Factors Influencing the Utilisation of Insecticide-Treated Nets to Prevent Malaria during Pregnancy: The Case of Rural Ekwendeni, Malawi

Background The consistent use of an insecticide-treated net (ITN) throughout pregnancy is a proven method for preventing the adverse effects of malaria. Although access to this intervention has increased in sub-Saharan Africa, consistent use of ITNs during pregnancy remains uncommon. Methods Our objective was to identify factors that contribute to the utilisation of ITNs throughout pregnancy. To achieve this, we conducted a population-based random sampling of 700 women who had given birth in the past year in Ekwendeni. Results In a study of 700 pregnant women, 359 (51.2%) reported having an insecticide-treated net (ITN) at the beginning of their pregnancy, while 28 (4%) had an ITN after the first trimester. Of the 514 ITN owners, 73% reported sleeping under their nets during every trimester of pregnancy or after obtaining it. The possession of multiple nets was marginally associated with consistently sleeping under an ITN during pregnancy (relative risk (RR): 1.13; 95% confidence interval (CI): 1.00-1.28). Pregnant women who consistently slept under an ITN were more likely to be influenced by a radio or billboard advertisement than a free ITN (RR: 1.48; 95% CI: 1.24–1.76). Other sociodemographic characteristics, pregnancy history, antenatal care (ANC) use, and sociocultural factors did not differ significantly. Conclusion Pregnancy is a critical period during which women in Malawi must adhere to recommended guidelines for using insecticide-treated bed nets (ITNs). However, many women in Ekwendeni do not follow these guidelines consistently. Despite this, frequent self-reported ownership and use of ITNs have been observed throughout pregnancy. It is essential to gather additional information about each household's capacity for ITN installation, as this may be a critical factor in developing future interventions aimed at improving daily ITN usage and convenience.