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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 1  |  Page : 81-91

Knowledge and preventive practices against malaria among pregnant women in urban and rural public healthcare facilities in nigeria’s federal capital territory


1 Federal Capital Territory Primary Health Care Board, 9, Abuja, Nigeria
2 Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
3 Office of the Honourable Secretary, Health and Human Services Secretariat, Federal Capital Territory (FCT) Administration, Abuja, Nigeria
4 Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria

Date of Submission06-Oct-2020
Date of Decision27-Apr-2021
Date of Acceptance17-May-2021
Date of Web Publication3-Dec-2021

Correspondence Address:
Sabastine N Esomonu
Federal Capital Territory Primary Health Care Board, 9, Orlu Street, Area 3, Garki, Abuja.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_66_20

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  Abstract 

Background: Malaria is a life-threatening parasitic disease, and pregnant women are at risk of its adverse consequences. Objectives: The study aimed to determine knowledge and preventive practices against malaria among pregnant women at urban and rural public health facilities in Abuja, Nigeria. Materials and Methods: A cross-sectional study design was used. The two-stage sampling method was used to select 520 pregnant women in 16 health facilities. A structured questionnaire was used for data collection. Data analysis was done using SPSS statistical software version 22.0, and the level of statistical significance was determined at P-value of less than 0.05. Results: The mean age of respondents was 29.6±4.6 and 27.9±4.9 years in urban and rural areas, respectively (P≤0.001). A significantly higher proportion of women in the urban area (44.2%) had good knowledge of malaria than those in the rural area (26.2%) (P < 0.001). Comparable proportions of respondents in urban (13.1%) and rural (23.1%) areas had good preventive practices against malaria (P = 0.218). The predictor of good knowledge of malaria in the urban area was using secondary health facilities for antenatal care [95% confidence interval (CI): 1.3–4.4], whereas tertiary education (95% CI=1.1–2.3) and utilizing secondary health facilities (95% CI=1.2–2.8) were predictors in the rural area. Predictors of good preventive practice included being self-employed (95% CI=1.5–11.6) and having good knowledge of malaria (95% CI=1.3–6.4) in the urban area. Conclusion: Minor proportions of respondents in the study area had good knowledge of, and good preventive practices against, malaria. There is a need for relevant authorities to enlighten women on malaria and its preventive practices and to motivate them to practice malaria prevention throughout pregnancies.

Keywords: Health facilities, knowledge, malaria, Nigeria, pregnant women, preventive practice, rural, urban


How to cite this article:
Esomonu SN, Ossai EN, Gadzama AD, Ashikeni MA, Uzochukwu BS. Knowledge and preventive practices against malaria among pregnant women in urban and rural public healthcare facilities in nigeria’s federal capital territory. Int J Med Health Dev 2022;27:81-91

How to cite this URL:
Esomonu SN, Ossai EN, Gadzama AD, Ashikeni MA, Uzochukwu BS. Knowledge and preventive practices against malaria among pregnant women in urban and rural public healthcare facilities in nigeria’s federal capital territory. Int J Med Health Dev [serial online] 2022 [cited 2023 Feb 8];27:81-91. Available from: https://www.ijmhdev.com/text.asp?2022/27/1/81/331733




  Introduction Top


The World Malaria Report (WMR) of 2018 indicated that 90% of deaths due to malaria occur in the African region, with pregnant women and their unborn children being particularly vulnerable to the deleterious effects of the disease.[1] Malaria infections in pregnancy remain a major public health problem in tropical and subtropical regions of the world, with substantial risks for the pregnant woman, her fetus, and the newborn child. The symptoms and complications of malaria during pregnancy depend on the intensity of malaria transmission and the level of immunity the pregnant woman had acquired.[2]

In Nigeria, malaria contributes to an estimated 11% of maternal deaths and 25% infant mortalities chiefly caused by Plasmodium falciparum through its impacts on maternal anemia, low birth weight, still births, abortions, and prematurity.[3],[4] In the African continent, about 30 million women living in malaria-endemic areas become pregnant each year. For these women, malaria is a threat both to themselves and to their babies; P. falciparum infection during pregnancy is estimated to cause about 10,000 maternal deaths, 200,000 new born deaths, and 11% of deaths from low birth weights.[5],[6]

The Roll Back Malaria (RBM) partnership recommends the use of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) for effective prevention of malaria in pregnancy in areas of stable malaria transmission.[7],[8] The IPTp-SP involves providing all pregnant women with at least three presumptive treatment doses of sulfadoxine-pyrimethamine (SP) drug during routine antenatal clinic visits, starting early in the second trimester and at least 1 month apart. This approach has been shown to be safe, inexpensive, and effective. In addition, most pregnant women in areas of stable malaria transmission in Africa attend antenatal care (ANC) at least once during their pregnancy, making clinic-based prevention feasible.[8],[9]

The ITNs are low cost and highly effective way of reducing the incidence of malaria in people who sleep under them. By preventing malaria, ITNs reduce the need for treatment and the pressure on health services.[7],[10],[11] They decrease both the number of malaria cases and malaria death rates in pregnant women and their children, and their use further benefits the infant who sleeps under the net with the mother by decreasing exposure to malarial infection.[11],[12],[13],[14] The RBM partnership further recommends that management of cases of malaria illness during pregnancy should be done as stipulated in the national and WHO malaria treatment guidelines.[15],[16]

However, available studies have shown variations in the implementation of malaria prevention programmes both within and across the countries of Africa, with level of knowledge and practice significantly different among pregnant women in urban and rural areas.[17],[18],[19],[20],[21] This study aimed to determine and compare the knowledge and preventive practices against malaria among pregnant women who attend ANC at urban and rural public health facilities in the Municipal Council of Nigeria’s Federal Capital Territory (FCT).


  Subjects and Methods Top


Description of study area

The study was carried out at public primary and secondary health facilities in Abuja Municipal Area Council (AMAC) of Nigeria’s FCT, Abuja. The Municipal Council is one of the six councils in the FCT with a land area of 156 km2 and a projected population of 2,473,764 based on the growth rate of 9.3% and a population density of 1,377 people per square kilometer.[22] The council harbors most federal government agencies and therefore home to the major and minor ethnic groups of Nigeria, as well as foreign nationals who constitute substantial part of the population. The indigenous people of the area include Gbagyi, Gwandara, and Hausa/Fulani, whose main occupation is farming and fishing at the subsistence level and mostly domiciled in rural areas. A total of 31 public primary and 6 public secondary healthcare facilities, as well as one public tertiary hospital and 315 private hospitals, are located within the Municipal Council.[23] All the health facilities conduct routine ANC services during the working days of the weeks.

Study design and population

This was a health facility-based comparative cross-sectional study. The population comprised pregnant women who registered for ANC services at the selected health facilities. Pregnant women who came for second visits and above were included, whereas those who declined consent were excluded.

Sample size determination

The minimum sample size for the study was determined by the formula for comparing two independent proportions.[24] A sample size of 520 respondents (260 each for urban and rural areas) was included in the study based on type 1 error (α) of 0.05, power of 80%, and proportions of 17.3% and28%, respectively, that used IPTp in urban and rural areas of south-east Nigeria.[18],[25]

Sampling technique

The two-stage sampling technique was used to select the study participants. In the first stage, health facilities were stratified into urban and rural areas. Out of the 37 public health facilities, the urban area has 6 public primary healthcare facilities (PHCs) and 5 general hospitals, whereas the rural area has 25 PHCs and 1 general hospital. Simple random sampling technique of balloting was used to select 3 PHCs and 3 general hospitals in the urban area and 9 PHCs and one general hospital in the rural area. This gave a total of 16 health facilities used for the study.

In the second stage, a systematic random sampling technique using facility registers was used to select pregnant women as they present for ANC services at the selected facilities on each day of data collection. The last 6 months attendance at the ANC clinics was used to determine the sampling frame. An average of 200 pregnant women present for ANC on a monthly basis at the PHCs, whereas an average of 750 clients present monthly at the general hospitals and these served as sample frames. Therefore, 60 women were allocated to the PHCs and 200 to the secondary facilities at the ratio of 1:3 proportionately. Sampling interval was determined by dividing the sampling frames by the sample sizes; hence, a sampling interval of 3 for the PHCs and 4 for the secondary facilities was obtained. So, every third client at the PHCs was included in the study, whereas every fourth client was included at the secondary facilities. The index clients in each day were selected using simple random sampling technique of balloting. Data were collected over a period of 1 month.

Study instrument

A pre-tested, semi-structured questionnaire which was developed by the researchers was used for data collection. The questionnaire contained information on respondents’ biodata and the outcome measures. Research assistants were recruited and trained to administer the questionnaire.

Data management

Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS), version 22. Frequency tables and cross-tabulations were generated. The χ2 test and multivariate analysis using binary logistic regression were used in the analysis, and the level of statistical significance was determined by a P-value of less than 0.05. The outcome measures of the study were good knowledge of malaria and good preventive practices against malaria. Similar principles adapted from past studies were used to generate multiple choice questions to measure knowledge and preventive practices.[19],[26]

Knowledge of malaria was measured using 10 variables: a correct answer was assigned a score of 1, whereas an incorrect answer attracted a score of 0. Good knowledge of malaria was determined by the proportion of respondents who correctly answered 6 of 10 questions used to assess knowledge. Preventive practices against malaria was assessed using three variables and a correct response attracted a score of 1, whereas incorrect responses attracted a score of 0. Good preventive practices against malaria was determined by the proportion of respondents who answered “Yes” to all three questions used to assess preventive practices.

In determining the factors that affect good knowledge and good preventive practices against malaria, variables that had P-values of ≤0.2 on bivariate analysis were entered into logistic regression model to determine the predictors of good knowledge and good preventive practices. This was done separately for urban and rural areas based on the study objective. The result of the logistic regression analysis was reported using adjusted odds ratios (AORs) and 95% confidence interval (CI), and the level of statistical significance was determined by a P-value of less than 0.05.

Ethical consideration

Ethical approval was obtained from the Health Research and Ethics Committee of FCT Health Authority. The respondents were required to sign or thumb print to a written informed consent before the interviews, and the nature of the study, its relevance, and the level of their participation were made known to them. Respondents were assured that participation in the study was voluntary, and all the information provided through the questionnaire will be kept confidential.


  Results Top


[Table 1] shows the sociodemographic characteristics of the respondents. The mean age of respondents in the urban area was 29.6±4.6 years, whereas the mean age of those in the rural area was 27.9±4.9 years (P < 0.001). Higher proportion of women in the urban area (61.2%) had post-secondary education (P < 0.001). The majority of unemployed women were in the urban area (36.9%), whereas the majority of self-employed women were in the rural area (40.0%) (P = 0.003).
Table 1: Sociodemographic characteristics of the respondents

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[Table 2] shows the knowledge of malaria among the respondents. A significantly higher proportion of respondents in the urban area had good knowledge of malaria (44.2%) when compared with those in the rural area (26.2%) (P < 0.001). A significantly higher proportion of respondents in the urban area (80%) knew that infected mosquito can transmit malaria when compared with those in the rural area (67.7%) (P = 0.001). Comparable proportions of women in the rural area (76.5%) had the idea of IPTp when compared with those in the urban area (73.1%). Similarly, comparable proportions of women in the rural area (61.2%) knew the correct dose for IPTp when compared with those in the urban area (58.5%).
Table 2: Knowledge of malaria among the respondents

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[Table 3] shows the preventive practices against malaria among the respondents. A significantly higher proportion of respondents in the rural area took drugs for IPTp (91.9%) than those in the urban area (60.8%) (P < 0.001). There was no significant difference in the ownership and use of ITNs among women in the two study groups. Respondents in the two study groups gave varying reasons for non-use of ITNs such as hot weather and the feeling of being encaged under the nets, and the difference was statistically significant (P = 0.007). Comparable proportions of women in the rural area (13.1%) had preventive practices against malaria than those in the urban area (13.1%).
Table 3: Preventive practices against malaria among the respondents

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[Table 4] shows the factors affecting good knowledge of malaria among respondents in the urban area. Knowledge of malaria was associated with the type of health facility where women registered for ANC. Those women who registered for ANC at secondary health facilities were twice more likely to have good knowledge of malaria when compared with those who registered at PHC facilities (95% CI = 1.3–4.4).
Table 4: Factors affecting good knowledge of malaria among respondents in urban area

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[Table 5] shows the factors affecting good knowledge of malaria among respondents in the rural area. Those women who had tertiary education were 1.5 times more likely to have good knowledge of malaria when compared with those who had secondary education and below (95% CI = 1.0–2.3). Also, women who registered for ANC at secondary health facilities were twice more likely to have good knowledge of malaria when compared with those who registered at PHC facilities (95% CI = 1.2–2.8).
Table 5: Factors affecting good knowledge of malaria among the respondents in rural area

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[Table 6] shows the factors affecting good preventive practices against malaria in the urban area. Those women who were self-employed were four times more likely to have good preventive practices against malaria when compared with those who were unemployed (95% CI = 1.5–11.6). Also, women who had good knowledge of malaria were three times more likely to have good preventive practices against malaria when compared with those who had poor knowledge of malaria (95% CI = 1.3–6.4).
Table 6: Factors affecting good preventive practices against malaria in urban area

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[Table 7] shows the factors affecting good preventive practices against malaria in the rural area. Those women who registered for ANC at secondary health facilities were 1.3 times more likely to have good preventive practices against malaria when compared with those registered at PHCs, but the difference was not statistically significant (5% CI = 0.7–2.6).
Table 7: Factors affecting good preventive practices against malaria in rural area

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  Discussion Top


The majority of the respondents in the two study groups (80% and 67.7%, respectively) knew that infected mosquitos could transmit malaria. This is a plus for the fight against malaria as they are likely to make conscious efforts to prevent mosquito bites. Findings from studies in Ethiopia and Lagos, Nigeria showed that 90.2% and 78% of the pregnant women, respectively, were aware that infected mosquitoes could transmit malaria.[20],[27] The proportion of respondents who had good knowledge of malaria was low (44.2% urban and 26.2% rural) and significantly different in the two study groups. Two Nigerian studies recorded good knowledge of malaria scores of 71.5% and 1% in the urban and rural areas, respectively.[19],[26] A study in Burkina Faso recorded 68.2% and 53% good knowledge of malaria for women in the urban and rural areas, respectively, with women in the rural area having lower odds for good knowledge of malaria.[28] The higher proportion of good knowledge of malaria recorded in the urban area in this study could be attributed to the higher educational attainment of women in the urban area, as recorded in the previous studies.[19],[28],[29] The implication is that the poor educational attainment of women in the rural area will continue to pose significant challenge to the fight against malaria. However, a study in south-eastern Nigeria found that awareness of mosquitoes being associated with malaria was high among mothers of under five children in rural settings.[30]

From the result of this study, there was no significant difference in the preventive practices against malaria among respondents in the two study groups. A Nigerian study reported 69% practice of malaria prevention strategies in a secondary health facility.[31] However, significantly higher proportion of women in the rural area took SP for IPTp, resulting in better preventive practices among them. The possible reason may be the higher knowledge and awareness of IPTp recorded among women in the rural area. This corroborates the finding from the Nigerian study that individual women’s beliefs and lack of understanding of IPTp contribute to low uptake and adherence to IPTp.[32] Related studies in Africa have shown IPTp to be very effective in preventing maternal and placental anemia, as well as in improving pregnancy outcomes.[33],[34],[35] Therefore, the good preventive practice using IPTp recorded among women in the rural area in this study is commendable as malaria endemicity and resultant effects are known to be more severe in rural communities.[36] However, a number of African studies reported that coverage for IPTp was higher in urban than in rural areas.[16],[17]

There was no significant difference in ownership and utilization of ITNs among respondents in the two study groups. The data further show comparatively lower ITNs utilization than ownership among women in the two study groups. A similar pattern was observed in a study in Abuja, Nigeria where 42.6% of the pregnant women own ITNs but only 24.6% of them used the nets.[26] Another Nigerian study found that a high proportion of pregnant women in the rural area who own ITNs slept under them in the night preceding the survey. This was because the women received lectures on ITN use and got free ITNs.[30] The figures on utilization of ITNs by respondents in this study (23.5% urban vs. 25.8% rural) are, however, much below the revised Abuja target of 80%,[37] but compare well with the figures from Ethiopia.[21] The major reasons advanced by respondents for non-use of ITNs included hot weather (62.7% urban vs. 48.3% rural) and the feeling of being caged (7.8% urban vs. 10.0% rural). These are comparable to findings from studies in Nigeria and Kenya, as well as those from a review of available evidence across sub-Saharan Africa.[38],[39],[40]

It has been reported that improvement in knowledge and education of women of child-bearing age has an influential impact on malaria control.[27] This was demonstrated at the rural area in this study as those who had tertiary education were one and half times more likely to have good knowledge of malaria when compared with those who had secondary education and below. This further agrees with the findings from Nigeria and Tanzania that higher knowledge of malaria was significantly associated with increasing educational status of pregnant women.[19],[26],[41] Therefore, improving the educational status of women in the study groups will likely improve their knowledge of malaria.

Preventive practices against malaria was generally poor among respondents in the two study groups. However, those women who were self-employed in the urban area were four times more likely to have good preventive practices against malaria when compared with the unemployed. A similar pattern was observed in Ugandan households where those who were not employed were less likely to use mosquito nets.[42] It has been documented that knowledge of malaria is positively associated with practice of malaria prevention among pregnant women.[18],[19],[31] This was corroborated by the results of this study, which showed that those women in the urban area who had good knowledge of malaria were three times more likely to have good preventive practices against malaria when compared with those who had poor knowledge of malaria. A different scenario was also observed in Yaoundé, Cameroon, where over 50% of the respondents had good knowledge of malaria and prevention measures but less than 50% applied good practices concerning malaria treatment and prevention.[29]

Study limitations: In assessing preventive practices against malaria among the respondents, the variable, “Slept under an insecticide treated net the previous night,” was assessed based on the responses of the respondents and not by observation. This may be subject to social desirability bias on the part of the respondents. However, the respondents were duly informed that information as obtained during the study was for research purposes and not an audit process by the government or any its agencies or organization.

In conclusion, this study revealed that minor proportion of respondents had good knowledge of malaria (44.2% and 26.2%) and good preventive practices against malaria (13.1% and 23.1%) in urban and rural areas, respectively. Knowledge of malaria was associated with preventive practices against malaria in the urban area. Health education and enlightenment of pregnant women on malaria prevention should be intensified in the study area. The FCT health authorities should motivate pregnant women to embrace the use of malaria preventive measures such IPTp-SP and ITNs throughout pregnancy through provision of affordable malaria commodities at public health facilities.

Acknowledgements

The authors appreciate the cooperation from the respondents and management of the health facilities during the study period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Malaria Report, 2018. Available from https://apps.who.int/iris/bitstream/handle/10665/275867/9789241565653-eng.pdf?ua=1 [Last accessed on 2019 Nov 1].  Back to cited text no. 1
    
2.
World Health Organization (WHO): Malaria in pregnant women, 2017. Available from https://www.who.int/malaria/areas/high_risk_groups/pregnancy/en/ [Last accessed on 2019 Nov 12].  Back to cited text no. 2
    
3.
Roll Back Malaria Partnership. Progress and impact series: focus on Nigeria. 2012. Available from https://apps.who.int/iris/bitstream/handle/10665/87100/9789241503310_eng.pdf [Last accessed on 2019 Nov 12].  Back to cited text no. 3
    
4.
National Population Commission, Nigeria 2016. Nigeria Malaria Indicator Survey (MIS) 2015. Available from https://dhsprogram.com/pubs/pdf/MIS20/MIS20.pdf [Last accessed on 2019 Nov 28].  Back to cited text no. 4
    
5.
World Health Organisation (WHO): Malaria in pregnant women, 2017. Available from https://www.who.int/features/2003/04b/en/ [Last accessed on 2019 Dec 6].  Back to cited text no. 5
    
6.
Eisele TP, Larsen DA, Anglewicz PA, Keating J, Yukich J, Bennett A, et al. Malaria prevention in pregnancy, birthweight, and neonatal mortality: A meta-analysis of 32 national cross-sectional datasets in Africa. Lancet Infect Dis 2012;12:942-9.  Back to cited text no. 6
    
7.
Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO. Quantifying the number of pregnancies at risk of malaria in 2007: A demographic study. PLoS Med 2010;7:e1000221.  Back to cited text no. 7
    
8.
RBM partnership. Implementing malaria in pregnancy programs in the context of World Health Organization recommendations on antenatal care for a positive pregnancy experience 2016. 2020. Available from https://apps.who.int/iris/bitstream/handle/10665/259954/WHO-RHR-18.05-eng.pdf?sequence=1 [Last accessed on 2020 Feb 6].  Back to cited text no. 8
    
9.
World Health Organization. Recommendation on intermittent preventive treatment of malaria in pregnancy 2016. Available from https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-intermittent-preventive-treatment-malaria-pregnancy [Last accessed on 2020 Jan 16].  Back to cited text no. 9
    
10.
Kayentao K, Garner P, van Eijk AM, Naidoo I, Roper C, Mulokozi A, et al. Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: Systematic review and meta-analysis. J Am Med Assoc 2013;309:594-604.  Back to cited text no. 10
    
11.
Nigeria National Malaria Elimination Programme. National guideline on integrated vector management (IVM) for malaria elimination in Nigeria, 2015. Available from http://nmcp.gov.ng/about-learning-hub/vector-management/ [Last accessed on 2019 Dec 16].  Back to cited text no. 11
    
12.
Oladokun A, Oladokun RE, Adesina OA. Knowledge and utilization of malaria control measures by pregnant and newly delivered mothers in Ibadan, Nigeria. Afr Health Sci 2011;11:573-7.  Back to cited text no. 12
    
13.
Gamble C, Ekwaru JP, ter Kuile FO. Insecticide-treated nets for preventing malaria in pregnancy. Cochrane Database Syst Rev2009:CD003755.  Back to cited text no. 13
    
14.
Menéndez C, D’Alessandro U, ter Kuile FO. Reducing the burden of malaria in pregnancy by preventive strategies. Lancet Infect Dis 2007;7:126-35.  Back to cited text no. 14
    
15.
FMoH, Nigeria. National guidelines and strategies for malaria prevention and control during pregnancy. 2014. Available fromhttps://drive.google.com/file/d/1e7vZBemlERxQ-l82P5UaZ4AtsbmQtYlu/view [Last accessed on 2021 Jan 14].  Back to cited text no. 15
    
16.
World Health Organization. Guidelines for treatment of malaria. 3rd ed. 2015. Available from http://www.who.int/malaria/publications/atoz/9789241549127/en/ [Last accessed on 2019 Dec 13].  Back to cited text no. 16
    
17.
Onoka CA, Hanson K, Onwujekwe OE. Low coverage of intermittent preventive treatment for malaria in pregnancy in Nigeria: Demand-side influences. Malaria J 2012;11:82.  Back to cited text no. 17
    
18.
Steketee RW, Eisele TP. Is the scale up of malaria intervention coverage also achieving equity? PLoS One 2009;4:e8409.  Back to cited text no. 18
    
19.
Onyeneho NG, Idemili-Aronu N, Okoye I, Ugwu C, Iremeka FU. Compliance with intermittent presumptive treatment and insecticide treated nets use during pregnancy in Enugu state, Nigeria. Matern Child Health J 2014;18:1169-75.  Back to cited text no. 19
    
20.
Akinleye SO, Ajayi IO. Knowledge of malaria and preventive measures among pregnant women attending antenatal clinics in a rural local government area in South-western Nigeria. World Health Popul 2011;12:13-22.  Back to cited text no. 20
    
21.
Belay M, Deressa W. Use of insecticide treated nets by pregnant women and associated factors in a pre-dominantly rural population in Northern Ethiopia. Trop Med Int Health 2008;13:1303-13.  Back to cited text no. 21
    
22.
Federal Republic of Nigeria Official Gazette. National Population Commission: Census 2006.  Back to cited text no. 22
    
23.
Federal Capital Territory Administration. 2018 Statistical Digest. Abuja: Manual Publication; 2018.  Back to cited text no. 23
    
24.
Onwasigwe C. Principles and Methods of Epidemiology. 2nd ed. Enugu: EL ‘Damak Publications; 2010. p. 147.  Back to cited text no. 24
    
25.
Ezeruigbo CFS, Okpara E, Nworie A, Uchenna U, Chibueze CI, Okeh E. Low utilization of two prophylactic measures of malaria in pregnancy (MiP) in some rural villages of Ebonyi State, Nigeria: A clarion call for enlightenment and strengthening of maternal and child health. IDOSR J Sci Tech 2017;2:42-8.  Back to cited text no. 25
    
26.
Akaba GO, Otubu JA, Agida ET, Onafowokan O. Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria’s Federal Capital Territory. Niger J Clin Pract 2013;16:201-6.  Back to cited text no. 26
  [Full text]  
27.
Iriemenam NC, Dosunmu AO, Oyibo WA, Fagbenro-Beyioku AF. Knowledge, attitude, perception of malaria and evaluation of malaria parasitaemia among pregnant women attending antenatal care clinic in metropolitan Lagos, Nigeria. J Vector Borne Dis 2011;48:12-7.  Back to cited text no. 27
    
28.
Yaya S, Bishwajit G, Ekholuenetale M, Shah V, Kadio B, Udenigwe O. Knowledge of prevention, cause, symptom and practices of malaria among women in Burkina Faso. PLoS One 2017;12:e0180508.  Back to cited text no. 28
    
29.
Talipouo A, Ngadjeu CS, Doumbe-Belisse P, Djamouko-Djonkam L, Sonhafouo-Chiana N, Kopya E, et al. Malaria prevention in the city of Yaoundé: Knowledge and practices of urban dwellers. Malar J 2019;18:167.  Back to cited text no. 29
    
30.
Uzochukwu BS, Onwujekwe EO, Onoka CA, Ughasoro MD. Rural–urban differences in maternal responses to childhood fever in southeast Nigeria. PLoS One 2008;3:e1788.  Back to cited text no. 30
    
31.
Ojong IN, Iheanacho LO, Akpan MI, Nlumanze FF. Knowledge and practice of malaria prevention among pregnant women attending secondary health facility in Calabar, Cross River State, Nigeria. Hamdard Med 2013;56:70-7.  Back to cited text no. 31
    
32.
Diala CC, Pennas T, Marin C, Belay KA. Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and cross river states in Nigeria. Malar J 2013;12:342.  Back to cited text no. 32
    
33.
Anchang-Kimbi JK, Achidi EA, Apinjoh TO, Mugri RN, Chi HF, Tata RB, et al. Antenatal care visit attendance, intermittent preventive treatment during pregnancy (IPTp) and malaria parasitaemia at delivery. Malar J 2014;13:162.  Back to cited text no. 33
    
34.
Menéndez C, Bardají A, Sigauque B, Sanz S, Aponte JJ, Mabunda S, et al. Malaria prevention with IPTp during pregnancy reduces neonatal mortality. PLoS One 2010;5:e9438.  Back to cited text no. 34
    
35.
Bouyou-Akotet MK, Mawili-Mboumba DP, Kendjo E, Moutandou Chiesa S, Tshibola Mbuyi ML, Tsoumbou-Bakana G, et al. Decrease of microscopic Plasmodium falciparum infection prevalence during pregnancy following IPTp-SP implementation in urban cities of Gabon. Trans R Soc Trop Med Hyg2016;110:333-42.  Back to cited text no. 35
    
36.
Ubajaka C, Adogu PO, Onwasigwe C, Ifeadike G. Comparative analysis of knowledge, attitude and use of ITN amongst pregnant women in an urban and rural LGA of Anambra state. J Prim Care Community Health 2009;21:1-11.  Back to cited text no. 36
    
37.
Federal Ministry of Health, Nigeria 2011. National policy on malaria diagnosis and treatment. Available from https://docs.google.com/file/d/0B5liZvEs6EVISTZ5TFNTaHFyTkU/edit [Last accessed on 2020 Feb 23].  Back to cited text no. 37
    
38.
Aluko JO, Oluwatosin AO. Utilization of insecticide treated nets during pregnancy among postpartum women in Ibadan, Nigeria: A cross-sectional study. BMC Pregnancy Childbirth 2012;12:21.  Back to cited text no. 38
    
39.
Njoroge FK, Kimani VN, Ongore D, Akwale WS. Use of insecticide treated bed nets among pregnant women in Kilifi District, Kenya. East Afr Med J 2009;86:314-22.  Back to cited text no. 39
    
40.
Singh M, Brown G, Rogerson SJ. Ownership and use of insecticide-treated nets during pregnancy in Sub-Saharan Africa: A review. Malar J 2013;12:268.  Back to cited text no. 40
    
41.
Spjeldnæs AO, Kitua AY, Blomberg B. Education and knowledge helps combating malaria, but not degedege: A cross-sectional study in Rufiji, Tanzania. Malar J 2014; 13:200.  Back to cited text no. 41
    
42.
Musoke D, Miiro G, Ndejjo R, Karani G, Morris K, Kasasa S, et al. Malaria prevention practices and associated environmental risk factors in a rural community in Wakiso district, Uganda. PLoS One 2018;13:e0205210.  Back to cited text no. 42
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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