Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: a cross-sectional study

Abstract

BackgroundMalaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Zomba district IPTp uptake falls far below the national average. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district after adoption of new IPTp-SP policy in 2014.MethodsThis was a cross-sectional survey. Two public health facilities (HFs) were randomly selected from urban and rural areas in Zomba district. Study participants were postpartum women selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire. Bivariate and multiple logistic regression was used in data analysis.ResultsOut of all the enrolled participants (n = 463), 92% women had complete information for analysis. Of these, (n = 426) women, 127 (29.8%, 95% CI: 25.6%–34.3%) received three or more doses of SP, 299 (70.2%, 95% CI: 65.7%–74.4%) received two or less doses. Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR = 0.31, 95% CI 0.13–0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR = 0.29, 95% CI 0.18–0.48); not taking SP under direct observation therapy (DOT) (AOR = 0.18, 95% CI (0.05–0.63).ConclusionsThere is low utilisation of at least three doses of SP in this population and this seems to be associated with the number of ANC visits and use of DOTs. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1744-y) contains supplementary material, which is available to authorized users.

Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda

“…It was revealed that women from other religious groups were more likely to receive optimal doses of IPTp-SP than Catholics. This is similar to findings in Malawi which showed that Catholic/Anglican women were less likely to complete at least 3 doses of IPTp-SP during pregnancy relative to women of other religions denominations, that is Baptists, Church of Central Africa Presbyterian and Seventh Day Adventists [33]. There is paucity of information that explains the low uptake of IPTp-SP among Catholic women especially in Uganda, which calls for further research.…”

“…The likelihood of completing optimal doses of IPTp-SP was statistically significantly higher among older women 30 years and above than younger women aged 25-30 years. This result compares to other similar results in Malawi [33,48]. It is therefore imperative that interventions to increase uptake of optimal doses of IPTp-SP among pregnant women focus on 25-30 years population group.…”

“…After the review of the existing relevant literature, 22 potential socio-economic, demographic, and healthcare utilization covariates associated with IPTp-SP uptake during pregnancy [30][31][32][33][34][35][36][37] were retrieved from the 2016 UDHS dataset for analysis. All the variables were categorical.…”

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

“…Moreover, the adjusted odds ratio results indicate that pregnant women who attended ANC three times only and those who visited ANC one-or two-times only during gestation period had lower odds of receiving optimal doses of IPTp-SP compared to pregnant women who had made four or more ANC visits. This finding is consistent with studies done in Malawi [30,31], Uganda [49], Tanzania [22,33], Ghana [36,39], Burkina Faso [34], Mali [35,37], Cameroon, and in women who managed at least four ANC visits [20].…”

“…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].…”