Factors Associated with Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy: A Cross-Sectional Study in Private Health Facilities in Tema Metropolis, Ghana

Abstract

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 (χ2 =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 (χ2 = 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 (χ2 = 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.

Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015–2016

“…Moreover, the adjusted odds ratio results indicate that pregnant women who attended ANC three times only and those who visited ANC oneor two-times only during gestation period had lower odds of receiving optimal doses of IPTp-SP compared to pregnant women who had made four or more ANC visits. This finding is consistent with studies done in Malawi [30,31], Uganda [49], Tanzania [22,33], Ghana [36,39], Burkina Faso [34], Mali [35,37], Cameroon, and in Benin [32].…”

“…This estimate is reflected in a study by Nkoka et al that used MDHS dataset [31]. Globally, studies have revealed that uptake of at least two doses of IPTp-SP is associated with number of ANC visits [5,22,[30][31][32][33][34][35][36][37][38][39], directly observed therapy (DOT) [5,30,38,40,41], residential area [22,30,42], age of woman [42], education level and socioeconomic status [43], parity [5,42], timing of initial ANC visit [5,31,44], knowledge about malaria/IPTp-SP [5,38] and stockouts of the commodity [5,38,45]. This study aimed to contribute to identifying factors associated with completion of recommended doses of SP during pregnancy post-adoption of the updated WHO policy in resource-limited settings from a nationally representative sample.…”

Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

“…Moreover, the adjusted odds ratio results indicate that pregnant women who attended ANC three times only and those who visited ANC one-or two-times only during gestation period had lower odds of receiving optimal doses of IPTp-SP compared to pregnant women who had made four or more ANC visits. This finding is consistent with studies done in Malawi [30,31], Uganda [49], Tanzania [22,33], Ghana [36,39], Burkina Faso [34], Mali [35,37], Cameroon, and in women who managed at least four ANC visits [20].…”

“…This estimate is reflected in a study by Nkoka et al that used MDHS dataset [31]. Globally, studies have revealed that uptake of at least two doses of IPTp-SP is associated with number of ANC visits [5,22,[30][31][32][33][34][35][36][37][38][39], directly observed therapy (DOT) [5,30,38,40,41], residential area [22,30,42], age of woman [42], education level and socioeconomic status [43], parity [5,42], timing of initial ANC visit [5,31,44], knowledge about malaria/IPTp-SP [5,38] and stockouts of the commodity [5,38,45].…”

Socioeconomic inequality in intermittent preventive treatment using Sulphadoxine pyrimethamine among pregnant women in Nigeria: A Decomposition analysis

“…This nding was comparable with the study reported from Kenya (25) which shows that poor individuals were less likely to use any kind antimalarial drugs for pregnant women. Other studies in some developing countries indicated that IPTp use during pregnancy was concentrated among women in the richest households (26)(27)(28).…”