Are pregnant women prioritized for bed nets? An assessment using survey data from 10 African countries

Background: Malaria in pregnancy is a major public health concern, contributing to roughly 11% of neonatal deaths and to 25% of all maternal deaths in some parts of the world. The World Health Organization has recommended priority interventions for malaria during pregnancy, including use of insecticide-treated nets (ITNs), but net distribution has shifted recently to a universal coverage paradigm rather than one targeting vulnerable populations. Methods: To determine whether and to what extent pregnant women are prioritized within the household for ITN use, we assessed national survey data from 2009-2013 in 10 African countries. Proportion of pregnant women who slept under an ITN the previous night and 95% confidence intervals were calculated and compared between countries. Within-country logistic regression examined whether pregnancy was significantly associated with ITN use the previous night compared with other risk groups, and the predicted probability of net use for each risk group was calculated holding other covariates constant. Results: A median 58% of households reported owning at least 1 ITN. On average, across all 10 countries, 35% of pregnant women in households with at least 1 ITN used a net. Households with universal coverage (at least 1 ITN per 2 people) had higher levels of net use among all family members; for example, 79% of pregnant women, on average, used a net in such households. In all countries, the predicted probability of ITN use by pregnant women was significantly higher than the probability of net use by most other household members except non-pregnant women of reproductive age. Conclusion: These findings suggest that both pregnant women and non-pregnant women of reproductive age are being prioritized within the household for net use. However, behavior change communication strategies are needed to achieve ITN use goals for pregnant women.