Determinants of uptake of intermittent preventive treatment for malaria with sulfadoxine pyrimethamine in pregnancy: a cross-sectional analytical study in the Sekondi-Takoradi Metropolis of Ghana

Abstract

Background Ghana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012. The uptake of higher doses of SP since the implementation of the new policy in 2016, has been low across the country. The current study determined factors that can be improved to increase uptake of SP for intermittent preventive treatment of malaria in pregnancy (IPTp-SP). Methods A cross-sectional analytical study was carried out among women who had just delivered in selected health facilities in the Sekondi-Takoradi Metropolis of Ghana. Participants were enrolled from the lying-in wards of the study facilities after delivery. Data including time of initiating antenatal care (ANC), number of visits, time of first dose of SP and number of doses were collected. ANC books were also reviewed. Logistic and ordered logistic regression analysis were done to determine respondent factors associated with uptake of IPTp-SP using Stata 15. Results Out of the 496 mothers who participated in the study, 370 (74.60%) initiated ANC during the first trimester, 123 (24.80%) during the second, with only three (0.60%) starting during the third trimester. Majority (463/496, 93.35%) made > 4 visits. Uptake of at least one dose of SP was 98.79% (490/496), ≥ 2 doses was 92.75 (460/496), ≥ 3 doses was 80.65% (400/496) and ≥ 4 doses was 40.32% (200/496). Uptake of IPTp 5 was very low (6.65%, 33/490). A unit increase of one ANC visit was associated with 20% higher odds of receiving 3-4 doses of SP with respect to receiving 1-2 doses (p < 0.001). The probability of receiving 5 or more doses of SP with respect to 1-2 doses was 26% higher with a unit increase of one ANC visit. Conclusion Uptake of 3-4 doses and ≥ 5 doses of SP were associated with making more ANC visits. Encouraging and motivating expectant mothers to make more ANC visits can improve uptake of ≥5 doses of SP.

Interventions for malaria prevention in pregnancy; factors influencing uptake and their effect on pregnancy outcomes among post-natal women in a tertiary facility in the Volta Region of Ghana

“…The uptake of optimal doses in the current study far exceeds the 64.5% and 71.0% reported in some Ghanaian studies 26,40 but comparable to the 2019 report of 80.7% in Sekondi-Tarkoradi also in Ghana. 24 It is, however, lower than the 95% reported among post-partum women about a year earlier at the same study site 32 and this calls for operational research into the seeming reduction in uptake of optimal IPTp-SP doses at HTH. Age >25 years, employment and good knowledge of MiP facilitated uptake of optimal IPTp-SP doses while starting ANC later than 13 weeks was a barrier.…”

“…22 Several studies have reported 32%-80.7% uptake of ⩾3 doses of IPTp-SP. [23][24][25][26][27] and ITN utilization of 40%-95% in pregnant women 25,[28][29][30][31] in Ghana over the last decade. However, there is a paucity of data on the uptake of these interventions and a limited understanding of local factors influencing them in the Ho Municipality of the Volta Region.…”