FACTORS ASSOCIATED WITH UTILIZATION OF INSECTICIDE …
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FACTORS ASSOCIATED WITH UTILIZATION OF INSECTICIDE TREATED NETS AMONG PREGNANT MOTHERS IN RUBAVU DISTRICT, RWANDA AKAYEZU GISELE MPH/2015/24988 A Thesis Submitted in Partial Fulfillment of the Requirements of the Award of Master Degree in Public Health (Epidemiology) of Mount Kenya University APRIL 2019
Transcript of FACTORS ASSOCIATED WITH UTILIZATION OF INSECTICIDE …
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FACTORS ASSOCIATED WITH UTILIZATION OF INSECTICIDE
TREATED NETS AMONG PREGNANT MOTHERS IN RUBAVU
DISTRICT, RWANDA
AKAYEZU GISELE
MPH/2015/24988
A Thesis Submitted in Partial Fulfillment of the Requirements of the Award
of Master Degree in Public Health (Epidemiology) of Mount Kenya University
APRIL 2019
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DECLARATION
This Thesis is my original work and has not been presented to any other institution. No part of
this thesis should be reproduced without the authors’ consent or that of Mount Kenya University.
AKAYEZU Gisele
MPH/2015/24988
Sign:______________________________________Date:_______________________
Declaration by the supervisors
This thesis has been submitted with our approval as Mount Kenya University Supervisors.
Nicholas Ngomi, PhD
Senior Lecturer, Department of Public Health,
Mount Kenya University
Sign:_________________________Date______________________.
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DEDICATION
This Thesis is dedicated to God Almighty, to my family members, my beloved husband for their
support in my studies.
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ACKNOWLEDGEMENT
Most of all, I am grateful to my supervisor Dr Nicholas Ngomi for his support and guidance
during this research. I would like to acknowledge the help, support and encouragement I received
from my husband Mushinzimana Benjamin. I appreciate the assistance and encouragement I
have received from all staff of Mount Kenya University, school of health sciences.
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ABSTRACT
Jungle fever in pregnancy has been seemed to cause both maternal and infant kid bleakness and
mortality especially in sub Saharan Africa. The purpose of this assessment is to develop factors
related with utilization of Insecticide Treated nets (ITNs) among pregnant mothers in Rubavu
area. Legislature of Rwanda will profits by this investigation in arranging, actualizing and
planning applicable methodologies for ITN conveyance and usage for intestinal sickness control
among pregnant moms in Rubavu District. This investigation furnish gauge data in regards to
components related with ITNs usage among pregnant ladies in Rubavu locale, which might be
utilized for further research. A cross-sectional investigation utilizing a blended methodology was
finished. An example size of 289 pregnant moms going to the administrations were chosen
utilizing orderly inspecting method. Quantitative information was gathered utilizing pre-tried
semi organized survey while the subjective information was gathered utilizing Focus Group
Discussions (FGDs) among pregnant moms. Distinct investigation utilizing recurrence and
extents was processed. Pearson's chi-square test (p<0.05) was utilized to build up relationship
between ward variable and free factors. Numerous calculated relapses were likewise used to
decide the free factors related with ITNs utilization. For qualitative data, thematic analysis was
used. The study found that most of the respondents 135 (46.7%) were Catholic, 223 (77.2%)
were having and occupation. The highest number of respondents were married 132 (45.7%).
Most respondents 96 (33.3%) were between 100001RWF -200000 RWF of monthly income. The
majority of the respondents (71.3%) were having adequate ITN utilization while the remaining
(28.7%) were having inadequate ITN among pregnant mothers and the main factors associated
with ITN utilization were occupation, number of ANC visits and pregnancy semester where
participants who had an occupation were 80% occasions bound to have sufficient ITN use
contrasted with the individuals who were empty [AOR= 0.12;95%CI=0.0096-0.0472;P=0.001].
Pregnant moms with one ANC visits were 80% occasions bound to have sufficient ITN usage
contrasted with those with multiple visits [AOR= 0.233, 95%CI=0.076-0.712;P=0.011] however
pregnant moms with two ANC visits were multiple times bound to have satisfactory ITN use
contrasted with those with multiple visits [AOR= 3.136,95%CI=0.915-10.742;P=0.069].
Strategies that should be put in place to improve use of ITNs in Rubavu district are the use of
insecticide-impregnated mosquito nets, measures should be taken to those who misuse mosquito
nets received, and mosquito nets should be provided to all pregnant mothers without considering
the number of pregnancies. The study recommends that Rwanda Biomedical center should
improve education on ITN utilization for malaria prevention among pregnant mothers as they are
most vulnerable group to malaria diseases and Community health workers should organize
campaigns to promote ITNs utilization among pregnant mothers as they are more exposed.
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TABLE OF CONTENTS
DECLARATION............................................................................................................ ii
DEDICATION............................................................................................................... iii
ACKNOWLEDGEMENT ............................................................................................ iv
ABSTRACT .....................................................................................................................v
TABLE OF CONTENTS ............................................................................................. vi
LIST OF TABLES ........................................................................................................ xi
LIST OF FIGURES ..................................................................................................... xii
LIST OF ABBREVIATIONS .................................................................................... xiii
OPERATIONAL DEFINITIONS OF KEY TERMS .............................................. xiv
1.1 Background of the study .............................................................................................1
1.2 Statement of the Problem ............................................................................................2
1.3 Objectives of the study................................................................................................4
1.3.1 General objective .....................................................................................................4
1.3 Research questions .................................................................................................4
1.5 Significance of the study .............................................................................................4
1.6 Limitations of the study ..............................................................................................5
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1.7 Scope of the study .......................................................................................................5
1.8 Organization of the study ............................................................................................5
CHAPTER TWO: REVIEW OF RELATED LITERATURE ...................................7
2.0 Introduction .................................................................................................................7
2.1 Theoretical Literature ..................................................................................................7
2.1.1 Malaria in Africa ......................................................................................................7
2.1.2 Malaria in Rwanda ...................................................................................................9
2.1.3 Vulnerable groups and consequences ....................................................................10
2.1.4 Insecticide Treated Nets (ITNs) distribution .........................................................11
2.4 Empirical literature ...................................................................................................11
2.4.1. Utilization of Insecticide Treated Nets among pregnant mothers ........................11
2.4.2 Factors associated with utilization of ITNs among pregnant.................................12
2.4 Critical review and identification of research gaps ...................................................13
2.5 Theoretical framework ..............................................................................................14
2.6 Conceptual framework ..............................................................................................15
2.7 Summary ...................................................................................................................15
3.1 Reseach Desigbn .......................................................................................................17
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3.2 Target Population ......................................................................................................17
3.3. Sample Design .........................................................................................................17
3.3.1 Sample size ............................................................................................................18
3.3.2 Sampling Techniques .............................................................................................19
3.4 Data Collection Methods ..........................................................................................20
3.4.2 Administration of Data Collection Instruments .....................................................20
3.4.3 Validity and Reliability ..........................................................................................21
3.5 Data Analysis Proceduress ........................................................................................21
3.6 Ethical Consideration ................................................................................................22
CHAPTER FOUR: RESEARCH FINDINGS AND DISCUSSIONS ......................23
4.0 Introduction ...............................................................................................................23
Quantitative analysis .......................................................................................................23
4.1 Socio-demographic characteristics ...........................................................................23
4.2 Presentation of Findings ...........................................................................................25
4.2.1 Objective one: ITN utilization level among pregnant mothers in Rubavu district 25
4.2.2 Objective two: Factors associated with ITN utilization among pregnant mothers 28
Qualitative analysis .........................................................................................................32
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4.2.3 Objective three: Stragetegies used to improve ITNs utilization level among pregnant
mothers ............................................................................................................................32
4.3 Discussions ...............................................................................................................35
CHAPTER FIVE: FINDINGS, CONCLUSIONS AND RECOMMENDATIONS..40
5.0 Introduction ...............................................................................................................40
5.1.1 ITN utilization level among pregnant mothers in Rubavu district ........................40
5.1.3 Strategies used to improve ITNs utilization level among pregnant mothers .........41
5.2 Conclusions ...............................................................................................................41
5.3 Recommendations .....................................................................................................42
5.4 Suggestion for further study......................................................................................43
REFERENCES ..............................................................................................................44
APPENDICES ...............................................................................................................49
Appendix 1: Informed Consent Form .............................................................................49
Appendix 2: Questionnaire for Pregnant Mothers ..........................................................50
Appendix 4: Recommendation letter from MKUR .......................................................53
Appendix 5: Data collection letter from GDH ...............................................................54
Appendix 6: Consent Form (Kinyarwanda) ....................................................................55
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Appendix 7: Questionnaire (Kinyarwanda) ....................................................................56
Appendix 9: Focus Group Discussion (FGD) Guide for Pregnant Mothers (Kinya……58
Appendix 10: Overall score of ITN utilization ...............................................................59
Appendix 11: Administrative Map of Rubavu District ...................................................60
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LIST OF TABLES
Table 4.1: Socio-demographic characteristics ......................................................................... 24
Table 4.2: ITN utilization among pregnant mothers ................................................................ 26
Table 4.3: Association between demographic characteristics and utilization ......................... 29
Table 4.4: Multivariate analysis for factors associated with ITN utilization ........................... 31
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LIST OF FIGURES
Figure 2.1: Conceptual framework .......................................................................................... 15
Figure 4.1: ITN utilization level among pregnant mothers ...................................................... 27
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LIST OF ABBREVIATIONS
ACT: Artemisinine Combination Treatment
ANC: Anti Netal Care
DHC: District Health Team
DHS: Demographic Health Survey
DHT: District Health Team
IPTs-SP: Intermittent Preventive Treatments with Sulfadoxine- Pyrimethamine
ITNs: Insecticide Treated Nets
LLITNs: Long Lasting Insecticide Treated Nets
MKU: Mount Kenya University
PMI: President’s Malaria Initiative
RBC: Rwanda Biomedical Center
RDHS: Rwanda Demographic Health Survey
RDT: Rapid diagnostic test
SSA: Sub Saharan Africa
UNICEF: United Nations International Children's Emergency Fund
WHO: World Health Organization
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OPERATIONAL DEFINITIONS OF KEY TERMS
Adequate ITN utilization: In this examination, sufficient ITN usage alludes to the activity of
making viable and viable utilization of Insecticide Treated Nets at level equivalent to the cut of
point (70%) or more.
Factors: a condition, certainty, or impact that adds to ITN use.
ITN Utilization: the activity of making handy and successful utilization of Insecticide Treated
Nets. This will be dictated by score appraisal of factors in area 3 of the survey
Insecticide Treated Nets: A net that has been treated with bug spray to ensure against
mosquitoes and intestinal sickness, for greatest adequacy, ITNs ought to be re-impregnated with
bug spray at regular intervals.
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CHAPTER ONE: INTRODUCTION
1.0 Introduction
This section as the early on alludes to the foundation of the investigation and it gives the issue
articulation, goals of the examination, explore questions, restrictions, and the noteworthiness of
the examination just as the extent of the examination.
1.1 Background of the study
Bug spray treated bed nets (ITNs) are an establishment of wilderness fever revultion; different
intensive examinations in sub-Saharan Africa have exhibited ITNs to be fruitful in turning away
intestinal infection dismalness when used dependably (Phillips-Howard, 2003).
Intestinal distress pollution amidst pregnancy is a genuine expansive restorative issue which can
accomplish maternal and new thought about terribleness and mortality, particularly in sub
Saharan Africa where around 30 millions pregnant ladies are in hazard of the ailment yearly
(Dellicour et al., 2010).
Pregnant ladies are more probable than non pregnant ladies to wrap up spoiled with Plasmodium
falciparum wild fever and, when tainted, there is a propensity toward broadened sincerity of
infection (Parise et al., 1998). The affliction rate is higher among primigravidae than multidravid
ladies (Brabin B, 1991).
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In Cameroon, much identical to in other endemic regions as Rwanda, intestinal disease has been
emitted an impression of being a clarification behind maternal whiteness, intra-uterine
improvement obstruction, low birth weight, stillbirths and awkward births (Anchang-Kimbi et
al., 2009).
The World Health Organization (WHO's) suggestion for the control and repulsiveness of
intestinal illness amidst pregnancy in zones of high to facilitate wild fever transmission in Africa
is ITNs with reasonable association of clinical intestinal issue and iron insufficiency, which is
generally gone on through joint effort among intestinal sickness and regenerative thriving
projects (WHO, 2004).
ITNs have been gave off an impression of being the most canny measures in the revultion of
Malaria (WHO, 2008). ITNs have been seemed to lessen intestinal infection mortality by 17% in
children underneath the age of five (Len geler C, 2004). In context of the suitability of ITNs, the
Roll Back Malaria Partnership (RBM) centers to guarantee 80% of children and pregnant women
in threat for intestinal infection with ITNs by 2015 (Eisele et al., 2009). In this way, this
investigation will build up elements related with usage on ITNs in Rubavu locale, Rwanda. The
main region revealed the high-trouble segment in Rwanda by January 2016.
1.2 Statement of the Problem
Wilderness fever is an important general restorative issue, particularly in SSA. Consistently,
300-500 million wilderness fever cases brief more than one million passings all around of which
90% occur in SSA (Lipa, 2010).
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Bug splash treated bed nets (ITNs) are practical in staying away from intestinal ailment where
vectors primarily eat inside and late during the night, yet their feasibility is questionable where
vectors snack outside and earlier around evening time (Steinhardt et al., 2017). A wilderness
fever plague, as portrayed by WHO ,is an occasion of a more prominent number of cases of
sickness than foreseen in a given region or among a specific get-together of people over a
particular time allotment (WHO, 2010). In this manner the service of wellbeing announced in
excess of a hundred cases for each day of jungle fever in Rubavu segment of Rubavu area in the
western region of Rwanda by January of 2016, intestinal sickness was then considered as a
pestilence infection during such timeframe.
Hence, it isn't known whether the number of inhabitants in Rubavu uses appropriately ITNs for
jungle fever control. In Rwanda, execution of network based intestinal sickness control programs
with expanded circulation and usage of ITNs by pregnant ladies and youngsters cut down jungle
fever forcefully from 44% to 90% in the network (Otten et al., 2009).
Furthermore, there have been no studies conducted in Rwanda specifically focusing on
utilization of ITN among pregnant women while Malaria affects children and pregnant women
more compared to the general population (Murphy, 2011). Despite the knowledge that ITN
utilization is an effective intervention for preventing malaria, many studies around the globe
reported barriers to ITN utilization, particularly among pregnant women. There is a need to
assess factors that affect utilization of ITN, so as to inform public health intervention in Rwanda.
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1.3 Objectives of the study
1.3.1 General objective
The main objective of this study will be to establish factors associated with utilization of ITNs
among pregnant mothers in Rubavu district.
1.3.2 Specific objectives
i. To determine utilization level of ITNs among pregnant mothers in Rubavu district
ii. To Establish factors associated with utilization of ITNs among pregnant mothers in
Rubavu district
iii. To explore strategies used to improve ITNs utilization among pregnant mothers in Rubavu
district
1.3 Research questions
i. How is the utilization level of ITNs among pregnant mothers in Rubavu district?
ii. What are factors associated with utilization of ITNs among pregnant mothers in Rubavu
district?
iii. What are the strategies used to improve ITNs utilization level among pregnant mothers in
Rubavu district?
1.5 Significance of the study
Government of Rwanda will benefits from this study in planning, implementing and designing
relevant strategies for ITN distribution and utilization for malaria control among pregnant
mothers in Rubavu District. This study also helps health policy makers identify the causes of
ITNs utilization and to update the existing data and policies on the distribution and use of ITNs
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in Rubavu. This investigation will furnish gauge data in regards to variables related with ITNs
use among pregnant ladies in Rubavu area, which might be utilized for further analysts.
1.6 Limitations of the study
Findings of this study may not be applicable to all areas in Rwanda since all households will not
be represented and only investigation will cover Rubavu district to represent all pregnant
mothers of Rubavu district. The findings of this study will be based on information obtained
from pregnant mothers in Rubavu district of Rwanda and may not be generalized beyond such
district.
1.7 Scope of the study
This study will be conducted in Rubavu district of western Province. The district is situated on
Latitude: -1°40'52.54"Longitude: 29°19'45.56". Rubavu area is made out of 12 parts and 525
Villages, 88849 family units and an all out populace of 303,549 of which 171,046 are female
(56.3%). In Rubavu area, just 0.4 percent of ladies have jungle fever when contrasted with 0.6
percent at national level (RDHS, 2014-2015).
As this study is a cross-sectional; the data will be collected at one point in time which is in July
2018. This exploration will be done to find out the variables related with use of ITNs among
pregnant moms in Rubavu area.
1.8 Organization of the study
The examination is partitioned into three sections. The section one incorporated the foundation
of the examination, proclamation of the issue, targets of the investigation, look into inquiries,
importance and the association of the examination. Section two contains hypothetical writing,
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experimental writing with the concentration to elements related with usage of ITNs just as
theoretical system of the investigation and Chapter three depicted techniques utilized in th
examination.
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CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.0 Introduction
This section contains the writing identified with the elements related with use of ITNs among
pregnant moms. It incorporates the hypothetical writing, exact writing, basic survey and research
hole recognizable proof, calculated system and also the recap of the writing audit.
2.1 Theoretical Literature
2.1.1 Malaria in Africa
ITNs are the fundamental obstruction technique in Malaria counteractive action. As a vector
control mediation, ITNs are viable in counteracting intestinal sickness grimness and mortality in
a scope of epidemiological settings. In decreasing densities and infectivity of jungle fever
vectors, they lessen general transmission and ensure all people inside a network if utilized
successfully by all network individuals (WHO, 2006).
Mosquito nets have been supported for as the most preventive apparatuses against intestinal
sickness particularly in SSA. Numerous individuals have kicked the bucket from jungle fever
contamination are as yet biting the dust progressive particularly moms and kids. In spite of this,
the control endeavors have paid off and there is a decrease in the quantity of cases and passings.
This is because of expanded utilization of preventive methodologies and enhanced mindfulness
on the significance of intestinal sickness aversion (UNICEF, 2016). The utilization of ITNs is a
financially savvy strategy used to decrease the quantity of cases and passings caused by intestinal
sickness and this has been accounted for in various Sub Saharan nations.
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This was done in order to reduce mortality in this group (UNICEF, 2016). The ITNs were
distributed during the antenatal clinics and during routine immunization for children below 5
years. In 2009, the ownership of ITNs was scaled up through the strategy of universal access and
nationwide distribution of ITN was adopted to cover all the populations at risk of getting malaria
infection. In 2012, a policy on universal coverage with ITNs was adopted by all the countries
which were at the risk of malaria infections. This was defined by one ITN for two people at the
risk of malaria infection. As a result, this led to free ITN distribution in 39 out of 44 malaria
endemic countries through the antenatal clinics and immunization clinics for children under the
age of five years (UNICEF, 2016).
Intestinal sickness keeps on being the main source of horribleness and mortality in Africa. As use
of intestinal sickness control mediations, for example, enduring bug spray treated bed nets
(LLINs) has expanded, numerous reports have demonstrated a considerable drop in jungle fever
occurrences, intestinal sickness related hospitalizations, and jungle fever related demise
(O'Meara, 2008, Ceesay, 2007, Otten, 2009a) these discoveries have not been uniform crosswise
over Africa (Roca, 2012). Studies have demonstrated an expansion in intestinal sickness related
hospitalizations over a period in Uganda (Okiro, 2011, Okello, 2006).
Be that as it may, the weight of jungle fever among schoolchildren differs as indicated by the
power of intestinal sickness transmission (Snow and RW, 1999). While the danger of clinical
assault is bring down in territories of unsteady jungle fever transmission, the assaults are more
extreme as kids have not gained any huge level of insusceptibility.
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2.1.2 Malaria in Rwanda
For the most recent decade, Rwanda has gained colossal ground in jungle fever control and
counteractive action with more than 75 for every penny decrease in intestinal sickness passings
and occurrence between the years 2005 and 2011 (RBC, 2017). Since 2009, Rwanda is moving
towards general scope of mosquito nets with 82 for each penny of family units having no less
than one enduring bug spray treated net. Once more, more than 70 for every penny of kids under-
five and pregnant ladies rest under a durable treated net (RBC, 2017).
By 2009, Rwanda had additionally accomplished all inclusive treatment of jungle fever cases
utilizing Artemisinine Combination Treatment (ACTs) both at wellbeing office level and at
network level utilizing Community Health Workers (CHW) who were prepared to test intestinal
sickness with Rapid Diagnostic Test (RDTs). Today more than 94 for every penny of every
wiped out tyke are dealt with inside 24 hours and 99 for every penny of jungle fever cases are lab
analyzed before getting the right treatment (RBC, 2017).
As indicated by the 2010 Demographic Health Survey (DHS), jungle fever pervasiveness
diminished from 2.6 out of 2008 to 1.4 of every 2010 in kids Under-five and from 1.4 of every
2008 to 0.7 out of 2010 among pregnant ladies. The way to our prosperity has to a great extent
been a forceful Government-drove rollout arrange for that joins an incorporated blend of
counteractive action, treatment and mosquito control exercises, with a solid accentuation on
reinforcing our wellbeing framework (RDHS, 2010).
Presently, the jungle fever trouble in Rwanda has progressed from an across the nation issue into
a central issue generally in six high intestinal sickness load areas along the outskirt in the Eastern
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and Southern regions, which represent more than 60 for each penny of the jungle fever load. As
an administration, we are resolved to guarantee that even these high-chance territories turn out to
be generally safe sooner rather than later by revealing a blend of preventive specifies and
participating in cross-fringe joint efforts with our neighbors since these influenced zones lie
along Rwanda's geological outskirts (RBC, 2017).
The Government of Rwanda, in close joint effort with accomplices like the Global Fund, PMI
and WHO, has begun advancements for supportability in the region of jungle fever control
mediations that amplify affect per cash spent and the welfare of the network. Rwanda centers
around accomplishing zero passings and diminishing intestinal sickness dismalness to pre-end
levels by 2017. This must be accomplished if all Rwandans clean their condition and mosquitoes
draining locales, rest each night under a treated mosquito net, look for medicinal services and get
the best treatment which is accessible in all wellbeing offices and at network level through the
30,000 Community Health Workers (CHWs) (RBC, 2016).
2.1.3 Vulnerable groups and consequences
Malaria affects children and pregnant women more compared to the general population (Murphy,
2001). It is responsible for spontaneous abortions especially among the first and second
pregnancies, leading to anemic and 19% low birth weight babies in Africa (Helen, 2004). Among
the general population, malaria is responsible for causing the wide spread poverty due to reduced
productivity on the farm land. In school going children, Malaria is responsible for poor
performance in class due to increased absenteeism and failure to concentrate. Among children of
school going age, malaria is associated with cognitive impairment, anemia, irregular school
attendance and consequently poor performance (Nankabirwa et al., 2013).
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2.1.4 Insecticide Treated Nets (ITNs) distribution
Durable ITNs are the primary obstruction preventive procedures utilized as a part of Uganda and
Tororo on the loose. Since 2006, in excess of 3 million ITNs have been scattered the nation over
with assistance from the President's Malaria Initiative (PMI) and the Global Fund for AIDS, with
the purpose of achieving the national focal point of 85%, house hold extension and 60% of
pregnant women and children under five napping under ITN.Tororo district with implementing
partners such as TASO, PACE, World Vision and plan Uganda have been actively involved in
free distribution to infants and pregnant women through mass campaigns and antenatal clinics
and immunization sessions. The malaria consortium has also scaled up the distribution of
insecticide mosquito nets to school going children in an attempt to promote a culture that
demands for use of mosquito nets (Malaria Consortium, 2013).
2.4 Empirical literature
2.4.1. Utilization of Insecticide Treated Nets among pregnant mothers
The appraisal done in Cameroun on parts related to the utilization of ITNs and broken preventive
treatment for wild fever control amidst pregnancy finds the general degree pace of IPT was 88.7
% and 43.8 % for ITN while the general non use rate for IPT and ITN was 11.3 % and 17.5 %
individually (Leonard et al., 2016).
A cross-sectional examination done in Cameroun on variables identified with bed net use in
Cameroon: a survey consider in Mfou prosperity region in the Center Region finds Net
proprietorship and use were independently, 59.7 and 42.6%; in this way, 2 out of 5 people who
went through the prior night in families, rested under a net (Tchinda et al., 2012).
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A Cross sectional investigation among pregnant ladies was embraced utilizing both quantitative
and subjective information gathering strategies. An aggregate of 267 members were chosen
utilizing straightforward arbitrary testing. The examination finds that 74% of every single
pregnant lady were utilizing bug spray treated nets. The inclusion if ITNs use was high however
this was not uniformly circulated crosswise over social and monetary status sections
(Ssedyabule, 2013).
2.4.2 Factors associated with utilization of ITNs among pregnant
A comparative report done in Cameroun on factors related to the utilization of bug shower
treated nets and broken preventive treatment for intestinal disease control amidst pregnancy
discovers Occupation, instructive measurement, trimester and number of ANC were quantifiably
basic to ITN use by bivariate assessments while being an understudy/jobless (OR = 0.25, 95 %
CI = 0.07–0.95)) was conflictingly related to ITN use by multivariate assessment. For IPTp-SP,
control of people, enlightening measurement, trimester of pregnancy and number of ANC were
really on an exceptionally fundamental level by bivariate assessments while going to ANC just
once (OR = 0.006, 95 % CI = 0.00–0.04) was horribly related to IPTp-SP use by multivariate
assessments (Leonard et al., 2016).
The investigation done by Tchinda et al. (2012) on elements identified with bed net use in
Cameroon: an audit consider in Mfou prosperity region in the Center Region finds variables
related with net use included: net density≥0.5 (OR=8.88, 95% CI: 6.24-12.64), age≥5 years
(OR=0.37, 95%CI: 0.28-0.47), discretionary guidance (OR=1.41, 95% CI: 1.11-1.80) appeared
differently in relation to fundamental/no preparation, parent status (OR=3.32, 95% CI: 2.31-
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4.76), house improvement (OR=1.37, 95% CI: 1.10-1.71) and condition characteristics
(OR=1.46, 95% CI: 1.18-1.80) (Tchinda et al., 2012).
Uganda finds the following factors that were associated with utilization of ITNs; being married
(OR=2.99; 95%C1 1.39-6.43) and higher income (OR=2.79; 95%C1 1.35-5.75) (Ssedyabule,
2013).
2.4 Critical review and identification of research gaps
Successful general wellbeing training on the utilization of ITNs ought to be fortified
notwithstanding giving them out for nothing, to upgrade availability to the utilization of ITN. It
may be beneficial for general wellbeing specialists and on-screen characters to embrace mass
mindfulness crusades to instruct moms on the significance of customary ANC visits and ITN
utilize focusing on particularly individuals with low levels of training, pregnant young people,
understudies and the jobless.This study was done using small sample size of 292 pregnant
women in Cameroun which should not be generalized to the whole country but to the district
level and was also done using only quantitative method while it should be done using both
quantitative and qualitative approaches in order to capture richly information regarding the topic
(Leonard et al., 2016).
In the examination done in Uganda on components related with use of bug spray treated nets
among pregnant ladies in Lyantonde locale, it demonstrates that lone two variables (conjugal
status &income) have been viewed as related to ITN use .The findings of the study done in
Zambia propose that tertiary instruction of the leader of the family unit and number of ITNs is
significant in deciding ITN usage by 5-multi year olds. In this manner, arriving at widespread
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inclusion on ITNs joined by wellbeing instruction particularly focusing on those with lower
training levels could prompt value of use over all age gatherings.
2.5 Theoretical framework
The hypothetical system of this examination in light of the wellbeing conviction display structure
(HBM). It is a social-mental model that endeavors to clarify and foresee singular wellbeing
conduct by concentrating on the state of mind and convictions of people. The model was created
in the 1950s. The HBM is stranded on three main components such as the perception of
individuals whereby this will explain how pregnant mothers perceive ITNs utilization, the action
of factor modification that may lead to the likelihood of taking recommended health action. This
explains how pregnant mothers take action regarding their health status.
The HBM suppose that person will obtain some action related health when such people perceives
susceptibility, the state of severity, importance in taking some action to reduce being at risk and
improve the believes that being able to successfully execute the necessary action to create a
desired results without blockage (Becker and Rosenstock 2011). This model assumes that
pregnant mothers will use ITNs if that they perceive susceptibility to malaria, depend on severity
of the problem and when understand the benefits of using ITNs.
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2.6 Conceptual framework
Independent variables Dependent variable
Intervening variables
Figure 1.1: Conceptual framework
Source: Researcher,2018
The theoretical system demonstrates the connection between autonomous, interceding and
subordinate factors. It shows the variables that effect the utilization of ITNs among pregnant
moms, for example, independents (Social demographic, Social economic, Social Culture,
knowledge, attitude, perception and belief, affordability )which influence directly the dependent
variable while intervening variables (Quality care services and Knowledge on the importance of
ITNs utilization) influence indirectly the dependent variable.
2.7 Summary
Malaria is caused by plasmodium infection and it is very common among pregnant mother.
Malaria affects children and pregnant women more compared to the general population. It is
responsible for spontaneous abortions especially among the first and second pregnancies, leading
Social demographic
variables
Social economic variables
Social Culture variables
Knowledge,attitude,percepti
on and beliefs
Affordability
Utilization of ITNs among
pregnant mothers
o Quality care services
o Health system factors
16
to anemic and 19% low birth weight babies in Africa. Among the general population, malaria is
responsible for causing the wide spread poverty due to reduced productivity on the farm land.
Bug spray treated nets (ITNs) are the primary boundary technique in Malaria avoidance. As a
vector control intercession, ITNs are powerful in avoiding jungle fever horribleness and
mortality in a scope of epidemiological settings.
In decreasing densities and infectivity of jungle fever vectors, they lessen general transmission
and ensure all people inside a network if utilized adequately by all network individuals. Usage of
bug spray treated nets can be impacted by various variables, including financial and socio –
statistic circumstance, information, conviction and reasonableness. Subsequently, this
examination looks to research the components related with use of ITNs among pregnant mother
in Rubavu District.
17
CHAPTER THREE: RESEARCH METHODOLOGY
3.0 Introduction
In this part, the analyst depicted the exploration outline and strategy that will be utilized as a part
of the examination, which incorporates populace, test plan, information gathering and
information investigation.
3.1 Reseach Desigbn
This will be a cross-sectional assessment using mixed procedures with both quantitative and
abstract data social occasion draws near. In any case the quantitative methodology of data
aggregation technique will be coordinated and after that abstract methodology will take after. A
sorted out survey will be used to accumulate quantitative data and FGDs for abstract data.
3.2 Target Population
The study population will be pregnant mothers attending ANC services in health centers during
the study period. The population of this study will consist of 473 pregnant women who were
receiving ANC services in public health institution in the district (GDH, 2017). The pregnant
mothers will be the primary respondents for quantitative data collection while CHWs will be
FGDs participants.
3.3. Sample Design
This includes sample size and sampling techniques that will be used.
18
3.3.1 Sample size
A sample is a portion of of the populace chose to speak to the populace in general. The possible
example measure is generally a trade off between what is alluring and what is practical.
Cochran (1963) recipe will be utilized to decide the example estimate as demonstrated as
follows. The Overall scope rate of ITN in the investigation done in Cameroun was considered as
P of 0.44 that will be utilized to appraise test measure.
n= (Z 2) p (1-p)
d2
Where:
z = standard normal deviate set at 1.96 z-score corresponding to 95% confidence level
p= will be set at 0.44
q= 1-p=1-0.44=0.56
d= Level of centrality. This value at 95% confidence level given as 0.05
n = (1.96) (1.96) 0.44 (1-0.44)
(0.05) (0.05)
n= 378.6
Since the target population is less than 10,000 as reported by GDH, the limited populace revision
factor is applied to the determined example size.
nc= Nn
(Cochran, 1977) (N+n-1)
Where,
nc =sample size after finite population correction factor
N = Target population size of 473
n = calculated sample size before adjustment
19
The sample size after finite population correction factor
(nc) = 473×378
(473+378-1)
nc = 210 pregnant women
The sample size after finite population correction factor will be 210 pregnant women; this will be
inflated for refusals to participate in the study by 10%. The adjusted sample size will be given
by:
n (new) = n (calculated)
1-λ
Where;
n (new) = Adjusted sample size
n (calculated) = Calculated sample size
λ = Adjustment for refusal to participate (10%)
n (new) = 210/0.9
The adjusted sample size = 233 study participants.
The sample size for qualitative data will be three FGDs composed by 24 CHWs
3.3.2 Sampling Techniques
ANC follow up logbook will be used to systematically select 233 eligible pregnant mothers
attending the clinic. The first patient will be selected on each ANC day by writing down the
names of the first two patients each on a separate piece of paper and one will be selected
randomly. Thereafter, every other patient that meets the selection criteria will be included. Then
the questionnaire will be administered to each selected individual.
20
For qualitative data, CHWs will be selected purposively considering those with knowledge
regarding ITN use.
3.4 Data Collection Methods
This part is depicting the strategies that will be utilized in information gathering. It incorporates
information gathering instruments, organization of information accumulation instruments and
furthermore legitimacy and unwavering quality of the devices.
3.4.1 Data collection instruments
Quantitative information was gathered by utilizing semi-organized poll (Appendix 2). The poll
will be converted into Kinyarwanda and made an interpretation of back to English to guarantee
that it keeps up its unique significance.
For qualitative data, FGDs guide was developed (Appendix 3) and conducted among CHWs
knowledgeable about the use of ITN. Digital voice recorder will be used to capture all
information. The principal investigator was conducted the interview and the information was
recorded.
3.4.2 Administration of Data Collection Instruments
First approval letter obtained from Mount Kenya University. Authorization to collect data will be
made by GDH administration and ethical clearance will be sought from Rubavu district hospital
ethical committee. Then data collection tools will be administered after receiving consent from
each study participants. Participants will be recruited after consent is sought and obtained from
each individual. The discussion will be expected to last for about 30 minutes. The principal
investigator will moderate the interview and will be assisted by one research assistant to write all
21
the notes. At the end of each day the researcher will cross check the questionnaire for
completeness. Only completed questionnaires will be considered for data entry.
3.4.3 Validity and Reliability
To guarantee the legitimacy of the exploration instrument, the analyst planned the poll by
looking into important writing and concentrates in the region of intrigue. The poll will be pre-
tried in Musanze region among 20 pregnant ladies so as to test if the instruments are solid.
Alterations will be made in like manner, on the off chance that required, direction of the
administrator. The Cochrane's coefficient will be determined to quantify the rate understanding
between the reactions from the two tests. A coefficient of 0.7 or more will be viewed as
satisfactory for field testing of the instrument. Research assistants will also be trained on how to
collect data and the overall study objectives.
3.5 Data Analysis Proceduress
Crude information from the poll will be gone into EPI information and transported into
Statistical Package for Social Sciences (SPSS) structure 22 for assessment. Unmistakable
measurements will be utilized to classify and portray the information and after that inferential
insights (Chi-square) will be utilized to build up factors related with use. The qualities of the
affiliations will be resolved with different strategic relapses. Surmising will be made utilizing a
95% certainty interim and a p-esteem under 0.05. The outcomes will be displayed in recurrence,
rates, tables and charts.
22
For the subjective examination, the unit of investigation will be the transcripts from the FGDs.
Recorded information will be deciphered and made an interpretation of from Kinyarwanda to
English.
Transcripts will be first perused a few times while making notes on them. All transcripts will be
perused however and codes created. Reactions with comparative codes will be re-sorted under a
bringing together sub-topics or subject. A lattice will be made and singular frameworks will be
inspected until the point that an assention is come to. The classifications will then be deciphered
for their distinct importance. Engaging statements speaking to key topics will be recognized and
incorporated into the last report composing.
3.6 Ethical Consideration
Moral endorsement to lead the investigation will be looked for from Gisenyi District Hospital
(GDH) moral board of trustees. All information and study subjects will be guaranteed of secrecy,
information security and proper information stockpiling; and that codes will be utilized to
supplant respondents' names amid information gathering,analysis, presentation and storage.
23
CHAPTER FOUR: RESEARCH FINDINGS AND DISCUSSIONS
4.0 Introduction
This part introduces the discoveries of the investigation. The outcomes are displayed and
deciphered dependent on the destinations of the examination. These incorporate the statistic; use
of Insecticide Treated Nets among pregnant moms in Rubavu region. A sum of 289 respondents
took an interest in the investigation giving a reaction rate of 100%. The outcomes are displayed
in recurrence tables and diagram shapes.
Quantitative analysis
4.1 Socio-demographic characteristics
The distribution of the selected Socio-demographic characteristics among pregnant mothers is
shown in Table 4.1.
24
Table 4.1: Socio-demographic characteristics Variable N=289 %
Residence type
Rural 130 45
Urban 159 55
Age group
18-27 years 71 24.6
28-37 years 191 66.1
38-47 years 27 9.3
Marital status
Married 132 45.7
Single 90 31.1
Divorced 39 13.5
Widowed 28 9.7
Sex of HH
Male 186 64.4
Female 103 35.6
Religion
Catholic 135 46.7
Muslim 62 21.5
Protestant 92 31.8
Number of HH members
Two-three 181 62.6
Four-five 36 12.5
>Five 72 24.9
Education level
Illitrate 62 21.5
Primary 116 40.1
Secondary 51 17.6
College/university 60 20.8
Have an occupation
Yes 223 77.2
No 66 22.8
If yes, monthly income (n=223)
Less than 50,000 Rwf 41 14.2
Between 50,000 and 100,000 Rwf 63 21.8
Between 100,001 and 200,000 Rwf 96 33.2
More than 200,000 Rwf 23 8
Primigravidae pregnancy
Yes 80 27.7
No 209 72.3
Number of ANC visits
One 165 57.1
Two 69 23.9
More than twice 55 19
Pregnant semester
First 75 26
Second 78 27
Third 136 47.1
Primary data
As indicated in the table above, the demographic characteristics show that the highest percentage
of respondents 159(55%) were living in urban area. Most of the respondents 191(66,1%) were
25
inside the age gathering of 28-37 years. The most elevated level of the respondents 186(64.4%)
were males. Taking into consideration of number of household members, the highest respondents
181(62.65) were between 2-3 and males 186(64.4%) were the head /chef of the house hold.
Regarding level of education, majority 116 (40.1%) was attending primary school. The findings
also show that most of the respondents 135 (46.7%) were Catholic while the remaining (21.5%)
were Muslims and Protestant 92 (31.8%). The respondents were asked about the employment
status and the majority 223 (77.2%) were having job while the remaining 66(22.8%) were not
occupied.
In terms of marital status, the highest number 132 (45.7%) of respondents were married followed
by single 90(31.1%), divorced 39(13.5%) and widow/widower with 28 (9.7%). Considering the
monthly income, most of respondents 96(333.3%) was between 100001RWF -200000 RWF. The
results further indicate that the high percentage of the respondents 165(57.1%) were their first
ANC and were in third semester with 136(47.1%) and the pregnancy was not primigravidae with
209(72.3%).
4.2 Presentation of Findings
The findings of this study are presented according to their study objectives as shown below.
4.2.1 Objective one: ITN utilization level among pregnant mothers in Rubavu district
The objective one was to evaluate the dimension of ITN use among pregnant moms in Rubavu
district and was calculated by score assessment of variables presented in Table 4.2 below.
26
Table 4.2: ITN utilization among pregnant mothers
Variable
N=289 %
Sleep under mosquito
Yes 235 81.3
No 54 18.7
If no, why
Nausea 29 10
High temperature in HH 25 8.7
Ever forgot to sleep under mosquito net in the last week
Yes 39 13.5
No 250 86.5
Every bed in household has mosquito net
Yes 98 33.9
No 191 66.1
Type of mosquito used in household
Only untreated net 27 9.3
Both treated and untreated net 209 72.3
Only treated net 53 18.3
In the last week, times slept under the net (n=235)
Daily 113 39.1
Thrice 67 23.2
Twice 60 20.8
Once 49 17
Mosquito net is need to be used regularly
Agree 235 81.3
Disagree 54 18.7
Source: Primary data
As indicated in Table 4.6, majority 235(81.3%) of respondents sleep under mosquito nets and
250 (86.5%) never forget to sleep under a mosquito net in last week. The majority of respondent
191 (66.1%) do not have mosquito nets for every bed in their house hold and 209(72.3%) had
both treated net and untreated nets.
27
Considering the frequency of sleeping in mosquito nets, the majority of respondents 113(39.1%)
sleep daily in ITN in the last week starting by the week the research has been conducted.
The high majority of respondents 235(81.5%) agreed that mosquito nets must be used regularly.
The overall score ITN utilization among pregnant mothers was determined by using a score of
responses. Six (6) variables presented in Table 4.2 were considered together and scores are
structured in Appendix 10. The maximum attainable total score was 9 and minimum score was 4
with the cut off point being (70%). The majority of the respondents had adequate utilization
(71.3%) while the remaining (28.7%) were having inadequate ITN utilization.
Figure 4.2: ITN utilization level among pregnant mothers
Source: Primary data
28
4.2.2 Objective two: Factors associated with ITN utilization among pregnant mothers
Second goal of the examination was to set up components related with ITN use among pregnant
moms. Bivariate and multivariate analyses were used to establish these factors as shown in the
following tables.
Bivariate analysis of pregnant mothers characteristics with utilization
Bivariate analysis of the association between pregnant mothers characteristics with ITN
utilization level is shown in Table 4.3.
29
Table 4.3: Association between demographic characteristics and utilization
Variables Adequate Inadequate Qui
square P value
n % n %
Residence type
2.191 0.139
Rural 87 66.9 43 33.1
Urban 119 74.8 40 25.2
Age group
10.076 0.006
18-27 years 57 80.3 14 19.7
28-37 years 125 65.4 66 34.6
38-47 years 24 88.9 3 11.1
Marital status
53.75 <0.001
Married 66 50 66 50
Single 140 89.2 17 10.8
Sex of HH
0.861 0.353
Male 136 73.1 50 26.9
Female 70 68 33 32
Religion
3.382 0.066
Christian 156 68.7 71 31.3
Muslim 50 80.6 12 19.4
Number of HH members
45.199 <0.001
Two-three 104 57.5 77 42.5
Four and more 102 94.4 6 5.6
Education level
13.258 0.001
Illiterate/primary 140 78.7 38 21.3
Secondary 28 54.9 23 45.1
College/university 38 63.3 22 36.7
Have an occupation
7.847 0.005
Yes 168 75.3 55 24.7
No 38 57.6 28 42.4
If yes, monthly income (n=223)
0.46 0.498
Less than 50,000 Rwf 152 76 48 24
More than 200,000 Rwf 16 69.6 7 30.4
Primigravidae pregnancy
2.131a 0.144
Yes 52 65 28 35
No 154 73.7 55 26.3
Number of ANC visits
48.732a <0.001
One 137 83 28 17
Two 27 39.1 42 60.9
More than twice 42 76.4 13 23.6
Pregnant semester
32.662 <0.001
First and second 131 85.6 22 14.4
Third 75 55.1 61 44.9
Source: Primary data
As indicated in Table 4.3, age group, marital status, number of house hold members, education
level, having an occupation, number of ANC visits and pregnancy semester were statistically
significant with ITNs utilization among pregnant mothers.
30
Multivariate analysis for significant variables and ITN utilization
Numerous strategic relapse investigation was connected to recognize the factors autonomously
connected with ITN utilization. Seven (7) variables were considered in the analysis including:
Respondents characteristics such as age group, marital status, number of household members,
education level, occupation, number of ANC visits and the pregnant trimester. Upon fitting these
factors using binary logistic regression and by specifying „backward conditional‟ method with
removal at P<0.05, three were significantly associated with ITN utilization.
31
Table 4.4: Multivariate analysis for factors associated with ITN utilization
Variables AOR
95% CI
P value Lower Upper
Full Model
Age group
0.054
18-27 years 1.903 0.426 8.504 0.4
28-37 years 3.883 0.969 15.56 0.055
38-47 years Reference
Marital status
Married Reference
Single UD UD UD 0.159
Number of HH members
Two-three UD UD UD 0.998
Four and more Reference
Education level
Illitrate/primary UD UD UD 0.754
Secondary UD UD UD 0.159
College/university Reference
Have an occupation
Yes 0.212 0.096 0.472 <0.001
No Reference
Number of ANC visits
One 0.233 0.076 0.712 0.011
Two 3.136 0.915 10.742 0.069
More than twice Reference
Pregnant semester
First and second 0.189 0.08 0.451 <0.001
Third Reference
Reduced Model
Age group
0.054
18-27 years 1.903 0.426 8.504 0.4
28-37 years 3.883 0.969 15.56 0.055
38-47 years Reference
Have an occupation
Yes 0.212 0.096 0.472 <0.001
No Reference
Number of ANC visits
<0.001
One 0.233 0.076 0.712 0.011
Two 3.136 0.915 10.742 0.069
More than twice Reference
Pregnant semester
First and second 0.189 0.08 0.451 <0.001
Third Reference * Significant at p<0.05 bolded; AOR= Adjusted odds ratio; CI = Confidence Interval; UD= Undefined
Source: Primary data
32
Individuals who had an occupation were 0.2 events increasingly unwilling to have acceptable
ITN utilization stood out from the people who were not having an occupation [AOR=
0.212;95%CI=0.0096-0.0472;P=0.001]. Pregnant mothers with one ANC visits were 0.2 events
increasingly loath to have agreeable ITN use appeared differently in relation to those with
numerous visits [AOR= 0.233, 95%CI=0.076-0.712;P=0.011] anyway pregnant mothers with
two ANC visits were on various occasions bound to have adequate ITN use diverged from those
with numerous visits [AOR= 3.136,95%CI=0.915-10.742;P=0.069].
Respondent in second/third pregnancy semester were 0.1 occasions less inclined to have
sufficient ITN usage contrasted with those with those in first semester
[AOR=0.189;95%CI=0.08-0.451;P=0.001].
Qualitative analysis
4.2.3 Objective three: Stragetegies used to improve ITNs utilization level among pregnant
mothers
This was qualitative method whereby three FGDs were conducted among pregnant mothers
attending health facilities of Rubavu district.
Themes
1 Knowledge about ITNs
2 The role of district health service in mobilizing people for ITNs use for malaria prevention
3 Strategies to improve ITNs utilization level at village level
33
Theme 1: Knowledge about ITNs
Most of respondents have adequate knowledge about ITN utilization as reported by respondent 4
of FGD 2 said that: "All what I know about insecticide- impregnated mosquito net is that it
prevents malaria and it should be regularly used to provide optimum protection and therefore
prevents us from going to hospital often. In addition, people should be sure of impregnation or
else let their mosquito nets be impregnated with insecticide to ensure effective protection”. The
same respondent 4 of FGD 2 also said that:
"The mosquito net is the way used to prevent the spread of malaria among people. When it is not
impregnated, it does not provide any protection against that disease, malaria, which is a killer in
case it is not treated well." The sentiments of respondent 4 were supported by that of the
respondents 2 and 3 of FGDs 1&3 respectively.
Theme 2: The role of district health service in mobilizing people for ITNs use for malaria
prevention
About all respondents cofirm that district officials have significant role in mobilizing people for
ITNs use for malaria prevention as reported by respondent 2 of FGD 1 said that: “The district
officials help us very much. They take initiative to mobilize the people for free while all services
rendered to us by the health center's workers are paid. The local leaders really consider it as
their responsibility.”. The respondent went further to say:
“The local leaders should assume a pivotal job in aversion and treatment of intestinal sickness in
light of the fact that the individuals spend more time with them and therefore trust them more
34
than they do for health center's workers”. The other respondents (1,3 and 5) of FGDs 2 and 3
comments supported the same motion.
Most respondent agreed that community health workers have considerable role in malaria
prevention as reported by the respondent 3 of FGD 2 said that “In our villages, we choose
community health workers among ourselves. They help us in malaria prevention. They carry out
effective mobilization thanks to trainings they attend”.
Theme 3: Strategies to improve ITNs utilization level at village level
Most of respondents confirm that use of ITN as instructed by the doctor, set punishment policy
to those who misuse ITN, use of loudspeaker while mobilizing people on the use of ITN,
mosquito net should be provided to all pregnant mothers and proper mobilization to vulnerable
people like pregnant mothers as reported by respondent 7 of FGD 3 participants said that:
“People must use insecticide-impregnated mosquito nets as instructed by the doctor”. The same
was supported by respondent 6 of FGD 1 participants.
The respondent 5 from FGD 2 said that: “There should be checking to find out those who misuse
the given mosquito nets. In case they find any, some other measures must be taken; for example
charging them a certain amount of money for that wrongdoing”. Her sentiments were supported
by the other FGDs 1&3.
The respondent 3 from FGD1 said that: “Community health workers should use loudspeakers to
mobilize all people, including those who haven't taken any mosquito nets, to help them know the
time of the distribution of mosquito nets”.
35
The respondent 2 of FGD 3 said that: “Actually, the mosquito net is given to the woman who gets
pregnant for the first time. This should be changed. They should rather provide all pregnant
mothers with mosquito nets without considering the number of pregnancies”.
The same respondent 2 of FGD3 also said that: “People, especially pregnant mothers, should be
effectively mobilized for the proper use of mosquito nets to avoid both the misuse of them like
using them as fishing nets, sheds for hens or selling them in the neighboring country, Democratic
Republic of Congo, and people's misconception that mosquito nets cause warming and eye-
related allergy”. Respondent 2 of FGD 3 went further to say: “The community health workers try
to always join people to collect their problems about mosquito nets and then advocate for those
who don't have mosquito nets”. Her sentiments were supported by FGDs 2& 3 partcipants.
4.3 Discussions
The present examination finds that lion's share of the pregnant moms were having sufficient ITN
usage (71.3%) while the staying (28.7%) were having deficient ITN use in Rubavu region. This
could be an eventual outcome of the extra positive data as a huge piece of the push to achieve the
2015 focus as showed by the national intestinal contamination rule (MoH, 2012) since the
previous assessments were facilitated. As showed by the standard getting ready, preparing and
honing at system level was progressed as a fundamental technique to accomplish higher LLIN
use.
In line also with a cross sectional examination among pregnant women which was grasped using
both quantitative and emotional data collection procedures and found that 74% of each and every
pregnant woman were using bug splash treated nets (Ssedyabule, 2013).
36
This is as per the assessment done by UNICEF in 2016 whereby their result provoked free ITN
scattering in 39 out of 44 wilderness fever endemic countries through the antenatal offices and
inoculation communities for kids more young than five years (UNICEF, 2016). Then again with
the appraisal done in Cameroun on elements related to the use of ITNs and broken preventive
treatment for intestinal contamination control amidst pregnancy which found the general joining
pace of IPT was 88.7 % and 43.8 % for ITN while the general non use rate for IPT and ITN was
11.3 % and 17.5 % independently (Leonard et al., 2016).
Having an occupation, number of ANC visit and the pregnant trimester were basic pointers
related with ITN utilization. Being at the second ANC visit was the most grounded pointer of
high ITN use among pregnant mothers in this examination. This could be in light of the fact that
pregnant mothers in the midst of first ANC visits are used to be told about wilderness fever
balancing activity by using ITN really. In any case, in the midst of the second ANC visit, they
ought to go with incredible heap of data about wilderness fever evasion while using ITN
suitably. This is as per the examination done in Cameroun on components identified with the use
of bug splash treated nets and sporadic preventive treatment for wild fever control in the midst of
pregnancy (IPTp) finds occupation, valuable estimation, trimester and number of ANC were
quantifiably gigantic to ITN use at bivariate assessments while being an understudy/jobless (OR
= 0.25, 95 % CI = 0.07–0.95)) was on the other hand identified with ITN use at multivariate
assessment. For IPTp-SP, control of individuals, educational estimation, trimester of pregnancy
and number of ANC were quantifiably basically at bivariate assessments while going to ANC
just once (OR = 0.006, 95 % CI = 0.00–0.04) was conflictingly identified with IPTp-SP use at
multivariate examinations (Leonard et al., 2016).
37
This is on the other hand with the examination done by Tchinda et al. (2012) on factors identified
with bed net use in Cameroon: an audit consider in Mfou prosperity region in the Center Region
which found that variables related with net use included: net density≥0.5 (OR=8.88, 95% CI:
6.24-12.64), age≥5 years (OR=0.37, 95%CI: 0.28-0.47), assistant preparing (OR=1.41, 95% CI:
1.11-1.80) diverged from basic/no guidance, parent status (OR=3.32, 95% CI: 2.31-4.76), house
advancement (OR=1.37, 95% CI: 1.10-1.71) and condition characteristics (OR=1.46, 95% CI:
1.18-1.80) (Tchinda et al., 2012). Alternately again with the assessment done in Uganda on
factors related with utilization of bug splash treated nets among pregnant women in Lyantonde
district, Uganda which found the going with segments that were connected with utilization of
ITNs; being hitched (OR=2.99; 95%C1 1.39-6.43) and more significant pay (OR=2.79; 95%C1
1.35-5.75) (Ssedyabule, 2013).
The accompanying like utilization of bug spray impregnated mosquito nets, take measures to the
individuals who abuse mosquito nets got, utilization of amplifiers for network activation by
CHWs, and give mosquito nets to every single pregnant mother without considering the quantity
of pregnancies are the primary procedures that ought to be utilized to improve ITNs use level
among pregnant moms in Rubavu region. This could be a result of unseemly dispersion of ITN
among pregnant moms and some of them don't know about the advantages of satisfactory ITN
use.
According to the assessment done by Tassew et al. (2017) in Ethiopia which found that over
30% of nets constrained by the family units were out of use. Resulting to controlling for baffling
parts, having at any rate two resting spots (balanced conceivable outcomes degree [aOR] = 2.58,
38
95% CI 1.17, 5.73), finding that LLIN anticipates intestinal disease (aOR = 2.51, 95% CI 1.17,
5.37), the nearness of hanging bed nets (aOR = 19.24, 95% CI 9.24, 40.07) and dividers of the
house put or painted >12 months back (aOR = 0.09, 95% CI 0.01, 0.71) were fundamental
markers of LLIN use.
Interestingly with the investigation done entitled evaluation of components related with usage of
bug spray treated bed nets among ladies of regenerative age: Observations from the Zambia
national jungle fever pointer study 2010 Found that the indicators of ITN utilize included age,
having <5 kids, data accessibility and instructive level. Though utilization of ITNs was more
outlandish in family units with a higher number of kids under five years (OR, 0.62; 95%CI 0.42,
0.92), a higher probability for use was seen in more established ladies than in more youthful
ladies (OR, 1.36; 95%CI 1.27, 1.47) who revealed having heard any data on intestinal sickness
(OR, 1.70; 95%CI 1.30, 2.24) and having had a more elevated level of training (OR, 1.58;
95%CI 1.34, 1.86). The family unit and qualified ladies reaction rates were 97.2% and 89.6%
individually (Rutagwera, 2014).
The present examination finds that area authorities have huge job in activating individuals for
ITNs use for jungle fever aversion and the greater part of respondents affirm the accompanying
techniques to be utilized by improving ITN usage, for example, utilization of ITN as educated by
the specialist, set discipline approach to the individuals who abuse ITN, utilization of amplifier
while preparing individuals on the utilization of ITN, mosquito net ought to be given to every
single pregnant mother and appropriate preparation to defenseless individuals like pregnant
moms. In accordance with the discoveries from five examinations done in Africa and India on
39
Strategies to expand the possession and utilization of bug spray treated bednets to counteract
jungle fever, including 12,637 family units, surveyed instructive intercessions in regards to ITN
use and reasoned that training may build the quantity of grown-ups and youngsters utilizing ITNs
(Polec et al., 2015). In accordance with the examination done by Polec et al. (2015) found that
the accompanying techniques, for example, disseminating ITNs free contrasted with making
ITNs accessible for buy through various systems, Education about suitable ITN use contrasted
and no ITN use instruction and Providing motivating forces to urge ITN use contrasted with no
impetuses.
For the most part, this overview was directed after the fundamental blustery season in the
examination region when mosquitoes were inexhaustible and there were presence of a bigger
number of cases than anticipated in the investigation region. Thus, such an explanation ought to
be considered in translating the discoveries as the season may have urged the individuals to
utilize the nets more. Results in ITN use could demonstrate various extents if studies led in
different periods of the year.
40
CHAPTER FIVE: SUMMARY OF FINDINGS, CONCLUSIONS AND
RECOMMENDATIONS
5.0 Introduction
This part contains the rundown, ends and proposals dependent on the examination discoveries.
The point of this investigation was to survey elements related with usage of ITNs among
pregnant moms in Rubavu District.
5.1 Summary of Findings
The most elevated level of respondents 159(55%) were living in urban zone. A large portion of
the respondents 191(66.1%) were inside the age gathering of 28-37 years. The most noteworthy
level of the respondents 186(64.4%) were guys.The majority of the study respondents 181(62.65)
were between 2-3 and males 186(64.4%) were the head /chef of the house hold and the majority
116 (40.1%) had primary level. The findings also show that most of the respondents 135 (46.7%)
were Catholic while the remaining (21.5%) were Muslims and Protestant 92 (31.8%)
The majority of respondents 223 (77.2%) were occupied while the remaining 66(22.8%) were
not occupied. The highest number of respondents were married 132 (45.7%) followed by single
90(31.1%), divorced 39(13.5%) and widow/widower with 28 (9.7%). Most of the respondents 96
(33.3%) were between 100001RWF -200000 RWF of monthly income.
5.1.1 ITN utilization level among pregnant mothers in Rubavu district
The majority of the respondents (71.3%) were having adequate ITN utilization while the
remaining (28.7%) were having inadequate ITN among pregnant mothers in Rubavu District.
41
5.1.2 Factors associated with ITN utilization among pregnant mothers
Occupation, number of ANC visits and the pregnancy semesters were the manin components
related with ITN usage among pregnant moms in Rubavu locale, Rwanda. Whereby, members
who had an occupation were about 80%times bound to have satisfactory use of ITNs contrasted
with the individuals who were abandoned [AOR= 0.12;95%CI=0.0096-0.0472;P=0.001]
Respondents with one ANC visits were 80% occasions bound to have sufficient use of ITNs
contrasted with those with at least two than two visits [AOR= 0.233,95%CI=0.076-
0.712;P=0.011] and respondent in second/third pregnancy semester were 90% occasions bound
to have satisfactory use of ITNs contrasted with those inside first
semester[AOR=0.189;95%CI=0.08-0.451;P=0.001].
5.1.3 Strategies used to improve ITNs utilization level among pregnant mothers
The accompanying, for example, use bug spray impregnated mosquito nets, measures ought to be
taken to the individuals who abuse mosquito nets got, network wellbeing laborers should utilize
amplifiers for network assembly, and mosquito nets ought to be given to every single pregnant
mother without considering the quantity of pregnancies are techniques that ought to be utilized to
improve ITNs usage level among pregnant moms in Rubavu region].
5.2 Conclusions
Adequate ITN utilization among pregnant mothers in Rubavu district was observed with (71.3%)
while the remaining was having inadequate ITN utilization. Occupation, number of ANC visits
and the pregnancy semesters were the main factors associated with ITN utilization among
pregnant mothers in Rubavu district and the following strategies such as use insecticide-
42
impregnated mosquito nets, measures should be taken to those who misuse mosquito nets
received, community health workers should use loudspeakers for community mobilization, and
mosquito nets should be provided to all pregnant mothers without considering the number of
pregnancies should be used to improve ITNs utilization level among pregnant mothers in Rubavu
district.
5.3 Recommendations
This study detailed components related with usage of ITNs among pregnant moms in Rubavu
District. In perspective on the disclosures from the assessment the going with recommendations
ought to be considered individually:
To the government of Rwanda:
As the Government of Rwanda will benefits from this study in planning, implementing and
designing relevant strategies for ITN distribution and utilization for malaria control among
pregnant mothers in Rubavu District.
Rwanda Biomedical center should improve education on ITN utilization for malaria prevention
among pregnant mothers as they are most vulnerable group to malaria diseases.
To the Ministry of Health and nongovernmental organization:
i. Ministry of health, Rwanda biomedical center and district health units need to work
together to sensitize more on ITN utilization among pregnant mothers
ii. Ministry of health need to push community health workers at village level in ITN
utilization and distribution of ITNs as they are very close with the community.
To the community health workers
43
Community health workers should organize campaigns to promote ITNs utilization among
pregnant mothers as they are more exposed
5.4 Suggestion for further study
A national wide investigation utilizing both quantitative and subjective methodologies ought to
be conveyed for best comprehension of components related with usage of ITNs among pregnant
moms.
44
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49
APPENDICES
Appendix 1: Informed Consent Form
Title of the examination: Factors related with usage of ITNs among pregnant moms in Rubavu
region.
I am AKAYEZU Gisele, an understudy at Mount Kenya University, examining bosses of Public
Health. I am leading this examination in incomplete Fulfillment of the Requirements for the
Master's certificate in Public Health-Epidemiology. The reason for this investigation is to set up
elements related with use of ITNs among pregnant moms in Rubavu region.
You have been chosen to take an interest in this investigation. Your interest is willful, and you
reserve the privilege to pull back from taking part whenever. The input from you and different
members will furnish data in regards to variables related with use of ITNs among pregnant moms
in Rubavu region which will direct general wellbeing endeavors in the use of bug spray treated
nets. This poll will take just around 15 minutes of your time. On the off chance that you would
prefer not to take an interest, it doesn't make a difference. In the event that you consent to take an
interest, you will show your name and mark/or thumbprint. The data you give will be carefully
private, and your names will not be distributed in any structure at all. In the event that you have
inquiries regarding this examination, you can ask the analyst to the accompanying locations:
AKAYEZU Gisele on Telephone number: (+250) 785308381 or (+250) 722308381
Do you consent to participate? Yes No
If yes:
Name of participant……………………….….…Signature……………. Date………………
Name of interviewer……………………………. Signature....................Date………………
50
Appendix 2: Questionnaire for Pregnant Mothers
Instruction: Please answer each of the following questions. Questions are itemized; please tick
the most appropriate answer using (˅) sign in the corresponding box. This study aims at
establishing components related with usage of ITNs among pregnant moms in Rubavu region.
Section I: Demographic characteristics of mothers
Village .....................................…, Cell………………………., Sector…………………………..
1. Marital status
(1) Married (3) Widowed 5) Separated
(2) Divorced (4) Single
2. Sex of household head (1) Male (2) Female
3. Religion
(1) Catholic (2) Protestant (3) Muslim (4) No religion
4. Number of household members
(1) One to two (2) Three (3) Four (4) Five (5) Six (6) More than six
5. Do you have an occupation?
1. Yes 2. No
If Yes for 8th
question, what is your main source of income? (Tick only one option
a) Less than 50,000 Rwf
b) between 50,000 and 100,000 Rwf
c) Between 100,001 and 200,000 Rwf
d) More than 200,000 Rwf
6. Is this pregnancy primigravidae?
a)Yes
b) No
51
10. Number of ANC visits One Twice Twice or more
11. Are you in which semester First Second Trimester
Section II: ITN Utilization
12. Did you sleep under mosquito net in the last night? Yes No
If yes, go to question 13.
If no, why? 1=Nosea 2= High temperature in household 3= Others, explain…………..
If no, skip question 13
13. Have you ever forgot to sleep under mosquito net in the last week? Yes No
14. Does every bed in household has mosquito net? Yes No
15. What type of mosquito do you use in your household?
(1) Only untreated net
(2) Both treated and untreated net (3) only treated net
16. In the last week, how many times did you sleep under the net? (1) Daily (2) Thrice
(3) Twice (4) Once
17. Mosquito net, need to be used regularly?
(1) Strongly Agree (2) Agree (3) Disagree (4) Strongly oppose this idea
END – THANK YOU FOR YOUR TIME
52
Appendix 3: Focus Group Discussion Guide for pregnant Mothers
This will determine the strategies used to improve ITNs utilization level among pregnant
mothers in Rubavu district.
I am AKAYEZU Gisele an understudy in Masters of Public prosperity from Mount Kenya
University and I will be the examiner in this assessment meet on factors related with utilization
of ITNs among pregnant mothers: logical examination of Rubavu district where both emotional
and quantitative systems for research will be used. I should begin my accomplice.
1. What do you think about ITNs?
- Please take as much time as is needed to clarify me how you comprehend ITNs
- The level of utilizing ITNs stays low, as per you, what can clarify this?
- What are the advantages of ITNs for jungle fever?
2. Do you think the locale wellbeing administration should assume a basic job in preparing
individuals for ITNs use for intestinal sickness counteractive action? It would be ideal if you
clarify why and how.
- Is ITNs use for jungle fever avoidance in Rubavu area all around oversaw at town level?
Clarify that administration
3. What do you think could be the systems to improve ITNs usage level at town level?
- Do you have whatever other data that you feel could be valuable in this investigation?
- Do you have any inquiry for me that is identified with this examination?
Much obliged to you for your time. If it's not too much trouble don't hesitate to get in touch with
us with any inquiries to look for explanation in regards to what we have been talking about
53
Appendix 4: Recommendation letter from MKUR
54
Appendix 5: Data collection letter from GDH
55
Appendix 6: Consent Form (Kinyarwanda)
Umutwe w’icyigwa (Ubushakashatsi): Ubu bushakashatsi bugamije kugaragaza akamaro ko
gukoresha inzitiramubu ziteye umuti mu bagore batwite bo mu karere ka Rubavu, Rwanda.
Njyewe AKAYEZU Gisele, Umunyeshuri wo muri kaminuza y’Abanyakenya (Mount Kenya
University), wiga mu cyiciro cya gatatu cya kaminuza (Masters), ndi gukora ubushakashatsi muri
gahunda yo kugira ngo nuzuze ibisabwa kugira ngo mbashe guhabwa impamyabumenyi yo mu
cyiciro cya gatatu mu ishami ry’ubuzima mpuzamahanga.
Intego nyamukuru y’ubu bushakashatsi ni kugaragaza akamaro ko gukoresha inzitiramubu ziteye
umuti mu bagore batwite bo mu karere ka Rubavu. Mwatoranijwe mu kugira uruhare muri ubu
bushakashatsi. Uruhare rwanyu ni ubushake, kandi mufite uburenganzira bwo kuva muri iki
gikorwa igihe cyose bibaye ngombwa. Amakuru uratanga n’andi aturuka ku bandi ku bijyanye
n’uko abaturage bakira n’uko bemera ipimwa ryihuse rya malariya bizafasha ubuvuzi rusange
mu gukumira malariya. Iri bazwa rirabatwara iminota cumi n’itanu (15 minutes). Udashaka
kugira uruhare muri iri bazwa, ntacyo bitwaye. Niwemera kugira uruhare muri iri bazwa,
uragaragaza amazina yawe, umukono cyangwa igikumwe byawe. Amakuru uratanga aragirwa
ibanga kandi amazina yawe ntazatangazwa mu buryo ubwo ari bwo bwose. Uramutse ufite
ibibazo kuri ubu bushakashatsi, wabariza umushakashatsi kuri aderesi zikurikira :
Amazina: AKAYEZU Gisele
Telefoni: (+250) 785308381 cyangwa (+250) 722308381
Wemeye kubazwa? Yego Oya
Niba ari yego,
Izina ry’ubazwa…………………..Umukono………………….Itariki…………………………
Izina ry’ubaza………………….....Umkono…………………..Itariki…………………………
56
Appendix 7: Questionnaire (Kinyarwanda)
Amabwiriza: Subiza buri kibazo mu bikurikira. Ibibazo biri mu byiciro, Shyira akamenyesto
gakurikira (˅) ku gisubizo kiricyo mu kazu kabugenewe. Ubu bushakashatsi bugamije
kugaragaza akamaro ko gukoresha inzitiramubu ziteye umuti mu bagore batwite bo mu karere ka
Rubavu.
Icyiciro cya I: Imiterere y’aho umubyeyi utwite atuye
Umudugudu........................ Akagari……………………Umurenge…………………………..
7. Ubwoko bw’aho atuye
(1) Icyaro (2) Umujyi
8. Ufite imyaka ingahe?
9. Irangamimerere
(3) Ndubatse (3) Umupfakazi 5) Simbana nuwo twashakanye
(4) Twatandukanye mu mategeko (4) Ingaragu
10. Igitsina cy’Uhagarariye Umuryango (1) Gabo (2) Gore
11. Idini
(2) umukatolika (2) umuporotesitanti ( 3) Umusilamu (4) Nta Dini
12. Umubare wabatuye mu rugo
(2) 1-2 (2) 3 (3) F 4 (4) 5 (5) 6 (6) M Barenze 6
13. Amashuri menshi wize? Hitamo igisubizo kimwe!
(1) Ntayo (2) Abanza (3) Sinarangije abanza
(4) Sinarangije ayisumbuye (5) Ayisumbuye narayarangije ndenzaho (Kaminuza)
14. Ufite akazi?
1. Yego 2. Yego
57
Niba ikibazo cya 8 ari Yego, Amafaranga winjiza angana ate? (Hitamo igisubizo kimwe)
e) Munsi 50,000 Rwf
f) Hagati ya 50,000 na 100,000 Rwf
g) Hagati ya 100,001 na 200,000 Rwf
h) Arenga 200,000 Rwf
15. Inda utwite ni iya mbere?
a) Yego
b) Oya
10. Inshuro wipimishije: 1 2 Inshuro zirenze 2
11. Inda yawe igeze mu gihembwe cya kangahe (Amezi) Cya mbere Cya kabiri
Cya gatatu
Icyiciro cya II: Ikoreshwa ry’inzitiramubu iteye umuti
17. Waba uryama mu nzitiramibu ? Yego Oya
Niba ari yego, jya ku gisubizo cya 13.
Niba ari oya, kubera iki?
1=Gusesemwa 2= Ubushyuhe 3= Ibindi, sobanura…………………………………..
18. Waba waribagiwe kurara mu nzitiramibu mu cyumweru gishize ? Yeego Oya
19. Buri buriri mu nzu yawe bufite inzitiramibu? Yego Oya
20. Ni ubuhe bwoko bw’Inzitiramibu mukoresha mu rugo?
(1) Ntayo (2) Ntiteye umuti
(3) Iteye umuti ndetse n’idateye umuti (4) Yonyine iteye umuti
21. Mu cyumweru gishize ni inshuro zingahe waryamye mu nzitiramubu?
22. (1) Buri munsi (2) Eshatu (3) Ebyiri (4) imwe (5) Sinibuka
17. Wumva ari ngombwa gukoresha inzitiramibu ?
(1) Ndabyemera cyane (2) Ndabyemera
(3) Ntabwo mbyemera (4) Ntabwo mbyemera cyane
Turashoje – Urakoze ku mwanya wawe
58
Appendix 9: Focus Group Discussion (FGD) Guide for Pregnant Mothers (Kinyarwanda)
Mbere yo gutangira, waba ufite ikibazo?
Njye ndi AKAYEZU Gisele, Umunyeshuri wo muri kaminuza y’Abanyakenya (Mount Kenya
University), wiga mu cyiciro cya gatatu cya kaminuza (Masters) mu ishami ry’ubuzima rusange,
ni njye uyobora ikiganiro muri ubu bushakashatsi bujyanye n’uburyo abagore batwite bakoresha
inzitiramibu n’ibibatera kuyikoresha cg kutayikoresha mu karere ka Rubavu aho dukoresha
uburyo bw’imibare n’ubwa amagambo.
1. Ni iki uzi ku nzitiramubu ikoranye umuti?
- Fata akanya unsobanurire uko wumva inzitiramubu ikoranye umuti
- Gukoresha inzitiramubu biracyari ku gipimo cyo hasi, kubwawe ubona biterwa n’iki?
- Ni akahe kamaro ko gukoresha inzitiramubu iteye umuti kuri Malariya?
2. Utekereza ko urwego rw’akarere rushinzwe Ubuzima hari icyo rwafasha abaturage mu
kurwanya malariya hakoreshejwe inzitiramubu ikoranye umuti? Dusobanurire
impamvu n’uko ubona byakorwa.
- Kurwanya Malaria hakoreshejwe Inzitaramubu ikoranye umuti mu karere ka Rubavu
ubona bikorwa neza ku rwego rw’UmuduguduIs? Sobanura uko bikorwa
- Ni izihe ngamba ubona zafatwa ku rwego rw’umudugudu kugirango inzitiramubu
zikoranye umuti zikoreshwe neza kurushaho.
- Umaze kumva akamaro kubu bushakashatsi, hari andi makuru ufite wumva
yakwifashishwa muri ubu bushakashatsi?
- Hari ikibazo wumva wambaza kijyanye nubushakashatsi?
Urakoze cyane kumwanya umpaye. Ushobora kumpamagara igihe cyose wumva hari
ikibazo ugize kubijyanye nibyo tumaze kuganira.
59
Appendix 10: Overall score of ITN utilization
The following elements were used to assess the overall score of ITN utilization among pregnant
mothers;
Sleep under mosquito (Yes=1; No=0)
Ever forgot to sleep under mosquito net in the last week (Yes=1; No=0)
Every bed in household has mosquito net (Yes=1; No=0)
Type of mosquito used in household (Only untreated net=1; Both treated and untreated
net=2; only treated net=3)
In the last week, times slept under net (Any=0; Once=1; Twice=2; Thrice=3; Daily=4)
Mosquito net is need to be used regularly (Agree=1; Disagree=0)
The maximum attainable total score was 11 and minimum score was 1. A percentage score was
generated and classified as adequate (70% and above) and inadequate ITN utilization (Below
70%).
60
Appendix 11: Administrative Map of Rubavu District
