The use of intermittent preventive treatment in pregnancy and insecticide-treated bed nets for malaria prevention by women of child-bearing age in eight districts in Malawi

Abstract

BackgroundIntermittent preventive treatment in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) can reduce the morbidity and mortality associated with malaria in pregnancy. Although the coverage for both IPTp and ITN use have been described in Malawi, the analysis of factors associated with IPTp receipt and ITN use is lacking. This analysis was conducted to assess IPTp and ITN use and predictors of use by women of child-bearing age (WOCBA).MethodsA two-stage cluster-sample cross-sectional survey was conducted April 16–30, 2009 in eight districts across Malawi. Information on receipt of two or more doses of IPTp, ITN ownership, and ITN use the night before the survey was collected. Multivariate logistic regression was used to assess predictors of IPTp and ITN use.ResultsData were collected from 7407 households containing 6985 WOCBA and 3213 recently pregnant women (women who reported a completed pregnancy in the 2 years before the survey). Most recently pregnant women (96 %) had at least one antenatal care (ANC) clinic visit; 91 % reported receiving at least one dose of IPTp, and 72 % reported receiving two or more doses of IPTp. Women in Phalombe, Rumphi, and Lilongwe were more likely to receive two doses of IPTp than those in Blantyre [adjusted odds ratio (aOR) 2.5 (95 % CI 1.5–4.5), 2.5 (95 % CI 1.5–4.3), and 2.0 (95 % CI 1.2–3.1), respectively]. Educated women were more likely to have received IPTp compared to women with no education [aOR 1.6 (95 % CI 1.0–2.6) for those who completed primary school, aOR1.9 (95 % CI 1.1–3.3) for some secondary school, and aOR 4.1 (95 % CI 1.9–8.7) for completed secondary school or above], and women in the poorest socioeconomic status quintile were less likely to receive IPTp than those in the least poor quintile [aOR 0.68 (95 % CI 0.48–0.97)]. In all, 53 % of WOCBA used an ITN the previous night. Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39–0.69) and aOR 0.67 (95 % CI 0.47–0.95), respectively]. In addition, age [aOR 0.61 (95 % CI 0.45–0.83) for women 15–19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2–2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1–2.8)] were associated with ITN use.ConclusionIn Malawi in 2009, IPTp and ITN use in WOCBA fell short of national and international goals. Adoption of new guidelines encouraging administration of IPTp at every scheduled ANC visit might increase IPTp use. Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use.

Predictors of the use of interventions to prevent malaria in pregnancy in Cameroon

“…There is an obvious clinical benefit to 2 or 3 doses of SP compared to single dose and longer time (>10 weeks) between doses has been associated with suboptimal outcomes [28]. Wealth was associated with access to and use of malaria prophylaxis medications in prior studies but was not seen in this study [21, 29]. Access to malaria prophylaxis among pregnant women may have become more equitable in Cameroon due to affordable essential drug schemes which lower costs for all.…”

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

“…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 (IPTp-SP) in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

“…This study, however, is limited to a particular district. Globally, studies have revealed that uptake of at least two doses of IPTp-SP is associated with number of ANC visits [5,21,[29][30][31][32][33][34][35][36][37][38], directly observed therapy (DOT) [5,29,37,39,40], residential area [21,29,41], age of woman [41], education level and socioeconomic status [42], parity [5,41], timing of initial ANC visit [5,36,43], knowledge about malaria/IPTp-SP [5,37] and stockouts of the commodity [5,37,44]. This study aimed to contribute to identifying factors associated with completion of recommended doses of SP during pregnancy using the updated WHO policy in resource limited settings from a nationally representative sample.…”