The study findings revealed that almost all the pregnant women owned an ITN. These findings of high ownership of ITNs among pregnant women resonate with the findings of several previously published studies [20 & 25]. Similarly, the findings concords with the findings of a research on the usage of long-lasting insecticide-treated bed nets in Uganda, which found that the ownership of ITNs high among the population and were covered by 69.5 percent of the population [34]. A major inference of this finding is that a good number of the pregnant women who attended ANC in the Presbyterian hospital, Bawku owned ITNs. Therefore, the midwives and community health officers who provide direct care to pregnant women in ANC clinics should leverage on this finding to ensure that all pregnant women own at least one (1) ITN.
The findings of the study indicate very low proportions of pregnant women utilising the ITNs. The pregnant women did not sleep under ITNs the night before the survey, they did not continuously sleep under ITNs throughout the year, and they did not sleep under the ITNs during pregnancy, but, slept under the ITNs only during the rainy season. This finding of very low utilisation of ITNs among pregnant women is in line with the findings of numerous earlier published surveys [21] that also identified low utilisation of ITNs among pregnant women.
Similar findings were reported in a study conducted in Northern part of Ghana by [14] among pregnant women which indicated just 23.1% utilization of the ITNs by households. [22] also reported that 83.4 percent of respondents possessed ITNs year-round, yet 13.8 percent utilized them during the rainy season, and 3.4 percent used them during the dry season among vulnerable populations (pregnant women and children under the age of 5) in the Northwest area of Cameroon. The inferences drawn from this finding of the study is that, the ownership of ITNs does not always resonate with the utilisation of ITNs among pregnant women. Therefore, given the important role ITNs play in the prevention of malaria and the cost incurred by countries to purchase the nets, there is an urgent need to develop pragmatic strategies to improve the utilisation of ITNs among the pregnant women.
The findings of the current study indicated that the pregnant women felt heat and warmth when sleeping under the ITN, they itched and had rashes when sleeping under the ITN, they had difficulty in hanging their ITNs, and they also had difficulty in breathing when sleeping under the ITN. These findings concord with the findings of several other previous studies [4, 7, 16, & 35] that also identified personal factors that influence the usage of ITNs among pregnant women.
Also, in two rural communities in the Greater Accra region of Ghana, a randomized control trial by [8] found that more than 90% of respondents found ITNs to be uncomfortable to use because they trap heat, especially during warm weather or dry seasons where 75% of respondents could not sleep under an ITN without a fan. The chemicals used to disinfect the nets were said to have an unpleasant scent, which caused over 55% of pregnant women to vomit or have breathing problems, causing them to avoid sleeping under ITNs [2].
The findings of this study showed that the pregnant women had inadequate room space to hang their ITNs, had too large household size, their roof construction did not permit ITN usage, and had too small bed to hang their ITNs. The findings of this study aligns with the results a correlated study on the use of large-scale malaria control interventions in Ghana, key factors such as the structure of sleeping places, type of bed or structure slept on, were further noted as technical obstacles influencing ITN use [1].
In addition, a research on bed net usage found that residents' use of ITNs was hampered by the poor quality of their homes' roofs [15]. These results are similar to those found in Nigeria, where it was shown that the style of housing, household income, and housing conditions all independently affected the adoption of bed nets [24].
The study identified that the pregnant women had their ITNs from the ANC clinic, the ITNs were not sold to them, and ITNs were frequently distributed at the ANC clinic. However, the pregnant women never had guidance and education concerning ITN usage at the ANC clinic. These findings validate the findings of several other previous studies [4, 19, 20, & 29] that also identified institutional factors that influenced ITN usage.
The findings of the study support a study the results from a randomized controlled cross-over trial in the greater Accra region of Ghana showing that pregnant women were more likely to sleep under the ITNs when given adequate guidance and education on how to correctly treat, hung, and use the nets. The study findings further indicated that, pregnant women who did not receive any information and guidance on net use, failed to consistently sleep under the ITNs [8]. The study findings calls for the need for stake holders to consider the specific individual, household and institutional factors when designing and rolling out such laudable interventions to ensure utility of the net for the prevention of malaria.