Determinants of insecticide treated nets ownership and use and antenatal attendance among pregnant women in selected hospitals in Enugu State, Nigeria

Insecticide-treated nets (ITNs) remain one of the most cost-effective interventions for malaria prevention. However, ownership and consistent use remain suboptimal in many malaria-endemic settings. This study evaluated the determinants of ITN ownership and utilization among pregnant women attending antenatal clinics in selected hospitals in Enugu State, Nigeria. A cross-sectional study was conducted among 219 pregnant women attending antenatal care. Data were collected using a pretested structured questionnaire, and malaria infection was diagnosed by microscopy. Associations between variables were assessed using odds ratio (OR) with 95% confidence intervals (CI). Malaria prevalence among participants was 64.4%. Only 97 (44.3%) respondents owned ITNs, and 56 (25.6%) reported using an ITN the night preceding the survey. The mean household size was 3.36 ± 1.65, while the mean number of ITNs per household was 0.79 ± 1.13. Significant disparities in access to ITNs were observed across healthcare facilities. ITN ownership was significantly higher among antenatal attendees at St. Patrick Hospital (OR = 5.088, 95% CI 1.854–13.965, p = 0.002) and Nsukka General Hospital (OR = 2.968, 95% CI 1.010–8.726, p = 0.048) compared with Obollor-Afor Health Centre. Maternal occupation, gravidity, and trimester of pregnancy were significant determinants of ITN ownership. ITN utilization was significantly lower among women from very rich households, with higher odds of use observed among the poor (OR = 10.833, 95% CI 1.790–65.550, p = 0.009) and average socioeconomic groups (OR = 4.048, 95% CI 1.058–15.478, p = 0.041). Malaria prevalence did not differ significantly between ITN owners and non-owners (p = 0.313), but was higher among ITN users than non-users (OR = 2.589, 95% CI 1.079–6.209, p = 0.033). ITN coverage among pregnant women in the study area remains inadequate. Strengthening ITN distribution through antenatal care services, addressing disparities in access, and promoting consistent and proper ITN use are essential for improving malaria prevention.