Review of Determinants of Low Insecticide Treated Net Utilization and Interventions to Improve Utilization Among Under-Fives in Ghana: An In-depth Review

Malaria continues to be a public health challenge in Ghana, especially among children under five years. World Health Organization recommends 80% usage of insecticide treated nets as it is one of the most effectiveness means of preventing malaria. However, usage of insecticide treated nets is only 47% among this vulnerable group in Ghana, which is below the recommended rate. This in-depth review aims to explore factors contributing to low net utilization among under-fives in Ghana and analyze interventions that have improved utilization in countries of similar context and discuss their applicability in Ghana. This review was based on secondary data. Using a conceptual framework, factors leading to low net usage among under-fives and interventions that have proved to increase usage in other countries were obtained from databases such as Global Health, Medline, PubMed and Web of Science and websites of organisations such as Ministry of Health, Ghana Health Service, Ministry of Education and World Health Organization. A feasibility assessment tool was applied in analysing each intervention identified and appraised based on their feasibility in Ghana. Increasing age of a child, lack of mechanisms for monitoring net usage at home, large family size, negative perception and attitude towards its usage and lack of education on its correct usage emerged as factors contributing to low net usage among children under five in Ghana. Having analysed these factors, in addition to feasible interventions in addressing low usage, malaria stakeholders in Ghana need to evaluate these interventions to assess how appropriate and applicable they are in Ghana to increase net usage among under-fives.