Protecting Pregnant Women
from Malaria:
Hanging and Using Nets
1
Pregnant Women Should Use Long Lasting
Insecticide-treated Nets
• Women are more vulnerable to
malaria during pregnancy
• Sleeping under nets is associated
with lower rates of anemia and
low birth weight
• Thus better maternal and child
survival
• Nets are the only safe protection
in first trimester – get and use
ITNs early!
2
LLINs protect pregnant women …
• … if they use them throughout
pregnancy
• Even within the household not
all pregnant women have access
to the nets
• We will examine today the
factors that might influence
whether women who attend
ANC use LLINs they may receive
3
Nigeria Malaria Survey Information
Target 2010
Now UHC
80
69
70
Even when a household
has nets, use is low
Percentage
60
50
40
60
55
48
41
41
30
28
30
16
20
10
0
HH w/≥ LLIN
Preg ♀ Slept
2010
2013
2015
Preg ♀ HH w/LLIN
4
The Community Setting
• Ramota is a primary school teacher who lives
along Ayodele Street in a small Nigerian town
• When Ramota became pregnant she
booked/registered at the ANC (PNC) clinic
when she was three months pregnant
• Hopefully she would obtain a LLIN at her first
ANC visit
5
How does the community view nets?
The Pros and Cons
üProvides sound sleep
üLLINs kill other insects
üFree nets helpful
üShows homeowners have some
status
ÒPoor ventilation = heat
ÒWhite net resembles funeral
shroud
ÒUseful to dry fish
ÒSubsidy, purchase a problem
ÒMosquito coils or herbs are
better
ÒMosquitoes are only a nuisance
ÒDifficult to hang if sleep on mat
or couch
6
Misuse of Nets
7
Ramota Prepares for ANC
• Ramota confided in her colleagues at school and they encouraged her
to register early for ANC
• They offered to cover her classes when she went to ANC, where they said she
would get medicines
• They reminded her of maternity leave and other work benefits
• Ramota’s mother and aunts expressed skepticism
• They believed one should not let people know about a pregnancy until it
really shows
• But her mother- and sister-in-law just laughed about ‘those old
fashioned women’ and encouraged Ramota to register at ANC
8
Sources of Social Support
• Members of her contribution
club moved her turn forward so
she could buy new baby things
• Thus she would collect 1,200 Naira
in a few months
• Her Muslim Women’s
Association held prayers for a
safe pregnancy
• They started making arrangements
and planning food for the baby’s
naming ceremony
9
Ramota attends the ANC Clinic
• At the ANC clinic Ramota was given an
insecticide treated bednet
• The Nurse asked if the family had any
nets at home, but Ramota said the last
mass campaign was 3 years ago and
those nets were no longer used
• The Nurse stresses dangers of malaria to
pregnant woman and fetus
• She was examined and given medicine
to make her blood strong
10
The Teacher at Home
• On reaching home, the elders (in-laws) were
happy to see the LLIN, but suggested that she
give it to her husband since he works hard and
needs better sleep
• On hearing about the visit to ANC her female inlaws said they thought malaria was not such a big
problem in their family – the nets were hot and
bothersome
• They echoed what people generally believe:
Malaria is a temporary indisposition caused by
too much sun, hard work, dust, red palm oil; It is
‘normal’
11
With this background, let’s analyze the
likelihood that she will use the net …
• Using the information about
Ramota herself and the views of
the family, friends and
community members with
whom she associates we will
look at:
• Health Belief Model
• Social Learning Theory
12
Modifying Factors:
• Local knowledge dust, sun
cause malaria
• Herself well educated
• Extended family, house
structure
Perceived Susceptibility:
Everyone gets malaria
Health Belief Model
Perceived
threat of
Malaria
Moderate*
Perceived Benefits:
+ Usually free
+ Good sleep
+ Kills other bugs
Constraints:
- May prefer other uses
- Hard to hang
- Not always available
- Heat, no air
Perceived Seriousness:
Generally not seen as serious
Cues to action:
in community unless miss
+ Friends support
work
*please explain decision
+ Nurse Stresses
- Relatives discourage
Likelihood
of sleeping
under LLIN
Moderate*
13
Social Learning Theory
ENVIRONMENT
Observational
Learning
•Some friends get,
hang nets
•People use nets on
gardens
PERSON
•Role of wife, family
member
•Educated
•Semi independent thinker
•Clinics that stock LLINs
•Available distribution points
•Gender issues viz use
•Malaria, mosquito beliefs
•Econocmic investments
like crops and livestock
Self-Efficacy
•Whether think capable
of hanging, caring, using
Outcome/Value
Expectancies
•If expect heat, discouraged
•If expect good sleep, less
malaria then encouraged
•If expect family discord
may give to husband
BEHAVIOR
Will she hang and sleep
under net each night?
14
Conclusions
• Each model contributes
something different to our
understanding of potential
behaviors
• HBM helps us contrast people’s
views about the disease with
their perceptions of the
solutions that are offered
• SLT shows an important dynamic
between the person and her
environment
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