Uptake of intermittent preventive treatment and pregnancy outcomes: health facilities and community surveys in Chókwè district, southern Mozambique

Abstract

BackgroundMalaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000–200,000 infant deaths every year. Currently, the World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) at each scheduled antenatal care (ANC) visit. This study aimed to assess IPTp-SP coverage in mothers delivering in health facilities and at the community. In addition, factors associated with low IPTp-SP uptake and malaria adverse outcomes in pregnancy were investigated.MethodsA community and a health facility-based surveys were conducted in mothers delivering in Chókwè district, southern Mozambique. Social-demographic data, malaria prevention practices and obstetric history were recorded through self-report and antenatal records. For women delivering at health facilities, a clinical examination of mother and child was performed, and malaria infection at delivery was determined by rapid diagnostic test, microscopy, quantitative PCR and placental histology.ResultsOf 1141 participants, 46.6, 30.2, 13.5 and 9.6% reported taking ≥ 3, two, one and none SP doses, respectively. Low IPTp uptake (< 3 doses) was associated with non-institutional deliveries (AOR = 2.9, P < 0.001), first ANC visit after week 28 (AOR = 5.4, P < 0.001), low awareness of IPTp-SP (AOR = 1.6, P < 0.002) and having no or only primary education (AOR = 1.3, P = 0.041). The overall prevalence of maternal malaria (peripheral and/or placental) was 16.8% and was higher among women from rural areas compared to those from urban areas (AOR = 1.9, P < 0.001). Younger age (< 20 years; AOR = 1.6, P = 0.042) and living in rural areas (AOR = 1.9, P < 0.001) were predictors of maternal malaria at delivery. Being primigravidae (AOR = 2.2, P = 0.023) and preterm delivery (AOR = 2.6, P < 0.001) predicted low birth weight while younger age was also associated with premature delivery (AOR = 1.4, P = 0.031).ConclusionThe coverage for two and ≥ 3 doses of IPTp-SP is moderately higher than estimates from routine health facility records in Gaza province in 2015. However, this is still far below the national target of 80% for ≥ 3 doses. Ongoing campaigns aiming to increase the use of malaria prevention strategies during pregnancy should particularly target rural populations, increasing IPTp-SP knowledge, stimulate early visits to ANC, improve access to health services and the quality of the service provided.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2255-z) contains supplementary material, which is available to authorized users.

Access to and use of preventive intermittent treatment for Malaria during pregnancy: a qualitative study in Chókwè district, Southern Mozambique

“…This was mainly linked to late and infrequent ANC attendance, which led to missed opportunities for the provision of the recommended IPTp-SP dosage. This is in agreement with our previously reported results in the study on IPTp-SP coverage among delivering women conducted in the same setting [17]. Similar studies conducted in Uganda and Mali also found that late and infrequent ANC attendance were important factors influencing poor uptake of IPTp-SP and other malaria preventive measures [23,24].…”

“…The semi-structured interviews with pregnant women and health workers provided useful information on the perceived gaps that challenges the uptake of IPTp-SP among pregnant women. The qualitative data supports quantitative findings from the study on IPTp-SP coverage among delivering women, that was undertaken in parallel to this study, reported similarly low levels of awareness and knowledge of IPTp services among pregnant women in the same area [17].…”

“…Since 2006, IPTp-SP is administered though the directly observed therapy approach, and ITNs are distributed free of charge to pregnant women at ANC visits [15]. However, according to the 2015 national survey data, the proportion of women receiving two doses and three or more doses of IPTp-SP was 34.2% and 22.4%, respectively [16], whereas our recent study in Chókwè rural district showed a coverage of 46.6% for three or more IPTp-SP doses at delivery [17].…”

Determinants of preterm birth among mothers who gave birth in East Africa: systematic review and meta-analysis

“…, 11 from Ethiopia[52][53][54][55][56][57][58][59][60][61][62][63], 6 from Kenya[5,54,[64][65][66][67], 7 from Malawi [4, 6, 68-72], 3 from Sudan [10, 73, 74], 3 from Zambia [75-77],3 from Zimbabwe [78-80], 2 from Uganda [7, 81], 2 from Mozambique[82,83], 1 from Rwanda[84], and 1 from Madagascar[85]. Twenty five studies were done by cohort study design[33, 35, 36, 39, 41, 43, 45-50, 59, 61, 65-68, 70, 75, 77, 80, 83-85], 9 studies by case control study design[7,10,37,38,53,55,57,73,79] and 24 studies by cross sectional study design[4-6, 34, 40, 42, 44, 51, 52, 54, 56, 58, 60, 62, 64, 69, 71, 72, 74, 76, 78, 81, 82] (Table 1).…”

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

“…Studies reported from Ghana indicate that coverage of IPTp3+ is 46.6% in Tema metropolis of the Greater Accra region [39], 31.8% in Kumasi [50] and in Osu Klottey sub-district of Accra Metropolitan is 73.8% [51]. A study conducted in Chókwè district, southern Mozambique showed that coverage of three or more doses of SP is 46.6% [52]. It should be noted that Uganda, Ghana and Mozambique adopted the updated WHO IPTp policy in 2014, 2012 and 2014 respectively [53].…”