Factors affecting uptake of???3 doses of Sulfadoxine-Pyrimethamine for malaria prevention in pregnancy in selected health facilities, Arusha region, Tanzania.
ABSTRACT: BACKGROUND:Tanzania adopted the revised World Health Organization policy in 2013 recommending a minimum of ?3 doses of Intermittent Preventive Treatment during pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) to protect against malaria. A study in Tanzania in 2014 reported low (9%) uptake. We investigated health workers knowledge about IPTp-SP and factors that influenced uptake of >?3 doses of IPTp-SP among pregnant women. METHODS:We conducted a cross-sectional study in 2017 among post-delivery women and health care workers from nine randomly-selected public health facilities in three Districts of Arusha Region. Probability proportional to size methodology was used to determine number of participants per facility. We used a structured questionnaire to collect socio-demographic and obstetric data, information on doses of SP received, and knowledge of SP for IPTp. Health care workers were interviewed about their knowledge for IPTp- SP and challenges encountered in its uptake and use. RESULTS:We interviewed 556 persons (median age 26?years, range 16-42?years) with the response rate of 99.3%. Of these, 484 (87.1%) had >?3 Antenatal Care (ANC) visits. A total of 402 (72.3%) were multigravida with 362 (65.1%) having given birth at least once. Of the 556 participants, 219 (39.4%) made their first ANC booking at ?3 doses of SP-IPTp. Factors associated with uptake of >?3 doses of IPTp-SP included having secondary or higher education [Adjusted Odds Ratio (AOR) =1.6, 95%CI 1.1-2.4], attending ?4 ANC visits [AOR?=?3.1, 95%CI 2.1-4.6], having first antenatal booking at ?3 doses of IPTp-SP. That is below the Tanzania national target of 80%. Making >?4 ANC visits, having secondary or higher education, making an early first ANC visit and having adequate knowledge on IPTp-SP promoted uptake of >?3 doses. Further qualitative studies are needed to explore factors that might contribute to low uptake of SP.
Project description:Malaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Zomba district IPTp uptake falls far below the national average. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district after adoption of new IPTp-SP policy in 2014.This was a cross-sectional survey. Two public health facilities (HFs) were randomly selected from urban and rural areas in Zomba district. Study participants were postpartum women selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire. Bivariate and multiple logistic regression was used in data analysis.Out of all the enrolled participants (n?=?463), 92% women had complete information for analysis. Of these, (n?=?426) women, 127 (29.8%, 95% CI: 25.6%-34.3%) received three or more doses of SP, 299 (70.2%, 95% CI: 65.7%-74.4%) received two or less doses. Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR?=?0.31, 95% CI 0.13-0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR?=?0.29, 95% CI 0.18-0.48); not taking SP under direct observation therapy (DOT) (AOR?=?0.18, 95% CI (0.05-0.63).There is low utilisation of at least three doses of SP in this population and this seems to be associated with the number of ANC visits and use of DOTs. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.
Project description:BACKGROUND:Malaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000-200,000 infant deaths every year. Currently, the World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) at each scheduled antenatal care (ANC) visit. This study aimed to assess IPTp-SP coverage in mothers delivering in health facilities and at the community. In addition, factors associated with low IPTp-SP uptake and malaria adverse outcomes in pregnancy were investigated. METHODS:A community and a health facility-based surveys were conducted in mothers delivering in Chókwè district, southern Mozambique. Social-demographic data, malaria prevention practices and obstetric history were recorded through self-report and antenatal records. For women delivering at health facilities, a clinical examination of mother and child was performed, and malaria infection at delivery was determined by rapid diagnostic test, microscopy, quantitative PCR and placental histology. RESULTS:Of 1141 participants, 46.6, 30.2, 13.5 and 9.6% reported taking???3, two, one and none SP doses, respectively. Low IPTp uptake (<?3 doses) was associated with non-institutional deliveries (AOR?=?2.9, P?<?0.001), first ANC visit after week 28 (AOR?=?5.4, P?<?0.001), low awareness of IPTp-SP (AOR?=?1.6, P?<?0.002) and having no or only primary education (AOR?=?1.3, P?=?0.041). The overall prevalence of maternal malaria (peripheral and/or placental) was 16.8% and was higher among women from rural areas compared to those from urban areas (AOR?=?1.9, P?<?0.001). Younger age (<?20 years; AOR?=?1.6, P?=?0.042) and living in rural areas (AOR?=?1.9, P?<?0.001) were predictors of maternal malaria at delivery. Being primigravidae (AOR?=?2.2, P?=?0.023) and preterm delivery (AOR?=?2.6, P?<?0.001) predicted low birth weight while younger age was also associated with premature delivery (AOR?=?1.4, P?=?0.031). CONCLUSION:The coverage for two and???3 doses of IPTp-SP is moderately higher than estimates from routine health facility records in Gaza province in 2015. However, this is still far below the national target of 80% for???3 doses. Ongoing campaigns aiming to increase the use of malaria prevention strategies during pregnancy should particularly target rural populations, increasing IPTp-SP knowledge, stimulate early visits to ANC, improve access to health services and the quality of the service provided.
Project description:BACKGROUND:Malaria remains a significant health problem in Mozambique, particularly in the case of pregnant women and children less than five years old. Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) is recommended for preventing malaria in pregnancy (MiP). Despite the widespread use and cost-effectiveness of IPTp-SP, coverage remains low. In this study, we explored factors limiting access to and use of IPTp-SP in a rural part of Mozambique. METHODS AND FINDINGS:We performed a qualitative study using semi-structured interviews to collect data from 46 pregnant women and four health workers in Chókwè, a rural area of southern Mozambique. Data were transcribed, translated where appropriate, manually coded, and the content analyzed according to key themes. The women interviewed were not aware of the risks of MiP or the benefits of its prevention. Delays in accessing antenatal care, irregular attendance of visits, and insufficient time for proper antenatal care counselling by health workers were driving factors for inadequate IPTp delivery. CONCLUSIONS:Pregnant women face substantial barriers in terms of optimal IPTp-SP uptake. Health system barriers and poor awareness of the risks and consequences of MiP and of the measures available for its prevention were identified as the main factors influencing access to and use of IPTp-SP. Implementation of MiP prevention strategies must be improved through intensive community health education and increased access to other sources of information. Better communication between health workers and ANC clients and better knowledge of national ANC and IPTp policies are important.
Project description:BACKGROUND:Growing concerns about the waning efficacy of IPTp-SP warrants continuous monitoring and evaluation. This study determined coverage of IPTp-SP and compared the effectiveness of the 3-dose to 2-dose regimen on placental malaria (PM) infection and low birth weight (LBW) in the Mount Cameroon area. METHODS:Consenting pregnant women were enrolled consecutively through a cross-sectional survey at delivery at four antenatal clinics, two each from semi-rural and semi-urban settings from November 2016 to December 2017. Reported IPTp-SP use, demographic and antenatal clinic (ANC) data of the mothers and neonate birth weights were documented. Maternal haemoglobin concentration was measured using a haemoglobinometer and PM infection diagnosed by placental blood microscopy. Logistic regression analysis was used to model study outcomes. RESULTS:Among the 465 parturient women enrolled, 47.0% (203), 34.7% (150), 18.3% (79) and 7.1% (33) reported uptake of???3, 2.1 dose(s) and no SP, respectively. Uptake of???3 doses varied significantly (p?<?0.001) according to type of medical facility, timing of ANC initiation and number of ANC visits. The prevalence of PM was 18.5% where uptake of???3 SP doses (AOR?=?2.36: 95% CI??1.41-4.87), primiparity (AOR?=?2.13: 95% CI??1.19-3.81), semi-rural setting (AOR?=?1.85: 95% CI??1.12-3.04) increased odds of infection. Also, three or more dosing was associated (p?<?0.001) with increased PM density notably among women from semi-urban areas. Compared with third trimester, ANC initiation in the second trimester (AOR: 0.39: 95% CI??0.20-0.74) lower odds of infection. The prevalence of LBW infants was 7.3% and were generally those of anaemic (AOR: 4.6: 95% CI??1.03-20.57) and semi-rural (AOR: 5.29: 95% CI??1.73-16.15) women. Although???3 (AOR: 0.31: 95% CI??0.11-0.87) and 2 (AOR: 0.32: 95% CI??0.11-0.93) doses of SP was associated with lower odds of LBW,???3 doses were not associated with additional increase in birth weight nor maternal haemoglobin levels when compared with 2 doses. CONCLUSION:In the Mount Cameroon area, reported uptake of IPTp with???3 SP doses did not provide observable prophylactic benefits. SP resistance efficacy studies are necessary.
Project description:BACKGROUND:In 2012, the World Health Organization recommended that pregnant women in malaria-endemic countries complete at least three (optimal) doses of intermittent preventive treatment (IPTp) using sulfadoxine-pyrimethamine (SP) to prevent malaria and related adverse events during pregnancy. Uganda adopted this recommendation, but uptake remains low in East-Central and information to explain this low uptake remains scanty. This analysis determined correlates of uptake of optimal doses of IPTp-SP in East-Central Uganda. METHODS:This was a secondary analysis of the 2016 Uganda Demographic Health Survey data on 579 women (15-49 years) who attended at least one antenatal care (ANC) visit and had a live birth within 2 years preceding the survey. Uptake of IPTp-SP was defined as optimal if a woman received at least three doses; partial if they received 1-2 doses or none if they received no dose. Multivariate analysis using multinomial logistic regression was used to determine correlates of IPTp-SP uptake. RESULTS:Overall, 22.3% of women received optimal doses of IPTp-SP, 48.2% partial and 29.5% none. Attending ANC at a lower-level health centre relative to a hospital was associated with reduced likelihood of receiving optimal doses of IPTp-SP. Belonging to other religious faiths relative to Catholic, belonging to a household in the middle relative to poorest wealth index, and age 30 and above years relative to 25-29 years were associated with higher likelihood of receiving optimal doses of IPTp-SP. CONCLUSIONS:In East-Central Uganda, uptake of optimal doses of IPTp-SP is very low. Improving institutional delivery and household wealth, involving religious leaders in programmes to improve uptake of IPTp-SP, and strengthening IPTp-SP activities at lower level health centers may improve uptake of IPTp-SP in the East-Central Uganda.
Project description:Introduction:Intermittent preventive treatment of malaria in pregnancy with sulfadoxine pyrimethamine (IPTp-SP) is effective in preventing the adverse consequences of malaria on birth outcomes. Methods:A cross-sectional survey was carried out among antenatal and postnatal women and midwives at private health facilities in Tema using the mixed method to investigate factors associated with uptake of IPTp-SP. Antenatal and postnatal women were consecutively enrolled and data on their sociodemographic characteristics and antenatal service utilization collected using a questionnaire and review of antenatal care (ANC) records. In-depth interviews involving attending midwives were conducted and data on ANC service delivery collected. The interviews were manually analyzed. Bivariate and multiple logistic regression analyses were done to determine factors associated with uptake of SP. Results:Of the 382 respondents, 178 (46.6%) took ? 3 doses of SP. Uptake was similar for those who had delivered and those yet to deliver (? 2 =2.94, p > 0.05). Ninety-seven of the 176 (55.1%) women who initiated antenatal visit during the first trimester received ? 3 doses of SP whilst 42.0% (76/181) of those who started during the second trimester received ? 3 doses (? 2 = 5.64, p = 0.02). Those who initiated ANC during the second trimester received more doses compared to those who started during the third trimester (? 2 = 4.43, p = 0.04). Respondents who attended ANC > 5 times increased their uptake by 83% compared to those who attended < 5 times (OR 0.2, 95% C.I 0.12-0.31). There was poor adherence to directly observed treatment and low knowledge of midwives on IPTp-SP protocol. Conclusion:Early initiation and regular visit to antenatal care centres promoted uptake of optimal doses of SP.
Project description:<h4>Background</h4>Malaria infection during pregnancy is of public health importance as it poses risk to the pregnant woman, her foetus and the newborn child. Intermittent preventive treatment during pregnancy using sulphadoxine-pyrimethamine is one way of reducing the effect of the disease on pregnancy outcomes. The study determined factors associated with uptake of sulphadoxine-pyrimethamine during pregnancy in the Cape Coast Metropolis of Ghana.<h4>Methods</h4>A health facility-based cross-sectional study involving pregnant women of ?36?weeks gestation visiting antenatal clinics in three selected health facilities in the Cape Coast Metropolis was conducted. Participants were consecutively recruited using a structured questionnaire over a 6-week period from May to June, 2018. Descriptive statistics was used to summarize the data whilst Pearson's chi-square/Fisher exact test was performed to determine associations and logistic regression done to determine the strength of the associations.<h4>Results</h4>A total of 212 pregnant women participated in the study. Formal education, initiating ANC early, taking first dose of SP during second trimester, not experiencing side effects of SP, having knowledge about schedule for taking SP and making ?4 ANC visits were factors associated with uptake of ?3 doses of IPTp-SP. Logistic regression analysis revealed that, mothers who made ?4 ANC visits were 53.77 times more likely to take ?3 doses of SP compared with those who made <?4 ANC visits (p?<? 0.001). Those who initiated ANC during the first trimester were 3.60 times more likely to receive ?5 doses compared with those who initiated ANC during the second or third trimester (p?=?0.022). Making ?8 ANC visits did not increase the chances of taking ?5 doses of SP.<h4>Conclusion</h4>Health promotion programmes targeting mothers with no formal education could increase their awareness about the importance of ANC services including uptake of IPTp-SP.
Project description:Background:Intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) decreases placental parasitaemia and improves birth outcomes. Currently, WHO recommends three or more doses of SP given during antenatal care (ANC), spaced one month apart after 16 weeks of gestation till delivery. This study determined the level of uptake of SP and its association with birth outcomes in rural northern Ghana. Methods:A survey was carried out at the War Memorial Hospital in Navrongo, Ghana, among mothers who had delivered within ten weeks and were seeking postnatal care. Data on time of first ANC, number of visits, receipt of IPTp-SP, and birth outcomes were extracted from the antenatal records of 254 mothers. Mothers were interviewed on their background characteristics and obstetric history. Chi-square tests and logistic regression were carried out to determine association between antenatal indicators, uptake of IPTp-SP, and birth outcomes using Stata version 13. Results:Uptake of three-five doses of SP was IPT3 =76.4%, IPT4 =37.3%, and IPT5 = 16.0%. Receipt of first dose of SP at 16, 17-24, and 25-36 weeks of gestation was 16.9%, 56.7%, and 26.4%, respectively. Taking the first dose of SP during the second trimester allowed for taking ?3 doses of SP compared to taking the first dose during the third trimester (?2 = 60.1, p<0.001). Women who made ?4 visits were more likely to receive ?3 doses of SP compared to those who made <4 visits (?2 = 87.6, p<0.001). Women who received ? 3 doses of SP were more likely (OR = 3.3; 95% CI: 1.69-6.33) to give birth at term and also have normal weight babies (OR =4.0; 95% CI: 1.98-8.06). Conclusion:Uptake of three or more doses of SP contributed to improved pregnancy outcomes. Increased efforts towards improving early ANC attendance could increase uptake of SP and improve pregnancy outcomes.
Project description:Background:We investigated whether adding community scheduled malaria screening and treatment (CSST) with artemether-lumefantrine by community health workers (CHWs) to standard intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) would improve maternal and infant health. Methods:In this 2-arm cluster-randomized, controlled trial, villages in Burkina Faso, The Gambia, and Benin were randomized to receive CSST plus IPTp-SP or IPTp-SP alone. CHWs in the intervention arm performed monthly CSST during pregnancy. At each contact, filter paper and blood slides were collected, and at delivery, a placental biopsy was collected. Primary and secondary endpoints were the prevalence of placental malaria, maternal anemia, maternal peripheral infection, low birth weight, antenatal clinic (ANC) attendance, and IPTp-SP coverage. Results:Malaria infection was detected at least once for 3.8% women in The Gambia, 16.9% in Benin, and 31.6% in Burkina Faso. There was no difference between study arms in terms of placenta malaria after adjusting for birth season, parity, and IPTp-SP doses (adjusted odds ratio, 1.06 [95% confidence interval, .78-1.44]; P = .72). No difference between the study arms was found for peripheral maternal infection, anemia, and adverse pregnancy outcomes. ANC attendance was significantly higher in the intervention arm in Burkina Faso but not in The Gambia and Benin. Increasing number of IPTp-SP doses was associated with a significantly lower risk of placenta malaria, anemia at delivery, and low birth weight. Conclusions:Adding CSST to existing IPTp-SP strategies did not reduce malaria in pregnancy. Increasing the number of IPTp-SP doses given during pregnancy is a priority. Clinical Trials Registration:NCT01941264; ISRCTN37259296.
Project description:To identify factors contributing to low uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in rural Mali.We conducted secondary data analysis on Mali's 2012-2013 Demographic and Health Survey (DHS) to determine the proportion of women who failed to take IPTp-SP due to ineligibility or non-attendance at antenatal care (ANC). We also identified the proportion who reported taking other or unknown medications to prevent malaria in pregnancy and those who did not know if they took any medication to prevent malaria in pregnancy. We conducted qualitative interviews, focus groups and ANC observations in six rural sites in Mali's Sikasso and Koulikoro regions to identify reasons for missed opportunities.Our secondary data analysis found that reported IPTp-SP coverage estimates are misleading due to their dependence on a variable ("source of IPTp") that is missing 62% of its data points. Among all women who gave birth in the two years prior to the survey, 56.2% reported taking at least one dose of IPTp-SP. Another 5.2% reported taking chloroquine, 1.9% taking another drug to prevent malaria in pregnancy, 4.4% not knowing what drug they took to prevent malaria, and 1.1% not knowing if they took any drug to prevent malaria. The majority of women who did not receive IPTp-SP were women who also did not attend ANC. Our qualitative data revealed that many health centers neither administer IPTp-SP by directly observed therapy, nor give IPTp-SP at one month intervals through the second and third trimesters, nor provide IPTp-SP free of charge. Women generally reported IPTp-SP as available and tolerable, but frequently could not identify its name or purpose, potentially affecting accuracy of responses in household surveys.We estimate IPTp-SP uptake to be significantly higher than stated in Mali's 2012-13 DHS report. Increasing ANC attendance should be the first priority for increasing IPTp-SP coverage. Reducing cost and access barriers, ensuring that providers follow up-to-date guidelines, and improving patient counseling on IPTp-SP would also facilitate optimal uptake.