Timing of intermittent preventive treatment for malaria during pregnancy and the implications of current policy on early uptake in north-east Tanzania

Abstract

BackgroundIntermittent preventive treatment (IPTp) is efficacious in reducing the adverse outcomes associated with pregnancy-associated malaria, however uptake of the recommended two doses is low in Tanzania, and little is known of the timepoint during pregnancy at which it is delivered. This study investigated the timing of delivery of IPTp to pregnant women attending antenatal clinics (ANC), and the potential determinants of timely uptake.MethodsStructured interviews were conducted with staff and pregnant women at antenatal clinics in northeast Tanzania, and antenatal consultations were observed. Facility-based and individual factors were analysed for any correlation with timing of IPTp uptake.ResultsAlmost half the women interviewed first attended ANC during or before the fourth month of gestation, however 86% of these early attendees did not receive IPTp on their first visit. The timing of IPTp delivery complied closely with the national guidelines which stipulate giving the first dose at 20–24 weeks gestation. Uptake of at least one dose of IPTp among women who had reached this gestation age was 67%, although this varied considerably between clinics. At one facility, IPTp was not delivered because SP was out of stock.ConclusionEarly uptake of IPTp was found to be hampered by factors external to health worker performance or women's individual preferences. These include insufficient drug stocks and an apparent lack of information to health workers on the reasoning for continued use of SP for IPTp when it has been replaced as a first-line treatment. In addition, an unexpectedly high proportion of women attend antenatal clinics before 20 weeks of pregnancy. While current policy denies the use of IPTp at this time, there is emerging, but incomplete, evidence that malaria in early pregnancy may contribute considerably to the burden of pregnancy-related malaria. Current policy may thus result in a missed opportunity for maximising the benefit of this intervention, and efforts to encourage earlier attendance at ANC alone are unlikely to improve uptake of IPTp. More evidence is needed to weigh the benefits of early IPTp use against theoretical risks of antifolate drugs in early pregnancy.

Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria

“…This highlights the need to explore other variables like sociocultural, economic, political, and individual perceptions regarding IPTp in a contextual perspective. 25 Tracking progress in relation to attainment of maternal-related MDG with respect to IPTp may be a bit difficult because the framework for effective monitoring and Note: a total of 13 women were not included in analyses because the gestational age at booking was not recorded. Abbreviations: iPTp, intermittent preventive treatment; n, number; df, degrees of freedom.…”

Chemoprophylaxis for malaria - in pregnancy by public and private health providers in Lagos

“…This is in keeping with the study in Enugu where the private providers were more aware of the timing than the public providers (6). The proper timing is very important so as to have full benefits of the policy which should be at least two or three times -during pregnancy (9). Proper timing with 3 or more doses of sulphadoxine-pyrimethamine was associated with higher birth weight and lower risk of low birth weight than the standard 2 dose regimens (12).…”

“…Therefore, it is necessary to assess the level of provision of IPTp and understand the underlying reasons behind the level of provision in both private and public health providers, Efforts have been made to alleviate the problem of malaria in pregnancy, this include the WHO recommendation of prompt and effective management of malaria in pregnancy, chemoprophylaxis, the use of long lasting insecticide nets and indoor residential spraying (IRS) and the use of IPTp (6,9).…”

Factors Influencing the Uptake of Intermittent Preventive Treatment for Malaria in Pregnancy: Evidence from Bungoma East District, Kenya

“…The timing of first visits to ANC clinics also influences the IPTp uptake. In this regard, [16] found that even though 48% of the participants started ANC visits before the 16 th week of pregnancy, up to 86% of this lot did not receive IPTp 1 because the gestation period was below the recommended 16 weeks. Those who did not receive proper explanation of this policy requirement were discouraged and failed to turn up for subsequent appointments.…”

“…Furthermore, IPTp uptake significantly associated with distance to ANC facilities, domestic chores and absence of health issues during pregnancy [15], as well as gravidity [16]. Hence, primigravid women were more likely to attend ANC in time for IPTp doses than multigravid women.…”