The knowledge and use of insecticide treated nets (INTs) among rural dwellers in Ivo L.G.A, Ebonyi State, Nigeria

Effective uses of insecticide-treated nets (ITNs) are considered key to the elimination of malaria among vulnerable populations. Several studies have revealed that the degree of awareness, ownership, and consistent use of ITNs by rural dwellers differ from one area or region to the other. The aim of the study was to determine the awareness of ITNs and factors affecting their use among rural dwellers in Ivo L.G.A of Ebonyi State. Simple survey method was adopted for the study. Three hundred (300) questionnaires were given out to respondents; however, 276 respondents representing 92% of the sample size returned their questionnaires. The data generated was analyzed and represented in simple frequency table and simple bar chart using IBM SPSS statistical package. The result indicated that majority of the respondents in the study area had vast knowledge of ITNs. Relationship between educational level, age, occupation of respondents and knowledge of ITNs was observed. The result showed that age, educational status, and educational status of rural dwellers were significantly associated with their knowledge of ITNs in Ivo LGA. Majority (72.5%) of the respondents in the study area had vast knowledge about ITNs, while minority (27.5%) had little or no knowledge of ITNs. The knowledge of ITNs by rural dwellers in Ivo LGA was independent of gender of the rural dwellers. A study to assess the actual use and impact of utilization of ITNs among children, pregnant mothers, nursing mothers, the adolescents, and the aged in Ivo communities is recommended.


INTRODUCTION
Malaria is a major inf ectious disease in most developing countries. Global Malaria Program organized by World Health Organization encouraged worldwide ef f orts to strengthen the ef f ective use of Insecticide Treated Nets (ITNs) f or the purpose of control and prevention of malaria. Ef f ective use of ITNs is considered the most ef f ective and saf e way to eliminating malariain the general population (Taremwa et al., 2017). Malaria is caused by intra-erythrocytic protozoa of the genus plasmodium transmitted by the bite of an inf ective f emale Anopheles mosquito. Of the f our plasmodium species that inf ect humans, P. falciparum is common in sub-Saharan Af rica and causes severe and potentially f atal malaria (Inungu et al., 2017). ITNs of fer adequate barrier or hindrance between the host and parasite or other related insects thereby preventing against malaria inf estation and transmission. The malaria incidence, across the globe is substantial, with an estimation of three hundred (300) million most likely cases each year of which about one million lives are lost (Edson and Kayombo, 2007). It was reported by Edson and Kayombo, (2007) that more than ninety percent (90%) of these deaths occur inSub -Saharan Af rica where young children are the most vulnerable population. The World malaria report according to WHO reported that 241 million cases of malaria occurred in 2020 compared to 227 million cases in 219 (WHO, 2021). The estimated number of malaria deaths stood at 627 000 in 2020. Malaria is one of the major public health problems in Sub-Sahara Af rican. Accessibility to the tools in Africa that are needed f or the prevention and treatment of malaria is not available to millions of vulnerable populations in the globe (Njumkeng et al., 2019).
Various health authorities have made concerted ef f orts to promote the use of ITNs by rural dwellers, yet research has shown that the degree of awareness, ownership, and ef f ective use of ITNs by these individuals has varied f rom one area or region to the other (Ezeigbo et al., 2015, Sunday et al,. 2021. As the knowledge of use of ITNs has improved over time, a lot of f actors still play against actual ownership and ef f ective use of ITNs (Owoseni, 2018). The most ef f ective and saf e malaria control tool is INTs when used as directed. Despite all these, utilization and general acceptance is still low: only a small percentage ( 3%) of Af rican children are currently utilizing the tool and about 20% are sleeping under any other kind of net. Owoseni, (2018) reported that cases of malaria pandemic continue to be the leading cause of child mortality and morbidity Problems of delivery, distribution, usage and even acceptability of this method in rural areas, has drastically reduced the success of malaria control using ITNs. In addition, public campaign and acceptance of insecticide-treated nets vary f rom community to community in states where this method of malaria control has been adopted (Steinhardt et al., 2017). Owing to poor acceptability of ITNs, the public health consequences is that more work need to be done by both authorities in government and in health sectors at various level to raise the general knowledge on the use of ITNs. This can be done through extensive health education, reduction in constrain to accessibility and af f ordability of ITNs. Mass importation and subsidizing the price of ITNs may be the best approach to solving the problem. This will reduce the notion that most people have towards accepting the use of the treated nets in line with its ef f icacy. Some either neglect or ignore usage of bed nets based on the earlier stated odds.
Prevalence of malaria vectors at late evening when people have not yet gone under their bed nets, presents an opportunity to transmit the disease (Adebayo et al., 2015). Sleeping outside is very common among students and this increases the chance of a mosquito bite and f ast transmission of the inf ectious plasmodium. Theref ore, individuals who sleep outdoors are exposed to mosquito bites and are prone to malaria. These problems are most of ten encountered and are common among young persons. The result of a study conducted to determine the prevalence of malaria across the Local Governments of Ebonyi State, show that among the Local Government Areas, Ivo had the highest prevalence rate. The results f urther showed that malaria was endemic in Ebonyi state and was a major health problem f or school children (Ani, 2008). Ebonyi state is one of the south-eastern states in Nigeria. The State is located between longitude 7 o 30′ E and 8 o 30′ and between latitude 5 o 40′ and 6 o 54′ (Ani, 2008). Ebonyi lies entirely in the Cross River plains with f requent f loods during the rainy season, resulting f rom poor drainage systems, stagnant streams and ponds that predispose the state to menace of mosquito inf estations and malaria endemicity (Joseph et al., 2017).
Theref ore, the aim of this investigation is to assess the knowledge of insecticide treated nets (ITNs) and f actors af f ecting its usage among rural dwellers in Ivo L.G.A of Ebonyi State. Specifically the study sort to f ind out the extent of awareness of Insecticide Treated Nets (ITNs) in Ivo L.G.A of Ebonyi State, estimate the number of rural dwellers sleeping under ITNs in the L.G.A, propose possible f actors af f ecting the use of insecticide treated nets among rural dwellers in the L.G.A and assess whether source and availability of ITNs af f ects its use by rural dwellers in Ivo L.G.A of Ebonyi State.
The objective of the work includes the determination of demographic data among the rural dwellers, and their responses on the f ollowing subjects; proportion of rural dwellers sleeping under ITNs, f actors af f ecting the use of ITNs among rural dwellers, responses on whether source and availability of ITNs inf luence their use by rural dwellers in Ivo L.G.A of Ebonyi State and f inally determine whether demographical subjects age, gender, occupation, educational status af f ects their knowledge of ITNs.
This research work has both theoretical and practical signif icance. On a theoretical aspect, the study shall be a source of secondary data collection f or f uture researchers on similar topic. It shall serve as a relevant contribution to knowledge and a source of ref erence. It will enrich the pool of existing literature in the subject area and will be of immense help f or policy f ormulation by present government and NGOs to of f er possible solution in preventing transmission of malaria on rural dwellers. Practically, the study will be of immense importance to the policy makers, policy implementers, decision takers and other stakeholders involved in making policies for on rural development. The issues raised in this study also helped to enhance understanding for better rural development programmes to be established, and as a result, the rural dwellers will benef it f ully in such grassroots development programmes.

Population
The population f or the study was 1000 people among rural dwellers in Ivo Local Government Area. (PHCD, Ivo L.G.A, 2019).

Area of the Study
This study was carried out in Ivo L.G.A Ebonyi State, Nigeria.

Study Design and Sampling Technique
The researcher adopted the simple survey method f or this study. The f ocus of this method was to enable the researcher to obtain the views on the use of insecticide treated net and f actors af f ecting their use among rural dwellers in Ivo L.G.A Ebonyi State, Nigeria. Again, the questionnaire was designed to help in the collection of relevant data. Moreover, the questionnaire was used because of its relative merit of wide coverage f or less expenses and some degree of anonymity of the respondents. The questionnaire contained ten close ended questions and three open ended questions.

Instrument/Method of Data Collection
The research involved questionnaire as the only instrument in this study. The total sample used was three hundred (300) questionnaires distributed to the rural dwellers representing 30% of the total population f or the study f rom the 18 electoral wards in Ivo L.G.A Ebonyi State, Nigeria.
Sample size is calculated thus: The sample size (n) was calculated using the f ormular where Zα, Z is a constant (set by convention according to the accepted α error) Z1-,β,Z is a constant set by convention according to power of the study σ = standard deviation △= estimated ef f ect size A total of 300 questionnaires were given out to respondents on the course of this survey of which 276 respondents representing 92% of the sample size returned their questionnaires, while 8% of the respondents could not return theirs. The questionnaire was pretested in a nearby tertiary health f acility f or clarity and content validity. It was distributed by f our research assistants with good medical and research knowledge who are f luent in English and Igbo languages. On collection f rom respondents, each questionnaire was checked f or completeness and where incomplete researc h assistants returned to the respondent to collect missing inf ormation. Following satisf actory f illing of questionnaires, they were stored in a f ile cabinet designated f or this purpose.

Data analysis
IBM SPSS sof tware Version 25 was used for analysis of data obtained through administration of questionnaire. The responses f rom the respondents were analyzed and represented in simple f requency tables, percentages, and simple bar charts (Owoseni, 2018).

Ethical consideration
The consent of the subjects was sought through verbal introduction of self and explanation of what the study entails bef ore the administration of the structured questionnaires to obtain their responses. The respondent's conf identiality of the inf ormation provided in the questionnaires were guaranteed.

RESULT
In table1, 200 respondents (72.5 percent) of the sample size were male, while 76 respondents (27.5 percent) were f emale.           30.8% of the respondents said that they were given in the health centres but was not enough f or their f amily; 41 respondents representing 14.9% of the respondents said that some health centres do sell the ITNs given to them share among pregnant women, thereby discouraging them f rom using it; 36 respondents representing 13% of the respondents insisted that it's always unavailable at the health centres; 23 respondents representing 8.3% of the respondents said that people in the rural areas are short changed in terms of the accessibility. This means that Source and availability of ITNs inf luence their use by rural dwellers in Ivo L.G.A of Ebonyi State.   It's always unavailable at the health centres. 36 13.0 People in the rural areas are short changed in terms of the accessibility 23 8.3 Total 276 100

DISCUSSION
The knowledge and Use of Insecticide treated nets in rural communities where there is high incidence of malaria is vital f or malaria vector control and prevention (Ezeigbo et al., 2015) and Nigerian population mostly rural dwellers stand the risk of having malaria. This study provides data on the knowledge and use of insecticide treated nets among rural dwellers of Ivo local government in Ebonyi State. Result of this study will serve as important guides f or policy makers and decision-making in malaria control programmes in Ebonyi State.
In the study, the awareness of INTs among the rural dwellers in Ivo communities of Ebonyi State was shown in table 7. Greater number of the respondents had vast knowledge about Insecticide Treated Nets (ITNs) having 200 (72.5%) of the respondents in agreement, while f ew of the respondents 76 (27.5%) have little or no knowledge of ITNs. However, it was f urther observed that high proportions of the respondents in the study area were sensitized enough on the use of Insecticide Treated Nets (table 8). This f inding was in contrary with a study conducted by Sunday et al (2021) which established that knowledge and awareness of insecticide treated bed nets use among the rural dwellers in the Ebonyi State was poor. The dif f erences in the f indings could be attributed to intensif y ef f ort to roll-back malaria in the mosquito endemic area such as the study area by government and nongovernmental agencies in recent times. Public campaign is a vital approach to comb the menace and rate of malaria inf estation especially in the rural areas. Adequate provision of ITNs through the Health f acilities is also a good measure.
On f actors af f ecting the use of INTs (table 9 and  Table 10), it can be deduced that there are f actors af f ecting the use of Insecticide Treated Nets among rural dwellers in IVO Local Government Area of Ebonyi State. Among such f actors which includes the weather condition, the chemical composition of the Net, the cost and accessibility of the net. The rural dwellers were on the opinion that It is always expensive to buy ITNs, while those rural dwellers who received INTs f rom the health centre complained that the number of nets they received was not adequate f or their f amily use. Those hindrances can be overcome by proper education on the merits of using ITNs in the mosquito endemic zone. Inf ant mortality and rate of anemia in pregnancy will be minimized.
This study f ound no association (x2=<0.001, p=983) between knowledge of ITNs usage and gender. This was in line with work of Njumkeng et al., 2009. According to Njumkeng et al .,2019, the f inding could be explained partially by the f act that malaria control strategies in the past, more attention were giving to the vulnerable groups such as children below f ive years and pregnant woman. The public health awareness campaign had educated people more on the benef its of using insecticide treated nets as a tool of malaria prevention. However, the recent move for universal coverage which has been improved and strengthened through repeated massive distribution of Insecticide treated nets may have been minimized these discrepancies.
A statistically signif icant association of knowledge of ITNs with Age (x2=33.218, p<0.001) was observed. This suggests that adults use ITNS more than young ones. This is also similar to the study of Ndjinga and Minakawa, 2010;Graves et al., 2010, which established that ITNs knowledge/usage is associated with age. A statistically signif icant relationship between educational level of respondents and knowledge of ITNs was observed (x2=112.322, p<0.001). This in agreement to the f indings in Ekiti State, Where Owoseni reported greater awareness and use of ITNs (98%) and knowledge among mothers and caregivers of children attending the clinic at health centre in Emure Local Government Ekiti State (Owoseni, 2018). However, this was contrary to the f indings in Ogun State, Nigeria, where poor awareness (48.9%) and knowledge (31.2%) of the importance of ITNs/LLIN among pregnant mothers was reported (Abiodun et al., 2012). Previous studies have also shown that ITNs knowledge/usage was associated with level of education, (Tchinda et al., 2012, Pettif or et al., 2008. Occupation is one of the means households meet to their daily needs. Occupation suggests weather the level of income of the household will be able to sustain and consequently meet to the household's needs. In this study, 76 respondents representing 27.5% are f armers, 50 respondents representing 18% are traders/ artisan, 120 respondents representing 43.5% are health workers, and 30 respondents representing 11% are unemployed. This shows that majority of the respondents are health worker. A signif icant association between occupational status of respondents and knowledge of ITNs was also observed (x2= 105.658, p<0.001).
It was recorded that 98% of health workers had knowledge of ITNs. This is also similar to a work done by Ugwu et al., (2013) where a signif icant association was also observed between occupational status and Utilization of Insecticide Treated Nets among Pregnant Women in Enugu.

CONCLUSION
The f inding of this study shows that age, educational status, and educational status of rural dwellers were signif icantly associated with their knowledge of insecticide-treated net in Ivo LGA, Ebonyi State, Nigeria. Majority (72.5%) of the respondents in the study area had a vast knowledge about Insecticide Treated Nets (ITNs ) while minority (27.5%) had little or no knowledge of ITNs. The knowledge of insecticide-treated net by the villagers in Ivo LGA was independent of gender of the rural dwellers. A study to assess the actual use and impact of utilization of ITNs among children, pregnant mothers, nursing mothers, the adolescents, and the aged in Ivo communities should be undertaken. Health education of the prevention of malaria attacks should be intensif ied; other strategies f or preventing transmission of malaria should be put concurrently in place with the ITN project.
Mobility was a challenge to this study due to lack of access road in the chosen area. Limited health f acilities in the area restricted mass mobilization of Health worker f or this study. Language barrier was encountered since some of the target subjects were illiterate. Also, the survey questionnaire was not translated into local languages; the interviewers interpreted them to the respondents who did not understand English. It is possible f or interviewers to misinterpret questions or introduce personal pref erences. However, because they were all trained and the hypothesis of this study was generated af ter data