Abstract
IntroductionMalaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions.MethodsA quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis.ResultsApproximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability.ConclusionsIPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.
Highlights
Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-Sulfadoxine Pyrimethamine (SP)) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana
While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women
In 2019, the World Health Organization (WHO) estimated that out of 33.2 million pregnancies that occurred in sub-Saharan Africa (SSA), approximately 11.6 million of them were exposed to malaria infection [3], and this resulted in about 822,000 low birth weighted (LBW) babies, half of whom were born in the West African sub region [2]
Summary
Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Everybody is at risk of the disease in endemic regions, children under 5 years old and pregnant women are the most vulnerable [3] For pregnant women, their increased vulnerability has been attributed to reduced immunity arising from immunological, hormonal and physiological changes [4, 5]. In 2019, the World Health Organization (WHO) estimated that out of 33.2 million pregnancies that occurred in sub-Saharan Africa (SSA), approximately 11.6 million of them were exposed to malaria infection [3], and this resulted in about 822,000 low birth weighted (LBW) babies, half of whom were born in the West African sub region [2]. In low or unstable malaria transmission areas, with low levels of acquired immunity, pregnant women are more likely to progress towards clinical cases, with untreated persons developing severe disease and even death [4, 5, 11]. The parasites may be present in the placenta and contribute to maternal anaemia [14, 15] which can lead to LBW [16, 17], an important contributor to infant mortality [18]
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