Utilisation of insecticide treated nets among women in rural Nigeria: Themes, Stories, and Performance
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AbstractBackground The effect of Malaria attack on maternal and child health in Nigeria is high compared with other countries in sub Saharan Africa. This problem has been a persistent issue in Nigeria and many researchers have tried to proffer solutions. Insecticide treated nets (ITN) have been identified as providing approximately 80% protection against malaria attack. However, all the measures put in place to control malaria failed to meet up with the set target of the Roll Back Malaria Initiative, which aimed at reducing malaria deaths in Nigeria by half by 2010 in line with the Millennium Development Goals (Anyaehie et al., 2009). As part of the global initiative to reduce malaria deaths before 2015 (Amoran, Senbanjo and Asagwara, 2011) the Nigerian government introduced intervention programmes to protect pregnant women, and children under-five years of age (Anyaehie et al., 2011). However, although there has been considerable and effective intervention in controlling this preventable disease in the African continent, marked inconsistency in the distribution of the ITN, scarcity and low usage in Nigeria (Amoran, Senbanjo and Asagwara, 2011) are apparent, despite emphasis on community-based strategies for malaria control (Obinna, 2011). For midwives in rural Nigeria the disproportionate vulnerability of pregnant women and young children is of great concern. This particular issue is the focus of a hermeneutic phenomenological inquiry into the experiences of pregnant women and mothers in their efforts to protect their families and themselves from malaria attack. The study contends that the ‘big (pan-African/national) story’ of malaria has found many voices, speaking from a predominantly positivist perspective. While some more interpretivist approaches to exploring experience have been employed elsewhere in Sub-Saharan Africa (Rachel and Frank 2005), there remains a need for more participatory research related to health care issues in Nigeria (Abdullahi et al 2013). Women and children make up the majority of the Nigeria population of over 160 million. An attack of malaria on them affects entire households and the economy of the nation. Therefore, the purpose of this study was to give voice to the ‘small (household) stories’ of Nigerian women (mothers and health workers), living and working in impoverished rural communities, and consider how their viewpoints, perspectives and imaginings might contribute to the fight for a malaria-free Nigeria. Methodological approach The research draws on the philosophy of Martin Heidegger, Hans-Georg Gadamer, and Maurice Merleau-Ponty. The participants’ accounts are interpreted in terms of Africana ‘Womanism’ as defined by Hudson-Weems (1993), the socio-narratology approach elaborated by Frank (2010), and Igbo world-view. Research procedure Individual semi-structured interviews and focus groups were conducted with Igbo women in three rural communities in Enugu State in eastern Nigeria (Nsukka, Ngwo, and Amechi). This was a three-phase process involving an initial orientation visit to engage with local gatekeepers and community health workers. A first round of interviews and discussion took place in three communities in 2014, followed by the first phase of interpretation. A second field trip took place in 2015, during which participants discussed the ongoing interpretation and elaborated further on some of the issues raised. Interpretive phases 2 and 3 followed this visit. Interpretive process Interpretive shifts in understanding were accomplished in three ways: 1. Seeking thematic connections between participants’ accounts of living with the threat of malaria. 2. Engaging in dialogical narrative analysis to explore the work done by the stories embedded in individual accounts of living under the threat of malaria. 3. Crafting found poetry from within the collective accounts to produce an evocative text that could mediate an emotional response and understanding of the malaria experience. Key outcomes The research was a response to calls for more participatory research into the detailed experiences of people in Africa facing up to the threat of malaria. It has provided a vehicle for the voices of a group of Nigerian women and health workers to bring attention to the continuing plight of pregnant women and their families with limited access to insecticide-treated bed nets in poor living conditions. They have told how they seek to empower themselves in their own small and particular ways. It has provided insights into their worldview(s) and what others might see from where they stand. As such it has added to their own call expressed during the research to “Keep malaria on the agenda.” The research has used the women’s own testimony to create an oral resource designed https://youtu.be/XelMXLUzTV0 to facilitate education and action among small local groups of women and their families, and for health workers in local rural communities.
DescriptionThesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy.