Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
Malar J. 2022 Dec 9;21(1):376. doi: 10.1186/s12936-022-04388-z.
Pregnant women and children are the most vulnerable group of people usually affected by malaria. The use of insecticide-treated nets is one of the proven interventions for mitigating malaria and its associated deaths in endemic regions, including Ghana. Meanwhile, there is limited evidence on the extent of inequality in insecticide-treated nets use by pregnant women in Ghana. This study assessed the inequalities in insecticide-treated nets use by pregnant women in Ghana.
Data from the 2011 and 2017 versions of the Ghana Multiple Indicator Cluster Surveys were used. The 2019 updated World Health Organization (WHO) HEAT software (version 3.1) was used for all analyses. Four equity stratifiers were employed to disaggregate insecticide-treated nets use by pregnant women in Ghana. These are economic status, level of education, place of residence, and sub-national region. Four measures were used to compute inequality namely Difference (D), Population Attributable risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).
The analyses indicated a rise in pregnant women's insecticide-treated nets use from 32.6% in 2011 to 49.7% in 2017. Except sub-national region, all the factors showed mild inequality in insecticide-treated nets use. For instance, with respect to the economic status of pregnant women, only a slight inequality was exhibited by one of the simple measures in both 2011 (R = 0.3; 95% UI = 0.2-0.6) and 2017 (R = 0.5; 95% UI = 0.3-0.7). Marginal inequality in insecticide-treated nets use was noted in 2011 (R = 0.6; 95% UI = 0.5-0.9) and 2017 (R = 0.8; 95% UI = 0.6-0.9) for level of education. In the same vein, slight inequality was realized with respect to place of residence in 2011 (R = 0.4; 95% UI = 0.3-0.6) and 2017 (R = 0.6; 95% UI = 0.5-0.7). For sub-national region, both simple (D = 50.5; 95% UI = 30.7-70.4) and complex (PAF = 91.3; 95% UI = 72.3-110.3) measures demonstrated substantial inequality in 2011. In the case of 2017, considerable inequality in insecticide-treated nets use occurred (D = 58; 95% UI = 42.2-73.8, PAF = 51.9; 95% UI = 36.2-67.6).
In conclusion, insecticide-treated nets utilization by pregnant Ghanaian women increased between 2011 and 2017. The findings show that Ghana's Ministry of Health in collaboration with anti-malarial non-governmental organizations must review patterns of insecticide-treated nets distribution and intensify advocacy among educated pregnant women, those in urban settings and the rich, to assuage the magnitude of inequality.
孕妇和儿童通常是受疟疾影响最严重的人群。使用经杀虫剂处理的蚊帐是减轻疟疾及其在包括加纳在内的流行地区相关死亡的已证实干预措施之一。然而，关于加纳孕妇使用经杀虫剂处理的蚊帐的不平等程度，证据有限。本研究评估了加纳孕妇使用经杀虫剂处理的蚊帐的不平等程度。
使用了 2011 年和 2017 年加纳多指标类集调查的数据。使用了 2019 年更新的世界卫生组织（世卫组织）HEAT 软件（第 3.1 版）进行所有分析。使用了四个公平分层因素来分解加纳孕妇使用经杀虫剂处理的蚊帐的情况。这些因素是经济状况、教育水平、居住地和国家以下地区。使用了四个指标来计算不平等，即差异（D）、人群归因风险（PAR）、人群归因分数（PAF）和比值（R）。
分析表明，2011 年至 2017 年期间，孕妇使用经杀虫剂处理的蚊帐的比例从 32.6%上升至 49.7%。除了国家以下地区，所有因素都表明经杀虫剂处理的蚊帐使用存在轻度不平等。例如，就孕妇的经济状况而言，2011 年（R=0.3；95%置信区间为 0.2-0.6）和 2017 年（R=0.5；95%置信区间为 0.3-0.7）仅有一种简单措施显示出轻微不平等。2011 年（R=0.6；95%置信区间为 0.5-0.9）和 2017 年（R=0.8；95%置信区间为 0.6-0.9），教育水平方面也出现了边缘不平等。同样，在居住地方面，2011 年（R=0.4；95%置信区间为 0.3-0.6）和 2017 年（R=0.6；95%置信区间为 0.5-0.7），也出现了轻微不平等。在国家以下地区，2011 年，简单指标（D=50.5；95%置信区间为 30.7-70.4）和复杂指标（PAF=91.3；95%置信区间为 72.3-110.3）都显示出了相当大的不平等。在 2017 年，经杀虫剂处理的蚊帐使用出现了相当大的不平等（D=58；95%置信区间为 42.2-73.8，PAF=51.9；95%置信区间为 36.2-67.6）。
总之，加纳孕妇使用经杀虫剂处理的蚊帐的比例在 2011 年至 2017 年间有所增加。研究结果表明，加纳卫生部必须与抗疟非政府组织合作，审查经杀虫剂处理的蚊帐分配模式，并加强对受过教育的孕妇、城市地区和富人的宣传，以减轻不平等的程度。
