ccording to a publication by center for Disease Control (2014), malaria infection is caused by a protozoan (Plasmodiae). However the report posited that malaria infection occurs when favorable environmental conditions of temperature, rainfall, and humidity are created for the female Anopheles mosquitoes, carrying the Plasmodium, to bite a susceptible host (CDC, 2014). Malaria infection is endemic in Nigeria, with a prevalence of 919 per 10,000 of population; it remains one of the leading causes of morbidity and mortality (Ganihu & Jimo, 2013;Oche et al., 2011;Aribodor et al., 2017) It accounts for seven out of ten outpatient visits in Nigerian hospitals as well as being responsible for about 20% and 30% of infant and under-5 mortality rate, respectively (Oche et al., 2011).

Following the attempts towards improving the coverage of malaria preventive measures, the 2015 goal of the World Health Organization's (WHO's) Roll Back Malaria Partnership are to reduce global malaria cases by 75% and to reduce malaria deaths to near zero through universal coverage by effective prevention and treatment interventions (RBM, 2010). Among other preventive interventions, WHO recommends the use of insecticide treated nets (ITNs), particularly Long-Lasting Insecticide Nets, which have been shown to be costeffective, to reduce malaria episodes among children under 5 years of age by approximately 50% and allcause mortality by 17%. Universal coverage with ITNs is defined as use by > 80% of individuals in populations at risk (WHO, 2019; RBM, 2010). Aribodor et al. (2017) in a report posited that the usage of long lasting insecticide treated nets is largely affected by distribution patterns and also the knowledge of people and their perception about it. Behavioral patterns of people-utilization of the LLITNs are dependent on their socio demographic characteristics on the consequence of nonuse (Aina and Ganihu & Jimo, 2013). Isah and Nwobodo (2009) reported that despite evidence that the use of LLITNs decreases malaria-related morbidity and mortality, the use of LLITNs in Africa remains relatively low. Estimates suggest that in 2005, only 3% of children under five years of age slept under LLITNs, while up to ten times as many are thought to sleep under any bed net (Baley & Deressa, 2008). This shows that the fact that ITNs are very effective in malaria prevention does not necessarily mean that people will use them after they have received those (Baley & Deressa, 2008). While the evidence based on the effectiveness of LLITNs in reducing malaria transmission has grown rapidly in recent years, utilization rates of LLITNs in most African countries have been very low (Chukwuocha et al., 2010;Ganihu & Jimo, 2013). The renewed Abuja, Nigeria, target for roll back malaria (RBM), a control program for malaria, targeted 80.0% of children <5 years of age and pregnant women to use long lasting insecticide-treated mosquito nets (LLITN) between 2006 and 2010 (FMOH, 2015; (Deneye et al., 2011).

The millennium development goal 6 has a target of halting and beginning to reverse the incidence of malaria in 2015 (Baley & Deressa, 2008). These control programs are aimed at reducing the morbidity and mortality, resulting from malaria infections in at-risk groups particularly at Households. The past decades have witnessed an increase in international funding for malaria control. This increased funding has led to an increase in accessing LLITNs in Sub-Saharan Africa (Deneye et al., 2011). At the end of 2010, approximately 289 million LLITNs were delivered to the Several Households at Sub-Saharan African region; this is enough to take care of 76% of the 765 million persons at risk (Deneyeet al., 2011). Insecticide Treated Nets is currently one of the most cost-effective options for reducing malaria-related morbidity and mortality and has been reported to reduce malaria mortality by 17% in children <5 years of age (Runsewe-Abiodun et al.,

Regrettably, malaria still constitutes a serious public health problem in Nigeria (Aina and Ayeni, 2011;Mbanugo and Okorudo, 2015;Aribodor et al., 2017). Malaria is endemic in the poorest countries in the world, causing 400 to 900 million clinical cases and up to 2.7 million deaths each year (Guyatt & Ochola, 2014). More than 90% of malaria deaths occur in Sub-Saharan Africa, resulting in an estimated 3,000 deaths each day. Almost all the deaths are among high-risk groups including women of childbearing age, women during pregnancy, non immune travelers, refugees and other displaced persons, and people of all ages living in Household areas of unstable malaria transmission (Mbanugo & Okorudo, 2015;Iwu et al., 2010: Aina & Ayeni, 2011: Ganihu & Jimo, 2013). In highly endemic countries, malaria poses a serious danger to women of child bearing age, women in pregnancy and their unborn children (Mbanugo & Okorudo, 2015). Malaria in pregnancy causes maternal anaemia, miscarriage, and low birth weight. In endemic countries, it is the leading cause of maternal mortality and one of the primary causes of neonatal deaths (Mbanugo & Okorudo, 2015).

According to some reports in Nigeria, malaria is the leading cause of Maternal Mobility contributing 33% of deaths among women of child bearing age and 25% infant mortality (Oche et al., 2011;Iwu et al., 2010)

The study excluded the following; i. Women of child bearing age who refused to give in their consent for the study ii. Women of child bearing age who were lunatic, sick or disabled during the time of data collection.

The sample size was determined using the Yamene formula (1967) for sample size determination. n = N_ 1+Ne 2 Where: n is the desired sample size N is the population size (12,389) = population of women of childbearing age at Nwangele LGA (NPC, 2010). e is margin of error (0.05) Therefore, n = 392.30362210 Furthermore, to adjust for a 10% rate of non response and invalid response (i.e 90% expected response rate =0.9). n= n/expected response rate n =392/0.90= 435.5 n= 436

A Probability based multi stage sampling method was adopted for the study on the coverage of Long Lasting Insecticide Treated Nets among women of child bearing age in Nwangele LGA.

First stage-Selection of Communities: A total of Three (3) Out of the communities in Nwangele LGA was selected by the researcher using simple random sampling via balloting to give every community an equal chance of selection. Second stage-Selection of villages: Three (2) villages each out of the total number of villages in the selected community was selected via simple random sampling using balloting giving every village in the selected community an equal chance of being selected. Third stage-Selection of Streets: A total of Five (5) streets each in the selected Six (6) villages were selected via simple random sampling (balloting) to give every street an equal chance of being selected. Fourth stage: Selection of households: A systematic probability sampling method was used to select each household in the selected streets giving each household an equal chance of selection. Fifth stage: Selection of Respondents: the researcher selected women of child bearing age in each household or any one present at the time of study. Selection of respondents was done via simple random sampling.

A semi-structured questionnaire was used as the instrument of data collection for this study on the coverage of Long Lasting Insecticide Treated Nets among women of child bearing age in Nwangele LGA.

The validity of the instrument of data collection by the researcher took the following shape; the questionnaire as the instrument of data collection was developed by researcher and submitted to the research supervisor for Face validity and proper scrutiny as well as two experts from department of public health for consensus validity in order to ensure that the questionnaire meets the objectives of study before reliability testing.

The Reliability of the instrument of data collection was determined using test retest method. Copies of the questionnaire were given to some respondents outside the area of study by the researcher. This area shared similar characteristics with Nwangele LGA that was used for this study. Chrombach alpha test was used to test for the reliability of the questionnaire to determine the consistency of the results with a reliability coefficient of 0.8 obtained.

Data was obtained using an interviewer based semi structured questionnaire. This will be done with the aid of Two (2) field assistants who will be Hired and trained to aid the researcher in the data collection process.

The Statistical Package for the Social Sciences (SPSS) was used in the analysis of the data gotten from the study. Results will be expressed in percentages, frequencies, tables and charts (Descriptive Statistics). Chi square was used to test the hypothesis statement of the study (p=0.05).

A letter of introduction and ethical clearance was obtained from the School of Postgraduate studies Ethical clearance committee in Federal University of Technology Owerri (FUTO) before the research was conducted. The purpose of the research was explained to each respondent and verbal informed consent obtained from them before inclusion into the study. Also, anonymity of the respondents was assured and ensured. The confidentiality of the information they gave was also maintained.

A total of four hundred and thirty six (436) copies of questionnaires were distributed for the study. They were properly filled and crosschecked for correctness, and 404 questionnaires were retrieved and were used for the purpose of the analysis.

From the table 1 below, 41.5% (169) of the respondents were aged between 26-30 years, 20.5% (83) between ages 15-20, 9.9% (40) were people in their early 20's (21-25), 14.3% (58) were between 31-40 years of age and 13.3% (54) were adults within 41-45 year age bracket. On ethnicity, 38.1% (154) opted for ethnic groups not listed but label 'others', 93.7% (379) were of the Igbo ethnic group, 1.9% (8) Yoruba, and 0.4% (2) of the respondents were Hausa/Fulani. On educational backgrounds, 30.9% (125) of the respondents had Informal education, 12.8% (52) had attained the Tertiary level of Education, and 22.2% (90) had primary education and 37.1% (150) of the respondents with secondary level of education. 50.7% (205) of the respondents did occupations not listed but label 'others', 17.3% (70) were civil servants, 18.8% (76) of the respondents housewives while just 13.1% (53) were self employed. On the marital status of the respondents, 26.2% (106) were widowed, 24.7% (100) were single, 24.5% (99) married while 12.6% (51) of the respondents were separated. 11.8% (48) opted to choose 'others'. 27.2% (110) of the respondents had an income level between 1-10,000, 21.7% (88) had an income level between 31,000-50,000, 20.2% (82) earned above 100,000, 17.0% (69) had an income level between 11,000-30,000, and the least percentage 13.6% (55) earned an income between 51,000-100,000.

Table 2 considering the level of knowledge of long lasting insecticide treated nets, a majority of the respondents with 96.5% (390) said "Yes" when they were asked if they had heard about malaria at any time prior to the questionnaires, while a small 3.4% ( 14) denied. When asked if they had suffered from malaria, a majority if the respondents also with 95.2% (385) replied "Yes" while just 4.7% (19) said "No". 61.6% (249) of the respondents believe mosquito bites causes malaria, 26.2% (106) said malaria is caused by dirt/stagnant water, 9.6% (39) chose plasmodium organisms and 4.7% (19) said "germs". Upon question on how malaria is transmitted, 44.0% (178) opted to choose 'Bites of any Mosquito', 19.0% (77) said "Bites of insect which has bitten a malaria Patient", and 36.8% (149) opted for 'Stagnant water and unclean environment'. 74.0% (299) of the participants replied "Yes" when asked if they had heard about LLITNs, while 25.9% (105) said "No". 24

The table 3 below revealed the choices of respondents relative to Distribution and Ownership of Long Lasting Insecticide-Treated Nets. When asked if Insecticide Treated Nets had been distributed in their environs, 48.0% (194) replied "Yes" while 51.9% (210) said "No". When the respondents were asked if they had any Insecticide Treated Net, 71.2% (288) affirmed, while 28.7% (116) said "No". The respondents were asked if they owned a Long Lasting Insecticide Treated Nets, 45.0% of the respondents (182) said Yes, while 54.9% (222) denied. On the question 'How did you get it?', 38.3% (155) chose Health Centers, 33.1% (134) said "Market", 7.1% (29) said "Friends", 15.0% (61) of the respondents replied "School" while some respondents 6.1% (25) chose options not listed but label 'Others'. When asked How Many ITNs their household Owned, 41.3% (167) of the respondents said "None", 17.8% (72) replied "1", 29.9% (121) said between 2-4, 10.8% (44) of the respondents said "Above 4".

Poor knowledge

Table 4 shows the Level of Utilization of Long Lasting Insecticide-Treated Nets among respondents. When asked if they had ever slept under an LLITN, 44.3% (179) said "Yes", while 55.6% (225) replied "No". The respondents were asked if they slept under an LLITN the previous night, 66.0% (267) confirmed, while 33.9% (137) denied. Respondents that denied were in turn asked when last they slept under an LLITN, 42.3% (58) told less than 7days ago, 33.5% (46) said between 8-29days, 24.0% (33) more than 30 days. When asked if their children/family members sleep under LLITN, 66.0% (267) confirmed "Yes", while 33.9% (137) said "No". The respondents who replied "No" were then asked if their children/family members slept under an LLITN the previous night, 62.8% (254) confirmed, while 37.1% (150) denied. Respondents that denied were in turn asked when last they slept under an LLITN, 32.0% (48) told less than 7days ago, 21.3% (32) said between 8-29days, 46.6% (70) more than 30 days.

Based on the Relationship between sociodemographic characteristics and level of utilization of long lasting insecticide treated nets, the table below shows that age not significantly associated with level of utilization insecticide treated nets (P = 0.5301). Furthermore, the table 4.6 shows that religion is not significantly associated with utilization of LLITNs (P = 0.115). Also, ethnicity doesn't show significant association with utilization of LLITNs (P = 0.074). Marital status is significantly associated with utilization of LLITNs (P = 0.0001). Moving further, the table reveals that parity is significantly associated with the level of utilization of LLITNs (P = 0.0001). Also, level of education shows significant association with level of utilization of LLITNs (P = 0.0001). Occupation is not significantly associated with level of utilization of LLITNs (P = 0.942). The level of income of the respondents shows significant association with level of utilization of LLITNs (P = 0.006) (Table 6

Based on the finding of this study on Long Lasting Insecticide Treated Nets among women of child bearing age in Nwangele LGA, considering the socio demographic characteristics, it was revealed that majority 41.5% (169) of the women were aged between 26-30 years. This finding goes in consistent with a study by Odoko et al., (2012), that women of child bearing age have a mean age of 32.4yrs. The study revealed that majority 93.8% (379) of the respondents were Igbo region. This could be due to the fact that the study was conducted in Nwangele LGA which is the southeastern part of Nigeria dominated by people of Igbo origin. The findings of the study revealed that 27.2% (110) of the respondents had an income level between 1-10,000 naira. A study by Kenneth and Amefume (2013) posited a significant improvement in income level among women in rural areas. However this goes in contrast with the study with women of child bearing age mostly involved in petty trading.

Considering the level of knowledge of long lasting insecticide treated nets, the study showed that a majority of the respondents with 96.5% (390) are aware and have had heard about malaria prior to the study in consistence with a similar study conducted among groups of women of childbearing age (WOCBA) in Malawi by Owen et al (2018) on the awareness of Malaria among pregnant women. Information on Malaria is now widely open with several source of information existing. The study posited that 74.0% (299) of the participants had knowledge of long lasting insecticide treated nets. Studies by Kyi et al. (2020) and Adebayo et al (2014) showed that respondents in an area had 69.6%, 81.5% respectively knowledge of long lasting insecticide treated nets which corroborates with the finding of this study. Women of child bearing age at Nwangele are more likely to get information on the utilization and adequate knowledge following community meetings, hospital visits and at educational institutions. The study further revealed that majority 24.2% (98) had heard about LLTINs from Health centers. This goes against a finding by Atenchong et al (2014) that revealed that majority of women had good knowledge of LLITNs and ITNs from a community follow up program. However from this study it implies that health workers proffer information to women on antenatal and other related periodic health visit by women of child bearing age in the community.

From the study it was revealed that the women when asked if Insecticide Treated Nets had been distributed in their environs, 48.0% (194) agreed. However this shows a poor reach of LLITNs in the community. The findings of this study on distribution of LLITNs reveal that women of child bearing age might experience shortfall of these LLITNs. A study by Kenneth and Amefume (2013) However in this study, participants posited that Considering the Distance to Facility, 62.8% (254) of the respondents said it was a factor towards their utilization. This implies that the health center is situated far away from them. When asked about Cultural Acceptance, 55.6% (225) denied it could influence their utilization and the coverage of LLITNS in the area. This goes against a study conducted at rural Dars es Salaam that showed majority of respondents agreeing cultural acceptance as a modifier to Malaria preventive behavior. The study revealed also that information during Distribution being a factor influencing use of LLITNs was met with 44.0% (178) confirming among the women of child bearing age (Charles et al., 2019). A publication by Kyi et al. (2020) revealed that source of information on malaria preventive approaches was imperative in determining its uptake. The finding of this study shows that for women of child bearing age, information on utilization is essential for them to utilize LLITNs.

Based on the Relationship between sociodemographic characteristics and level of utilization of long lasting insecticide treated nets, the study revealed that marital status is significantly associated with utilization of LLITNs (P = 0.0001). This implies that husbands acceptance of the utilization of LLITNs is a motivating factor. This goes in line with a study by Atenchong et al (2014) which found marital status to be associated with uptake of bed nets among pregnant women (P=0.004). Moving further, the study also demonstrated that parity is significantly associated with the level of utilization of LLITNs (P = 0.0001). This could be due to the fact that increasing number of children can lead to uptake as well as less number of children. This goes in contrast with a report published by Nankinga et al (2012) on Parity and Usage of Nets. Also, from the study among women of child bearing age in Nwangele, it was posited that level of education shows significant association with level of utilization of LLITNs (P = 0.0001). Women of child of bearing age with educational level and information on ITNs would likely utilize LLITNs. The study revealed that the level of income of the women shows significant association with level of utilization of LLITNs (P = 0.006). A study by Owen et al (2018) opined that women with higher income status could afford malaria preventive. This implies that from the findings of this study among women of child bearing age at Nwangele it is more likely for them to purchase LLITNs if they have the money.

V.

However, from the study, the coverage and distribution of long lasting insecticide treated nets in Nwangele LGA forms part of the component of the 2011 RBM integration which is effective in rapidly increasing household possession and use of bed nets, achieving national bed net coverage goals set by National Health Development Plan (NHDP) 2012-2015. Low Ownership of LLITNs was reported in the study and malaria is a very serious public health problem; prompt treatment alone cannot guarantee the achievement of the goal. All strategies must be strengthened and employed in fight against malaria, if the desired goal is to be achieved. Findings from this study showed that majority of the residents had a considerable good knowledge of the use of insecticide treated nets but low ownership.

The recommendations for this study include the following;

1. Health education on the effective use of long lasting insecticide treated nets among residents and practices to improve ownership and function.