It is a beautiful Thursday evening in the La area of the La Dadekotopon Municipality of the Greater Accra Region. The moon has shown up for night duties, casting its rays on dark places like backyard gardens, where man-made light rarely reaches.
This illuminating act of the moon exposes an irony of life in that area. While some humans sleep, leaving their flesh at the mercy of mosquitoes, plants in some gardens, on the other hand, are enjoying the protection of the Insecticide Treated Nets known as the ITNs, from rodents and other animals.
This irony of plants enjoying what is meant to protect humans from the blood-sucking and malaria-causing insects is made even more glaring during the day when the sun takes over the sky and shows that the plants are safe, but the evidence of mosquito bites are left on human flesh.
The non-use of the treated nets especially by expectant mothers who receive the nets at health facilities at no cost is a risky choice that exudes a lot of concern because they do not only put their lives in danger but that of their innocent unborn babies.
Naa Torshie has three children and is five months pregnant with her fourth child. She says she has never fallen sick or been infected with malaria since she became pregnant although she constantly gets mosquito bites, so she does not see the essence of using the mosquito nets.
Naa has constantly received mosquito nets from the Teshie Community Clinic but never uses them to protect herself or any of her three babies. Her excuse?
“It is so hot to use the mosquito nets. I am never comfortable and find it difficult to sleep.”
Even though she has received counselling on several occasions, she has vowed not to use the ITNs at any point in time, saying: “It is just lying there in my room, maybe I will give it out as a gift to someone one day but as for me, there is no way I will use that.”
Matilda is 20 years old and seven months pregnant but used the ITN which was given to her during antenatal only once.
She said her body itches anytime she uses the net due to heat and the current power outages in the country have compounded the problem hence she is reluctant to use the mosquito net.
Fortunately or unfortunately for her, she has found “good use” for the net. It serves as a protective cover in her mother’s garden to prevent birds from coming near.
She is not the only pregnant woman not using the nets for its intended purpose.
Chochoe lives in a chamber and hall room with a corridor in front, accommodating her husband and three kids at Chorkor, a suburb of Accra.
She has used her mosquito nets as a covering in her corridor and converted the space into a kitchen. She says she used it a few times after her last born, who is seven years, was born but does not see the essence of the net again and decided it could be of good use in her improvised kitchen.
Despite all these complaints, health workers in the district have done everything possible to ensure the use of the ITNs and the safety of pregnant women with regard to malaria.
A nurse in one of the health centres in the district said on anonymity that the pregnant women sometimes wait till in their last trimester or have complications before visiting so there is usually little to be done for them.
According to an article published by Malaria Journal, malaria in pregnancy leads to low birth weight, premature birth, anaemia, and maternal and neonatal mortality.
A recent report by the World Health Organisation revealed that 219 million cases and 435,000 deaths were reported worldwide of which 80 percent of such cases were from sub-Saharan Africa and India.
The Pan African Medical Journal reports that approximately, 19-24 million women in Africa are at risk of malaria and its adverse consequences with the use of insecticide-treated nets (ITNs) during pregnancy as one of the proven interventions to reduce the malaria burden.
The use of these bed nets has been shown to reduce about 20 percent of child mortality. However, Ghana has not achieved its target for ITN use among pregnant women.
In 2020 alone, Ghana recorded over 600 maternal mortality cases, according to the United Nations Population Fund, a situation which could have been prevented if some mothers adhered to the advice of their health workers.
Philomina Amponsah is a health worker who helps with the distribution of ITNs in one of the public health facilities in the country.
She said ITNs are distributed to all people especially pregnant women for their safety but there have been several instances where follow-ups by health workers have revealed the low or no use of these nets, making them wonder about the importance of the distribution of these nets.
“Why will you take the nets and refuse to use it all in the name of it is uncomfortable to use?” she queried.
During the distribution of the ITNs, she said, residents are advised to hang the nets in an open space with fresh air for a period before their first use.
This is to prevent them from inhaling and suffering from the heat that comes from the chemicals used in the manufacturing of these ITNs.
“It is even advisable they do not dry them in the sun to also prevent the medication used from being dried out. Once this principle is adhered to, a lot of others would not find the use of the ITNs uncomfortable anymore,” Ms Amponsah added.
The District Director of Nursing Services at the Accra Metro, Vivian Hodgson, said complaints of heat and discomfort with the use of the ITNs are rarely made at the Accra Metro due to the extensive education given to pregnant women who come for antenatal before the ITNs are given to them.
She, however, indicated that the use of ITN is not the only malaria preventive method for pregnant women.
“There is a malaria drug known as sulfadoxine-Pyrimethamine (SP) which is given to women when they are 16 weeks pregnant and all other pregnancy-related tests are done to ensure they are free from all diseases.
“The only problem we usually have is the late report to antenatal by some pregnant women which makes it difficult for them to get the full benefit of the SP,” she said.
The director with over ten years experience said pregnant women were usually prone to all kinds of diseases and infections so she encouraged them to continue to ensure good practices like clean surroundings and prevent stagnant waters and poodles in and around their homes and adhere to the doctors’ advice to ensure their safety and that of their babies especially at home.
By Adwoa Adobea-Owusu