Intermittent use of sulphadoxine-pyrimethamine for malaria prevention: a cross-sectional study of knowledge and practices among Ugandan women attending an urban antenatal clinic

Abstract

BackgroundThe WHO recommends supervised administration of sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment for malaria (IPTp) during pregnancy. Logistical constraints have however favoured unsupervised intake of SP-IPTp, casting doubts whether recent guidelines requiring more frequent intake can be effectively implemented. To propose strategies for enhancing compliance under limited supervision, this study sought to identify pregnant women’s knowledge and practices gaps as well as determine predictors of compliance with SP-IPTp, given under limited supervision.MethodsA cross-sectional study of 700 women used exit interviews at an urban clinic in Uganda to obtain a descriptive summary of demographic and obstetric characteristics, including knowledge, practice and experiences with SP. Predictors of compliance with SP intake instructions were explored using logistic regression.ResultsMedian age of respondents was 25 (IQR 22–28) and median parity was two (IQR one to three) while median number of antenatal clinic (ANC) visits was 3.0 (IQR three to four). Most women had completed primary (36%) or ordinary secondary education (25.6%) while 16.1% had not completed primary education. Awareness about SP was high (99.4%) although correct knowledge regarding its use in pregnancy was low (57%), with 15.4% thinking it was used to treat malaria and 26.7% lacking any idea about its use. Correct knowledge on SP use during pregnancy significantly predicted compliance with SP-IPTp instructions (OR 1.98, C.I. 1.12-3.55), while age, education level, parity, number of ANC visits, or history of unwanted effects with SP did not. SP was mostly accessed from hospitals (64.4%) followed by private clinics (16.9%) both for preventive and treatment purposes. SP was considered safe by most women, who were willing to take it again in future, without supervision.ConclusionDespite high awareness, knowledge of SP as an intervention for malaria prevention in pregnancy was low. Correct knowledge on use of SP predicted compliance with SP-IPTp intake instructions. Focused malaria-related education during ANC visits may improve compliance with SP intake amidst limited supervision.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-399) contains supplementary material, which is available to authorized users.

Is there a distinction between malaria treatment and intermittent preventive treatment? Insights from a cross-sectional study of anti-malarial drug use among Ugandan pregnant women

“…Exit interviews were used to collect data from pregnant women attending ANC at Mulago Hospital. Data for this study was obtained as part of a larger cross-sectional study on malaria, IPTp and anti-malarial drug use among Ugandan women, some of which was recently published [ 19 ].…”

Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala

“…Where no effort is made to ascertain actual user compliance, such findings remain questionable, especially coming from resource-constrained settings where unsupervised administration of SP is the norm, contrary to guidelines. As argued elsewhere, the presence of such records does not necessarily translate into intake compliance [21, 22]. Our findings are however limited by the small sample sizes used that may not be adequately powered to detect true differences between the groups.…”

“…However, such findings in most cases are hampered by the exclusive reliance on self-reports and antenatal records to ascertain SP use. Because unsupervised SP-IPTp administration is a common occurrence in many resource-limited settings, we have previously argued that self-reports and ANC records may not necessarily translate into SP intake compliance [21, 22]. Moreover, where intake was ascertainable, studies have continued to show effectiveness of SP-IPTp [13, 23–29].…”

Adherence to Intermittent Preventive Treatment of Malaria in Pregnancy with Sulfadoxine–Pyrimethamine and Associated Factors: A Cross-Sectional Survey in Benin’s Public Hospitals.

“…Thus, according to one of these studies, good knowledge on the use of SP during pregnancy was significantly predictive of good adherence to IPTp-SP [25]. In 2010, in Nigeria, another study showed that women's comprehensive knowledge of malaria including its prevention during pregnancy through the use of IPTp-SP was associated with good adherence to IPTp-SP [25]. All this confirms that adequate knowledge on IPTp-SP by pregnant women could improve their adherence.…”

“…In addition, they identified other factors such as low antenatal coverage and prenatal consultations in the private sector. Thus, according to one of these studies, good knowledge on the use of SP during pregnancy was significantly predictive of good adherence to IPTp-SP [25]. In 2010, in Nigeria, another study showed that women's comprehensive knowledge of malaria including its prevention during pregnancy through the use of IPTp-SP was associated with good adherence to IPTp-SP [25].…”