Abstract
ObjectivesTo evaluate barriers preventing pregnant women from using insecticide-treated nets (ITN) and intermittent presumptive treatment (IPT) with sulphadoxine-pyrimethamine (SP) 5 years after the launch of the national malaria strategy promoting these measures in Kenya.MethodsAll women aged 15–49 years were interviewed during a community survey in four districts between December 2006 and January 2007. Women pregnant in the last 12 months were asked about their age, parity, education, use of nets, ITN, antenatal care (ANC) services and sulphadoxine-pyrimethamine (SP) (overall and for IPT) during pregnancy. Homestead assets were recorded and used to develop a wealth index. Travel time to ANC clinics was computed using a geographic information system algorithm. Predictors of net and IPT use were defined using multivariate logistic regression.ResultsOverall 68% of pregnant women used a net; 52% used an ITN; 84% attended an ANC clinic at least once and 74% at least twice. Fifty-three percent of women took at least one dose of IPT-SP, however only 22% took two or more doses. Women from the least poor homesteads (OR = 2.53, 1.36–4.68) and those who used IPT services (OR = 1.73, 1.24–2.42) were more likely to sleep under any net. Women who used IPT were more likely to use ITNs (OR = 1.35, 1.03–1.77), while those who lived more than an hour from an ANC clinic were less likely (OR = 0.61, 0.46–0.81) to use ITN. Women with formal education (1.47, 1.01–2.17) and those who used ITN (OR: 1.68, 1.20–2.36) were more likely to have received at least one dose of IPT-SP.ConclusionAlthough the use of ITN had increased 10-fold and the use of IPT fourfold since last measured in 2001, coverage remains low. Provider practices in the delivery of protective measures against malaria must change, supported by community awareness campaigns on the importance of mothers’ use of IPT.
Highlights
Infection with Plasmodium falciparum during pregnancy often results in maternal anaemia and low birth weight, under stable endemic transmission (Brabin 1983; Steketee et al 1996, 2001; Parise et al 1998; Shulman et al 1999)
Nancy to reduce the incidence of malaria attributableanaemia and low birth weight: intermittent presumptive treatment (IPT) using sulphadoxine-pyrimethamine (SP) in the second and third trimesters and the use of insecticidetreated nets (ITN) (Gamble et al 2006; Garner & Gulmezoglu 2006)
We present the findings of a recent survey of pregnant women and their use of IPT and ITN in four rural districts of Kenya in 2006, 5 years after the launch of the national malaria strategy and we highlight the current barriers to effective coverage among biologically and economically vulnerable women
Summary
Infection with Plasmodium falciparum during pregnancy often results in maternal anaemia and low birth weight, under stable endemic transmission (Brabin 1983; Steketee et al 1996, 2001; Parise et al 1998; Shulman et al 1999). Malaria contributed to an estimated 400 000 cases of anaemia among pregnant African women in 1995 (Guyatt & Snow 2001a) and indirectly caused about 100 000 infant deaths through low birth weight (Guyatt & Snow 2001b). But variable, uptake of antenatal care (ANC) clinics by pregnant women in Africa (http://www.measuredhs.com), this Abuja target should be attainable by 2010.
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