, consistency of use, sleeping under an ITN on the previous night, duration of net use, physical condition of the net, access to ITN distribution programmes, household availability of nets, and knowledge of appropriate ITN use and care. Malaria prevention will be assessed using indicators such as malaria infection during pregnancy, malaria test results, malaria episodes, malaria-related healthcare visits, malaria-related hospitalization, maternal anaemia associated with malaria where documented, and uptake of other recommended malaria prevention measures. Data will be collected using structured questionnaires, antenatal care records, malaria screening and laboratory records, maternal medical records, ITN distribution records, and relevant malaria programme documents. Descriptive statistics will be used to summarize maternal characteristics, ITN ownership and utilization patterns, malaria prevention practices, and malaria infection outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of ITN use on malaria prevention. Where a cohort design is adopted, malaria infection rates among pregnant women who consistently use ITNs may be compared with rates among women who use ITNs inconsistently or do not use them, while relevant maternal, environmental, socioeconomic, and pregnancy-related factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that consistent ITN use during pregnancy has a significant positive impact on malaria prevention among pregnant women in Nigeria. Pregnant women who consistently sleep under insecticide-treated nets are expected to have a lower risk of malaria infection compared with women who use ITNs inconsistently or do not use them. Regular ITN use may reduce exposure to malaria-transmitting mosquitoes and complement other preventive interventions provided through antenatal care. However, the effectiveness of ITNs may be influenced by mosquito density, environmental conditions, household characteristics, net condition, correct use, adherence, and access to other malaria prevention and treatment services. Heat, discomfort, damaged nets, limited availability, inadequate knowledge, cultural practices, and inconsistent use may reduce their protective benefits. The study therefore expects consistent and correct ITN use, combined with other recommended malaria prevention measures and quality antenatal care, to contribute significantly to reducing malaria infection among pregnant women in Nigeria. The study is expected to contribute to the literature on insecticide-treated nets, malaria prevention in pregnancy, malaria infection, vector control, antenatal care, maternal health, malaria prevention behaviour, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Malaria Elimination Programme, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, malaria control programme managers, community health workers, development partners, and policymakers regarding strategies for improving malaria prevention during pregnancy. The study will also provide evidence-based recommendations for improving ITN availability and distribution, strengthening antenatal malaria education, promoting consistent net use, replacing damaged or worn-out nets, addressing barriers to utilization, strengthening community-based malaria prevention programmes, and integrating ITN promotion with other malaria prevention and maternal health interventions across Nigeria.

Keywords: Insecticide-treated nets, ITN use, malaria prevention, pregnancy, pregnant women, malaria infection, vector control, antenatal care, maternal health, Nigeria, public health.