Determinants of Use of Intermittent Preventive Treatment of Malaria in Pregnancy: Jinja, Uganda

Abstract

BackgroundMaternal malaria is associated with serious adverse pregnancy outcomes. One recommended means of preventing malaria during pregnancy is intermittent preventive therapy (IPTp) with sulfadoxine/pyrimethamine (SP). We sought to identify determinants of preventive use of SP during pregnancy among recently pregnant women in Uganda. Additionally, we characterized the timing of and indications for the administration of SP at antenatal care (ANC) visits and missed opportunities for SP administration.Methodology/Principal FindingsUtilizing a population-based random sample, we interviewed 500 women living in Jinja, Uganda who had been pregnant in the past year. Thirty-eight percent (192/500) of women received SP for the treatment of malaria and were excluded from the analysis of IPTp-SP. Of the remaining women, 275 (89.3%) reported at least two ANC visits after the first trimester and had an opportunity to receive IPTp-SP according to the Ugandan guidelines, but only 86 (31.3%) of these women received a full two-dose course of IPTp. The remaining 189 (68.7%) women missed one or more doses of IPTp-SP. Among the 168 women that were offered IPTp, 164 (97.6%) of them took the dose of SP.Conclusions/SignificanceUse of IPTp in Uganda was found to be far below target levels. Our results suggest that women will take SP for IPTp if it is offered during an ANC visit. Missed opportunities to administer IPTp-SP during ANC were common in our study, suggesting provider-level improvements are needed.

Assessing demand-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study in two regions of Uganda

“…This is in line with a number of recent studies that have concluded that the main reason for not taking IPTp was not being offered the drug by the health worker [37, 44–47]. It has also been found that frequent ANC visits do not ensure access to IPTp-SP where other barriers exist [7, 46].…”

“…Reluctance to take SP on an empty stomach has also been reported [37, 44], even though there is no evidence suggesting a link between nausea and taking SP on an empty stomach. From this research it appears that, in analogy with general concerns over taking medication in pregnancy, women can generally be persuaded to accept IPTp when recommended by a health worker.…”

Factors influencing the usage of different types of malaria prevention methods during pregnancy in Kenya

“…24 These results are similar to an earlier study where significant associations were established between women with a primary level of education and IPTp administration in Uganda. 25 The higher uptake of malaria prevention among women from wealthier households was also noted in previous studies. In Uganda, for example, high costs of ITNs inhibited malaria prevention among pregnant women.…”

Coverage and efficacy of intermittent preventive treatment with sulphadoxine pyrimethamine against malaria in pregnancy in Côte d¿Ivoire five years after its implementation

“…Consistent with other studies, our findings suggest that health provider practices rather than women's ANC attendance are primarily responsible for the ineffectiveness of the IPTp strategy in this setting [18,[21][22][23][24].…”