Predictors of insecticide-treated bed nets use among pregnant women in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey

Background Malaria remains a significant public health threat in Sierra Leone, particularly for pregnant women and their unborn children. Infection during pregnancy can lead to severe consequences, including maternal anaemia, low birth weight, premature birth, and even death. Therefore, preventing malaria during pregnancy is crucial for improving maternal and child health outcomes. This study investigated the predictors of insecticide-treated bed net (ITN) use among pregnant women in Sierra Leone.Methods The study analysed the 2019 Sierra Leone Demographic and Health Survey data (SLDHS). The study comprised a total of 900 pregnant women aged 15-49 years, representing the nationally representative sample. A multivariable binary regression analysis was used to explore the predictors of ITN use. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI).Results The study found that the prevalence of ITN use among pregnant women was 64.2 [60.4, 67.9] in Sierra Leone. Pregnant women who were married [aOR = 2.02, 95% CI 1.32, 3.07] had higher odds of bed net use than those who were unmarried. Pregnant women with five or more children [aOR = 1.69, 95% CI 1.01, 2.84] had higher odds of mosquito bed net use than those with four and below children. Pregnant women living in the Northern, Northwestern, Southern and Western regions all had lower odds of bed net use than those in the Eastern region, with the lowest odds among those living in the western region [aOR = 0.19, 95% CI 0.09, 0.40]. Pregnant women who were Muslims [aOR = 0.63, 95% CI 0.41, 0.95] had lower odds of mosquito bed net use than Christians. Pregnant women with female household heads [aOR = 0.65, 95% CI 0.44, 0.95] had lower odds of mosquito bed net use than those with male household heads.Conclusion ITN use among pregnant women in Sierra Leone remains suboptimal. Marital status, parity, sex of household head, region and religion were associated with bed net use. The government and policymakers in Sierra Leone should integrate ITN education and distribution into prenatal care services, emphasizing the benefits for both mother and baby-partnering with healthcare providers to raise awareness and encourage consistent use. Involve local leaders, religious figures, and mothers' groups to promote the benefits of ITN during pregnancy. Educate husbands and partners on the importance of ITN use during pregnancy and encourage their support in its consistent use.