Improving the utilization of insecticide-treated nets for malaria prevention among pregnant women, lactating mothers and children in Sierra Leone: a commentary.

Malaria in pregnancy poses significant public health challenges with severe consequences for mothers, fetuses, and newborns. Despite the proven efficacy of insecticide-treated nets (ITNs), the coverage rate among pregnant women, lactating mothers and young children in sub-Saharan Africa remains suboptimal. For example, in Sierra Leone, only 52% of pregnant women and 50% of children under five years utilize ITNs. This coverage rate fell short of the national target, in which at least 80% of pregnant women are expected to report sleeping under an ITN. While considerable research has examined ITN access and usage in the general SSA population, focused implementation research on these high-risk groups in Sierra Leone is notably lacking. Addressing this gap is vital for enhancing intervention effectiveness and achieving sustained malaria control. The authors of this commentary recommend that further implementation research is needed to investigate the barriers and enabling factors to ITN adoption and utilization in pregnant women, lactating mothers and children under five years of age. Implementation research is crucial for understanding the gap between ITN access and actual use, enabling the design of effective and equitable interventions to boost utilization rates. Implementation research anchored in frameworks like Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) offers a pathway to decode these complexities, ensuring that global strategies resonate with local realities. By centering the voices of pregnant women, lactating mothers, and caregivers as well as addressing structural, cultural, and logistical barriers, Sierra Leone can transform ITN coverage into tangible reductions in malaria morbidity and mortality, advancing equity in its march toward elimination.