Suboptimal distribution and utilization of antenatal care given bed Nets undermine pregnant women's protection in Benin: a prospective field study.

Background: The World Health Organization (WHO) recommends that pregnant women in sub-Saharan Africa (SSA) receive a free long-lasting insecticidal net (LLIN) during their first antenatal care (ANC) visit to prevent malaria. This study, conducted in Benin, evaluates the distribution and utilization rates of LLINs provided at the first ANC visit among pregnant women.

Methods: Data were collected from 14 public and private health centers located in urban and rural areas across Southern, Central, and Northern Benin. Pregnant women were enrolled in the study during their initial ANC visit and were subsequently visited at home twice, where a questionnaire was administered. The study assessed the distribution and use of LLINs during the first ANC visit. After the second home visit, the LLIN found on the pregnant women's sleeping unit was collected to evaluate its physical integrity and bio-efficacy. Chi-square tests were used to compare each indicator across three variables: region, urban/rural setting, and public/private status of health centers.

Results: A total of 718 pregnant women were included in the study. LLIN ownership and usage before the first ANC visit were 94% [89-97%] and 93% [85-97%], respectively. During the first ANC visit, 63% [40-80%] of the pregnant women received an LLIN, but only 11% [7-22%] installed it on their sleeping area. During the pregnancy period, 72% [64-78%] of the LLINs in use were found to be either physically damaged or not bio-effective.

Conclusion: The distribution of LLINs to pregnant women during their first ANC visit was inadequate, with only a small fraction of recipients actively using the net. This shortfall leads to suboptimal protection for this vulnerable population during pregnancy.