Predictors of optimal uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine and outcome of pregnancy in selected health facilities: a cross-sectional study in Northern Ghana

Abstract

Background Ghana adopted the 2012 World Health Organization (WHO) policy on intermittent preventive treatment of malaria in pregnancy (IPTp) and implemented it in 2014 in all regions of Ghana. Despite the implementation of this policy, there has been an unacceptably low percentage of eligible women receiving the optimal dose of IPTp in Ghana which leaves millions of pregnant women unprotected from malaria. The study, therefore, assessed the predictors of three or more doses (optimal dose) of sulfadoxine-pyrimethamine (SP) in Northern Ghana. Methods A cross-sectional study was conducted among 1188 women in four selected health facilities in Northern Ghana from September 2016 to August 2017. Information on socio-demographic and obstetric characteristics reported SP use, and maternal and neonatal outcomes were collected which was double-checked from the maternal health book as well as the antenatal care register. Pearson chi-Square and ordered logistic regression were used to determine the predictors of reported optimal SP use. Results Out of the 1146 women, 42.4% received 3 or more doses of IPTp-SP as recommended by the national malaria control strategy. SP uptake was significantly associated with antenatal care (ANC) attendance (aOR 0.49, 95% CI 0.36–0.66, P < 0.001), primary education (aOR 0.70, 95% CI 0.52–0.95, P = 0.022), four or more antenatal care visits (aOR 1.65, 95% CI 1.11–2.45, P = 0.014), ANC care visit in second trimester (aOR 0.63, 95% CI 0.49–0.80, P < 0.001) and third trimester (aOR 0.38, 95% CI 0.19–0.75, P = 0.006) and malaria infection during late gestation (aOR 0.56, 95% CI 0.43–0.73, p < 0.001). Conclusion The percentage of pregnant women who received three or more doses is below the target of the National Malaria Control Programme (NMCP). The push factors for the optimal use of SP are higher educational attainment, four or more ANC visits, and early initiation of ANC. The study also confirmed earlier findings that IPTp-SP uptake of three or more doses prevents malaria in pregnancy and improves birth weight. The uptake of IPTp-SP among expectant women will be informed and increased by encouraging formal general education beyond the primary level and encouraging early initiation of ANC visits.

Knowledge, Uptake and Therapeutic Effectiveness of Sulfadoxine-Pyrimethamine (IPTp-SP) among Pregnant Women Attending the Antenatal Clinic at Ayeduase Health Centre in Oforikrom Municipality in the Ashanti-Region, Ghana

“…The findings also resonate with those conducted in Tanzania, which reported that ≥ 4 ANC visits were statistically associated with 3 or more doses of IPTp-SP [32]. Similarly, 4 or more ANC visits were a significant predictor of 3 or more doses of IPTp-SP uptake, as reported in a study in northern Ghana [41]. This reflection may be explained by the fact that regular ANC visits among these pregnant women frequently expose them to health educational information on IPTp-SP by health providers, and this may go a long way in influencing their decision-making during pregnancy.…”

“…This is because initiating ANC early increases the chances of pregnant women receiving more doses of IPTp-SP than those who initiate ANC late or in their 3 rd trimester. In Northern Ghana, Malaria and anaemia infection in pregnancy was 53% and 46% times less among pregnant women who received 3 or more doses of SP [41]. This finding supports the claim that an appropriate dose of SP is still helpful in reducing the risk of malaria during pregnancy and increasing the weight of the baby.…”

“…Again, uptake was significantly associated with an increasing number of pregnancies, and pregnant women with 3-4 and 5 or more pregnancies were 4.2 and 9.2 times more likely to receive optimal doses of IPTp-SP, respectively. Similarly, multigravida and multiparous pregnant women had increased odds of receiving 3 or more doses of IPTp-SP in a study conducted in northern Ghana [41]. This could be attributed to the experienced benefits of IPTp-SP in pregnancy and childbirth outcomes among these pregnant women in their previous pregnancies.…”

“…In the Ghanaian setting, research has been conducted in the area of IPTp-SP uptake and its predictors [18,22,23]. However, there is no evidence-based assessment of the uptake and effectiveness of IPTp-SP among pregnant women visiting ANC at the Ayeduase Health Centre in the Ashanti region of Ghana.…”