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

Abstract

BackgroundIn Uganda, treatment of clinical malaria and intermittent preventive treatment with sulphadoxine-pyrimethamine (SP) are common during pregnancy. As a result, both formal and informal reports from antenatal sources suggest possible misuse of SP for malaria treatment among pregnant women. The objective of this study was to investigate anti-malarial drug use patterns among women who had recently suffered malaria illness before and during pregnancy.MethodsA cross-sectional study in which a structured questionnaire (interviewer-administered) was used to collect data from pregnant women attending an urban antenatal clinic. Details of medicines used to treat malaria episodes suffered before and during pregnancy were captured. A first order Markov probability model was used to estimate probabilities of transitioning between treatment choices made before and during pregnancy. Logistic regression was used to explore whether demographic and obstetric characteristics were associated with transition patterns.ResultsSeven hundred women were interviewed among whom 428 had suffered malaria in both instances. Three hundred thirty of these could recall the medicines used in both instances. Women who used ACT/QNN (correct choice) before pregnancy had higher probabilities of transitioning to SP than staying on ACT/QNN during pregnancy (0.463 versus 0.451). Access of medicines from private outlets (clinics and pharmacies) were more than nine times predictive of receiving correct medicines (p=0.035 and p=0.039 respectively). Access of medicines from clinics was 5.9 times protective against receiving SP for malaria treatment (p=0.033). Among those who used SP before pregnancy, there was a 0.75 probability of staying on it during pregnancy. None of the factors explored could explain this observation.ConclusionUse of SP for malaria treatment is common during pregnancy. This may be contributing to adverse pregnancy outcomes. Antenatal care providers should endeavour to emphasize the distinction between treatment and prevention of malaria during pregnancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0702-7) contains supplementary material, which is available to authorized users.

Predictors of residual antimalarial drugs in the blood in community surveys in Tanzania

“…Considering that women aged between 15–49 years represent around 25.0% of the total population [ 43 ], one would expect around 2.0% of the participants to have SP in their blood, much lower than the proportion measured in our study. As mentioned before, this large discrepancy goes in line with previous studies reporting the common use of SP as self-medication [ 11 , 22 , 44 ]. Measuring SP in the blood provides interesting insight on how these treatments are used in different regions of the country and by different population groups.…”

Benchmarking health system performance across regions in Uganda: a systematic analysis of levels and trends in key maternal and child health interventions, 1990–2011

“…A nationally-representative survey of health facilities found that over 90 % of facilities in Uganda had sulfadoxine/pyrimethamine in stock in 2012 [ 67 ], indicating that stock-outs were an unlikely root cause of low IPTp2. Previous work suggests that prescription practices by health providers, including the misuse of sulfadoxine/pyrimethamine to treat clinical malaria, may be the main driver of low rates of IPTp [ 77 , 78 ]. Further examination is needed to identify and address the factors leading to low IPTp2 coverage throughout Uganda.…”

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].…”