Obstacles to the use of intermittent preventive treatment and insecticide-treated nets for malaria prevention among pregnant women in the N’Djamena South Health District

Abstract

Despite ongoing malaria control strategies in Chad, including the promotion of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs), coverage and utilization among pregnant women remain suboptimal, particularly in high-burden districts such as N'Djamena-South. This study therefore aimed to assess the influence of education level, monthly income, and occupation on the use of IPTp and ITNs among pregnant women in the N'Djamena-South Health District. A cross-sectional study with an analytical component was conducted among 400 pregnant women selected through stratified sampling in households within the N'Djamena-South Health District. The KoboCollect software was used to gather the data which were later processed in Microsoft Excel 2013 and analyzed via SPSS (Statistical Package for Social Sciences) version 27. Although (354/400; 88.7%) of respondents reported knowing how malaria is transmitted, only 48.2% correctly identified mosquito bites as the vector. Knowledge of preventive measures was reported by 71.4%, most commonly ITNs (52.8%) and IPTp (23%). More than half cited unavailability of IPTp (58.5%) and ITNs (50.7%), mainly due to stockouts and high cost. Low education level was strongly associated with non-use of IPTp (aOR = 3.2, 95% CI 1.17–8.74) and ITNs (aOR = 4.9, 95% CI 1.66–14.45). Monthly income below 50,000 FCFA was also linked to reduced IPTp use (aOR = 2.15, 95% CI 1.00–4.62). Occupation showed no significant association. The use of IPTp and ITNs remains insufficient in the N'Djamena-South Health District, largely due to structural and socio-economic barriers. Targeted interventions for women with low socio-economic status, along with improved supply of malaria prevention commodities in health facilities, are necessary.