Late ANC initiation and factors associated with sub-optimal uptake of sulphadoxine-pyrimethamine in pregnancy: a preliminary study in Cape Coast Metropolis, Ghana

Abstract

Background Malaria infection during pregnancy is of public health importance as it poses risk to the pregnant woman, her foetus and the newborn child. Intermittent preventive treatment during pregnancy using sulphadoxine-pyrimethamine is one way of reducing the effect of the disease on pregnancy outcomes. The study determined factors associated with uptake of sulphadoxine-pyrimethamine during pregnancy in the Cape Coast Metropolis of Ghana. Methods A health facility-based cross-sectional study involving pregnant women of ≥36 weeks gestation visiting antenatal clinics in three selected health facilities in the Cape Coast Metropolis was conducted. Participants were consecutively recruited using a structured questionnaire over a 6-week period from May to June, 2018. Descriptive statistics was used to summarize the data whilst Pearson’s chi-square/Fisher exact test was performed to determine associations and logistic regression done to determine the strength of the associations. Results A total of 212 pregnant women participated in the study. Formal education, initiating ANC early, taking first dose of SP during second trimester, not experiencing side effects of SP, having knowledge about schedule for taking SP and making ≥4 ANC visits were factors associated with uptake of ≥3 doses of IPTp-SP. Logistic regression analysis revealed that, mothers who made ≥4 ANC visits were 53.77 times more likely to take ≥3 doses of SP compared with those who made < 4 ANC visits (p < 0.001). Those who initiated ANC during the first trimester were 3.60 times more likely to receive ≥5 doses compared with those who initiated ANC during the second or third trimester (p = 0.022). Making ≥8 ANC visits did not increase the chances of taking ≥5 doses of SP. Conclusion Health promotion programmes targeting mothers with no formal education could increase their awareness about the importance of ANC services including uptake of IPTp-SP.

The Association Between Early Antenatal Care and Intermittent Preventive Treatment of Malaria in Pregnancy in Sub-Saharan Africa: Effect Modification by Planned Pregnancy Status

“…Our finding on the association between early ANC and IPTp+3 has been reported among women in Ghana [ 13 ], Malawi [ 12 ], and Bangladesh [ 14 ]. A number of reasons may account for our study findings across Sub-Saharan African countries.…”

“…Pregnant women who had early ANC are educated on the importance of ANC including IPT with SP, which is given in the subsequent ANC schedule [ 6 10 ]. Such women are likely to return for their second ANC contact during which they receive their first dose of SP, which is associated with IPTp+3 [ 13 ]. Pregnant women who had early ANC may also already be aware of the significance of ANC and SP, and are more likely to make the required ANC contacts needed to receive IPTp+3.…”

“…Due to the significance of early ANC, it may play an important role in increasing the coverage of IPTp3+. However, there are limited studies on the relationship between early ANC and IPTp3+ [ 12 13 14 ]. In addition, no multicountry study has assessed the relationship between early ANC and IPTp3+ across the Sub-Saharan African region.…”

Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine-Pyrimethamine and its Associated Factors in the Atwima Kwanwoma District, Ghana

“…However, the present finding and those from previous studies conducted in other parts of the country have reported different levels of IPTp-SP uptake. For instance, Amoako and Anto [ 11 ] reported 90.6% level of IPTp-SP uptake in the Cape Coast Metropolis, Ibrahim et al [ 17 ]. reported an uptake of 71% in Sunyani in the Bono Region, while Addai-Mensah et al [ 9 ].…”

“…Previous studies on the topic have reported mixed findings. While some have reported high levels of uptake, ranging from 71% [ 10 ] to 90.6% [ 11 ] in some parts of the country; others have reported below 50% levels of uptake [ 9 12 ].…”