title: Predictors of the use of interventions to prevent malaria in pregnancy in Cameroon.
abstract: Malaria in pregnancy is common in sub-Saharan Africa where it contributes to perinatal morbidity and mortality. Use of insecticide-treated bed nets and intermittent preventive therapy with sulfadoxine-pyrimethamine during pregnancy are effective but underutilized interventions to prevent infection. Factors associated with bed net ownership and usage, and use of prophylaxis among recently pregnant women in Cameroon were investigated.
  
  
  
  National data from the 2011 Cameroon Demographic Health Survey was used to identify women with a pregnancy within the previous 5 years. Logistic regression models were created to assess for independent predictors of reported bed net ownership, bed net usage, and the use of malaria prophylaxis medications during pregnancy.
  
  
  
  Nearly one in two women surveyed had a recent pregnancy (n = 7647). In this group, bed net ownership and usage rates were low (33.7 and 16.9%, respectively); 61.6% used medication for malaria prophylaxis during pregnancy. Bed net ownership and usage were associated with maternal literacy (aOR 1.4 for net usage, 95% CI 1.1-1.8) and the presence of children under age 5 in the home (aOR 2.3 for net usage, 95% CI 1.6-3.3). The use of malaria prophylaxis medication was associated with measures of healthcare access (aOR 17.8, 95% CI 13-24.5 for ≥4 antenatal care visits), higher maternal education (aOR 1.5, 95% CI 1.1-2.1) and maternal literacy (aOR 1.4, 95% CI 1.1-1.7).
  
  
  
  Women in Cameroon and their antenatal providers missed many opportunities to prevent malaria in pregnancy. Efforts toward ensuring universal bed net provision, consistent antenatal care and the education of girls are likely to improve birth outcomes attributable to malaria infection.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 908 20th Street South, Room 325A, Birmingham, AL, 35294-2050, USA. jdionne@uabmc.edu.
authors.forename: Jodie
authors.identifier: 0000-0002-3625-5174
authors.initials: J
authors.lastname: Dionne-Odom
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
authors.forename: Tobias O
authors.initials: TO
authors.lastname: Apinjoh
authors.affiliation: Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
authors.forename: Judith
authors.initials: J
authors.lastname: Anchang-Kimbi
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Achidi
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Alan T N
authors.initials: AT
authors.lastname: Tita
mesh_terms: D000328:Adult; D002163:Cameroon; D005260:Female; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control*; D010067:Ownership; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Bed nets; Cameroon; Malaria in pregnancy; Malaria prevention; Sulfadoxine–pyrimethamine (SP)