Impact of long-lasting insecticidal nets on Plasmodium falciparum infection among women attending antenatal clinic at the Bonassama District Hospital, Littoral Region of Cameroon

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Abstract Malaria during pregnancy continues to be a significant cause of morbidity and mortality for both infants and mothers, particularly in sub-Saharan African (SSA) countries, despite increased efforts to control it. The utilization of long-lasting insecticide-treated nets (LLINs) during pregnancy is a well-established strategy to reduce the prevalence of malaria. Nonetheless, inadequate adherence remains a persistent challenge in certain regions with high malaria endemicity. This research aimed to assess the effectiveness of long-lasting insecticidal nets in preventing asymptomatic malaria infections among pregnant women attending antenatal care at the Bonassama District Hospital in the Littoral Region of Cameroon. A hospital-based cross-sectional study was conducted from March to June 2022. Data on sociodemographic characteristics and LLIN usage were collected through a structured questionnaire, while asymptomatic malaria infections were identified using a PfHRP2/pLDH malaria qualitative rapid diagnostic kit. The relationship between categorical variables was analyzed using the chi-square test and logistic regression at a significance level of 5%. Out of the 411 pregnant women included in the study, 156 (35.4%) were diagnosed with malaria. The LLIN utilization rate was 65.1% (287). The risk of malaria infection was 2.7 times higher (AOR = 2.75, 95% CI = 1.83-4.14, p < 0.001) among women who did not consistently use LLINs compared to those who did. The majority (65.1%) of pregnant women always used LLINs, while 34.9% did not consistently use them. Pregnant women aged 20-29 were 3.5 times more likely to use LLINs (AOR = 3.53, 95% CI = 1.61-7.75, p = 0.002) compared to those in the 30-39 and >39 age groups. Furthermore, women practicing Christianity were 1.7 times more likely (AOR = 1.72, 95% CI = 1.01-2.96, p = 0.047) to consistently use LLINs than those of the Islamic faith. Pregnant women in their first trimester (AOR = 3.40, 95% CI = 1.24-4.64, p = 0.010) and second trimester (AOR = 1.90, 95%CI = 0.99 -3.62, p = 0.055) were more likely to sleep under net when compared to those in the third trimester. Among the reasons reported by participants for not frequently using LLINs were heat [55.2% (85)], suffocation [13.6% (21)] and the smell of nets [8.4% (13)]. The use of LLIN was moderately high among the participants in this study, though still below national target. Age group, occupation, religion and gestation period were the major factors determining the use of LLINs. Considering the proven effectiveness of LLINs in reducing malaria morbidity and mortality, it is imperative for the National Malaria Control Programme (NMCP) to remain focused in promoting both LLIN ownership and utilization to achieve the national target of 100% and 80%, respectively.

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