Introduction: Insecticide Treated mosquito Nets (ITNs) are recommended as one of the
most effective interventions for the prevention of malaria in pregnancy. It is recommended
that pregnant women sleep under an ITN everyday through their pregnancy to avoid
exposure to the mosquitoes. Despite increased coverage due to free distribution programs,
ITN use remains low among some pregnant women, attributed to various factors. This study
investigated the effect of fear on the use of insecticide treated nets amongst pregnant
women 15-49 years in Tororo district in eastern Uganda. Other factors affecting ITN use
were also explored.
Methods: A cross sectional study was conducted with 230 pregnant women attending
antenatal care services at Tororo district hospital in January 2015. Data were collected using
an interviewer-administered questionnaire with items measuring ITN use, the four
constructs of the Extended Parallel Process Model (perceived susceptibility, perceived
severity, self efficacy, and response efficacy), and covariates including age, education,
marital status and socio economic status. Bivariate and multivariate analysis was conducted
to establish the relationship between perceived susceptibility, severity, self efficacy and
response efficacy and ITN use among the study population.
Results: More than a three quarters of the participants (n=230) reported using ITNs the
night before the study. The two constructs of the Extended Parallel Process Model which
were associated with ITN use were perceived efficacy (aOR 4.96, 95% CI 2.42 – 10.18) and
perceived severity, which was negatively associated with ITN use (aOR 0.35, 95% CI 0.14 –
0.85). Other factors which were marginally associated with ITN use were socio economic
status (aOR 1.67, 95% CI 0.95 – 2.92) and educational attainment (aOR 3.59, 95% CI 0.85 –
15.11).
The main reasons given for not using ITNs were net being too hot (23.91%), worn-out or in
poor condition (21.74%), not enough nets in the house (10.87%), net not hung (6.62%) and
net being too cold or used by someone else (both at 2.17%). Majority of the non ITN users
(32.61%) mentioned other reasons for non use such as visiting a friend where there was no
net, and spending the night at a funeral.
Conclusion: Overall the findings of this study show that efficacy is significantly associated
with ITN use among pregnant women more than any other known factors including fear.
Results have important implications for social and behavior change communication (SBCC)
viii
programs aimed at promoting ITN use for pregnant women as behavioral interventions
should focus on increasing the self-efficacy to use the ITNs.