INSECTICIDE TREATED NET'S AND IT'S LEVEL OF ACCEPTANCE AMONG PEOPLE RESIDENTING IN EZIONUM COMMUNITY IN UKWUANI LGA

Abstract

This study examined the ownership, usage, and acceptance level of insecticide-treated nets (ITNs) among residents of Ezionum community in Ukwuani Local Government Area. A cross-sectional survey research design was adopted to collect data from a sample of 333 respondents using a structured questionnaire. The data collected were analyzed using SPSS version 27, where descriptive statistics were used to summarize the demographic characteristics and patterns of ITN ownership and use. Additionally, a one-sample t-test was conducted to test hypotheses concerning the relationship between household educational level, socio-cultural beliefs, awareness of malaria prevention, and ITN acceptance and usage. The findings revealed that most households owned at least one ITN, and many reported consistent use, especially among vulnerable groups like children and pregnant women. The study also found a significant positive relationship between household educational level and ITN usage, indicating that education enhances acceptance and utilization. Socio-cultural beliefs were shown to significantly influence acceptance, with some traditional views either facilitating or hindering ITN use. Awareness of malaria prevention was also significantly associated with ITN use, emphasizing the role of health education. However, challenges such as discomfort caused by heat, cost, and misinformation were identified as barriers to regular ITN use. In conclusion, the study established that education, socio-cultural factors, and malaria awareness are key determinants of ITN acceptance in Ezionum. It recommended enhancing community education, addressing cultural misconceptions, and improving access to affordable ITNs to increase their consistent use and contribute to malaria control in the community.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria remains one of the most pressing public health concerns across sub-Saharan Africa. Despite advances in prevention and treatment, it continues to pose a significant burden on health systems and communities, particularly in Nigeria. The disease is endemic throughout the country and contributes substantially to outpatient consultations, hospital admissions, and deaths, especially among vulnerable groups such as children under five and pregnant women (Sharma et al., 2021; Yaro et al., 2021). Although several interventions have been introduced to combat malaria, the disease remains persistent largely due to challenges associated with the implementation and uptake of preventive measures.

Insecticide-treated nets (ITNs) are widely recognized as one of the most effective malaria prevention tools. They serve as both a physical barrier and a chemical deterrent against mosquitoes, significantly reducing mosquito-human contact and thereby decreasing malaria transmission (Andrada et al., 2019). Empirical evidence demonstrates that ITNs, when properly and consistently used, can reduce malaria transmission by up to 50% and child mortality by 20% (Ameyaw et al., 2020). However, while mass distribution campaigns have led to significant increases in ownership, utilization rates still lag behind expected outcomes, particularly in rural and hard-to-reach communities (Muhammad et al., 2021).

Nigeria has adopted numerous strategies to scale up ITN distribution and usage through the National Malaria Strategic Plan and other donor-funded interventions (Federal Ministry of Health, 2015; U.S. President’s Malaria Initiative, 2022). These initiatives have included free mass distributions, integration into antenatal care services, and community-based education programs. Nonetheless, the challenge remains not just in distributing the nets but in ensuring their actual use. Factors such as socio-economic status, education, awareness, sleeping arrangements, and cultural beliefs influence the adoption and consistent use of ITNs (Olukosi et al., 2020; Balogun et al., 2018).

In many parts of Nigeria, especially rural areas such as Ezionum in Ukwuani Local Government Area of Delta State, malaria continues to have a stronghold due to both environmental conditions and behavioral patterns. The community faces challenges such as poor housing structures, stagnant water bodies, and limited access to quality health services, all of which are conducive to mosquito breeding and disease transmission (Akpan et al., 2018; Olabimi et al., 2021). Furthermore, while ITN ownership may be relatively high due to free distributions, their proper usage is often hampered by cultural and logistical barriers (Nnaemeka et al., 2022; Ogba et al., 2022).

Several studies have emphasized the role of socio-demographic and behavioral factors in influencing ITN usage. For instance, a study conducted in Lagos State found that low education levels, myths about side effects, and household sleeping arrangements contributed to poor utilization among pregnant women (Olukosi et al., 2020). Similarly, another study in Ebonyi State highlighted that although awareness of ITNs was high, misconceptions about their use and discomfort during sleep deterred many from using them (Akpa et al., 2019). In Cross River State, a case of severe malaria leading to spontaneous abortion in a pregnant woman further underscored the risks of non-usage and the need for community health education (Oboh et al., 2022).

Rural-urban disparities further compound the issue. ITN usage among urban dwellers is generally higher due to better education, awareness, and accessibility to health services. On the other hand, rural communities are often excluded from consistent health messaging and are less likely to be reached by media campaigns or health workers (Ameyaw et al., 2020). In Nasarawa State, for example, a study found that while indoor residual spraying (IRS) was accepted, there was a lack of understanding about its purpose, which parallels the gap in ITN usage (Dimas et al., 2019). These disparities underscore the importance of tailoring interventions to local contexts.

Moreover, knowledge, attitudes, and practices (KAP) play a crucial role in determining whether individuals use ITNs effectively. A study in Kano State among Hausa communities revealed that even though malaria knowledge was high, actual protective practices were limited, illustrating the gap between awareness and behavior (Dawaki et al., 2020). Another study in Ghana found that ITN ownership did not always translate to use among pregnant women, indicating that deeper socio-cultural dynamics need to be explored to drive behavior change (Duut & Alhassan, 2022).

Furthermore, logistical issues such as the design of sleeping spaces and household sizes can affect ITN usage. In some homes, multiple individuals share one room, making it difficult to hang nets appropriately (Jegede et al., 2020). Similarly, some residents complain that the nets are too hot or uncomfortable to use during warm seasons, which discourages consistent use. In East Sumba Island, Indonesia, it was found that successful ITN usage required not only distribution but also education and engagement with local communities through culturally sensitive health programs (Bandzuh et al., 2022).

Compounding these behavioral and socio-cultural factors are structural and policy-related issues. While the National Malaria Elimination Programme (NMEP) continues to set ambitious targets, the absence of strong monitoring systems has made it difficult to assess the real impact of interventions (Federal Ministry of Health, 2015). Additionally, although campaigns often focus on distribution, follow-up visits to ensure usage and maintenance of nets are seldom carried out, leading to reduced effectiveness over time (Owoeye et al., 2018).

The issue of net misuse also presents a considerable challenge. Anecdotal evidence and some studies suggest that in rural communities, ITNs are sometimes repurposed for other domestic uses such as fishing or gardening (Nnaemeka et al., 2022). This practice undermines the goals of malaria prevention programs and reflects deeper issues in community health education. Without sustained behavior change communication, the benefits of ITN ownership may not be realized.

The high burden of malaria among pregnant women and children further highlights the urgency of addressing ITN utilization. In Burkina Faso, a cross-sectional study revealed that pregnant women were disproportionately affected due to both biological vulnerability and limited access to preventive tools (Yaro et al., 2021). Similar trends have been observed in Nigerian settings, with studies noting that maternal and child health outcomes are directly linked to the uptake of malaria prevention strategies (Iwuchukwu & Vincent, 2021).

Given these complexities, localized research becomes critical. A one-size-fits-all approach is unlikely to yield sustainable results. Communities like Ezionum, with unique socio-cultural dynamics and environmental realities, require tailored interventions that go beyond distribution to include education, follow-up, and community engagement. For instance, profiling analyses have shown that regional differences are one of the strongest predictors of ITN ownership and use in Nigeria, thereby making subnational strategies a necessity (Andrada et al., 2019).

Understanding the nuances of ITN acceptance and usage in Ezionum can provide valuable insights for improving public health outcomes and refining malaria prevention strategies. This study, therefore, aims to examine the level of ITN acceptance and usage in Ezionum community and identify the socio-demographic, cultural, and behavioral factors that influence these outcomes. It is only by addressing these contextual factors that meaningful progress can be made toward malaria elimination in Nigeria.

1.2 Statement of the Problem

Despite numerous efforts by global and national health agencies to curb the burden of malaria through the widespread distribution of insecticide-treated nets (ITNs), malaria remains a major cause of morbidity and mortality in Nigeria, particularly among pregnant women and children under five years (Yaro et al., 2021; Olukosi et al., 2020). While ITNs have proven effective in preventing malaria transmission, the actual utilization of these nets continues to lag behind distribution rates, especially in rural communities such as Ezionum in Ukwuani Local Government Area, Delta State. Previous studies have largely concentrated on urban centers or generalized regions, often failing to provide granular insights into community-specific barriers to ITN usage (Ameyaw et al., 2020; Dawaki et al., 2020).

Although national and international campaigns have significantly increased ITN ownership, several behavioral, cultural, and environmental factors continue to undermine their effective use. For example, misconceptions about discomfort, heat, side effects, and beliefs about malaria causation persist in many rural areas (Akpa et al., 2019; Nnaemeka et al., 2022). In some instances, ITNs are repurposed for domestic activities such as fishing or gardening, highlighting a disconnect between awareness and proper utilization (Oboh et al., 2022). However, there remains a lack of empirical data focused specifically on Delta State’s rural communities, where local dynamics and belief systems may significantly influence ITN use patterns (Olabimi et al., 2021; Dimas et al., 2019).

Moreover, existing studies have largely emphasized ownership and general usage trends without sufficiently interrogating the socio-cultural and demographic predictors of ITN adoption within small communities (Jegede et al., 2020; Duut & Alhassan, 2022). There is also limited evidence on the long-term retention and maintenance of ITNs in these contexts, as well as the role of gender, household sleeping arrangements, and traditional health beliefs in shaping usage behaviors (Bandzuh et al., 2022).

Therefore, this study seeks to address these gaps by exploring the level of acceptance and actual utilization of ITNs in Ezionum community. It aims to identify the unique socio-demographic, environmental, and cultural factors influencing ITN use, which have not been thoroughly examined in previous research. Filling this knowledge gap is critical for informing locally relevant interventions and improving malaria prevention strategies in similarly under-researched rural areas across Nigeria.

1.3 Objectives of the Study

The main objective of this study is to assess the level of acceptance and usage of insecticide-treated nets among residents of Ezionum community in Ukwuani LGA, Delta State. Specifically, the study aims to:

1. Determine the proportion of households in Ezionum community that own and use insecticide-treated nets.
2. Examine the socio-cultural and demographic factors influencing the acceptance and use of ITNs among the residents.
3. Identify the challenges or barriers to the consistent use of insecticide-treated nets in the community.

1.4 Research Questions

The study will be guided by the following research questions:

1. What proportion of households in Ezionum community own and consistently use insecticide-treated nets?
2. What are the socio-cultural and demographic factors that influence the acceptance and usage of ITNs in Ezionum?
3. What challenges do residents of Ezionum face in the regular use of insecticide-treated nets?

1.5 Research Hypotheses

The following hypotheses will be tested in the course of the study:

1. H₀₁: There is no significant relationship between household educational level and the usage of insecticide-treated nets in Ezionum community.
2. H₀₂: Socio-cultural beliefs do not significantly affect the acceptance of insecticide-treated nets among residents of Ezionum.
3. H₀₃: The level of awareness of malaria prevention does not significantly influence the use of insecticide-treated nets in Ezionum community.

1.6 Significance of the Study

This study holds considerable significance for a wide range of stakeholders involved in public health, community development, and academic research. By examining the level of acceptance and utilization of insecticide-treated nets (ITNs) among residents of Ezionum community in Ukwuani Local Government Area, Delta State, the research will contribute valuable empirical data that can be used to enhance malaria prevention strategies at both local and regional levels.

For public health policymakers and local health authorities, the study will provide a clearer understanding of the current patterns of ITN usage and the underlying factors that influence acceptance. This evidence will enable the design and implementation of more targeted and culturally appropriate intervention strategies aimed at increasing ITN utilization, particularly in rural settings. It will also help in identifying the shortcomings of existing programs and in adjusting policy frameworks to address real-world challenges faced by communities.

Health educators and community health workers are also expected to benefit from the study, as it will reveal the socio-cultural, economic, and behavioral barriers to ITN use. Such insights will be instrumental in developing more effective health education campaigns that resonate with the lived experiences of local residents. Tailored messaging and community-specific outreach initiatives can significantly enhance the impact of malaria prevention efforts.

Non-governmental organizations, donor agencies, and international partners involved in malaria control and eradication will find the study useful in assessing the outcomes of their previous interventions in the area. The findings can guide the planning of future distribution programs and help in allocating resources more efficiently. By identifying what works and what does not in a specific community context, these stakeholders can improve the sustainability and effectiveness of their support initiatives.

From an academic standpoint, the study adds to the existing body of knowledge on malaria control and health behavior in rural Nigerian communities. It provides a basis for further research into the determinants of health intervention acceptance and the dynamics of disease prevention in similar environments.

Finally, the Ezionum community itself stands to benefit directly and indirectly. The research could lead to increased awareness, improved health practices, and a reduction in malaria cases. Over time, this could translate into better overall wellbeing and improved quality of life for residents, as well as reduced healthcare costs and increased productivity.

1.7 Scope of the Study

This study focuses exclusively on the acceptance and usage of insecticide-treated nets among residents of Ezionum community in Ukwuani Local Government Area, Delta State. It will examine variables such as household ITN ownership, frequency of use, perceptions of effectiveness, cultural and demographic influences, and common challenges encountered. The research will not cover other malaria prevention methods such as indoor residual spraying or chemoprophylaxis. Data collection will be limited to adult members of households who are primarily responsible for household health decisions.

1.8 Operational Definition of Key Terms

Insecticide-Treated Nets (ITNs): Nets treated with chemical insecticides that are used primarily to protect individuals from mosquito bites, especially during sleep, in order to prevent malaria transmission.

Acceptance: The willingness or decision by individuals or households in Ezionum to use ITNs regularly as a malaria prevention measure.

Utilization: The actual practice of using ITNs consistently, particularly at night, by members of the household.

Ezionum Community: A rural community located within Ukwuani Local Government Area in Delta State, Nigeria, which constitutes the geographic focus of this study.

Socio-Cultural Factors: Community-based beliefs, norms, practices, and perceptions that influence individuals’ health behaviors, including the use of ITNs.

Malaria: A life-threatening parasitic disease transmitted by female Anopheles mosquitoes, prevalent in tropical and subtropical regions, including Nigeria.

Awareness: The extent of knowledge or information that residents of Ezionum have about malaria, its transmission, and the role of ITNs in its prevention.

Barriers: Factors or challenges that hinder the effective and consistent use of insecticide-treated nets, such as discomfort, heat, poor net design, or misconceptions.