Abstract
BackgroundAnnually, 125.2 million pregnant women worldwide risk contracting malaria, including 30.3 million and 1.5 million in Sub-Saharan Africa and Kenya respectively. At least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) is recommended for optimal benefit. Kenya recorded low IPTp-SP optimal uptake in 2015. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya.MethodsA cross-sectional study was conducted in Sabatia Sub County from April to October 2020. Using a validated semi-structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15–49 years with live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during pregnancy were excluded. Pearson Chi-square and Fisher’s Exact test were measures of association used. Binary logistic regression analysed predictors of optimal IPTp-SP uptake.ResultsOptimal IPTp-SP uptake was 79.6%, 95% CI 75.5%–83.7%. Predictors of IPTp-SP optimization were gestational age at first antenatal care (ANC) visit (P = 0.04), frequency of ANC visits (P < 0.001), maternal knowledge of IPTp-SP benefits (P < 0.001), maternal knowledge of optimal sulphadoxine pyrimethamine (SP) dose (P = 0.03) and SP administration at ANC clinic (P = 0.03). Late ANC initiators were less likely to receive optimal IPTp-SP (aOR = 0.4, 95% CI 0.2–0.9). Odds of optimizing IPTp-SP increased among women with ≥ 4 ANC visits (aOR = 16.7, 95% CI 7.9–35.3), good knowledge of IPTp-SP benefits (aOR = 2.4, 95% CI 1.3–4.5) and good knowledge of optimal SP dose (aOR = 1.9, 95% CI 1.1–3.4). Women who never missed being administered SP were highly likely to receive optimal IPTp-SP (aOR = 2.9, 95% CI 1.1–7.2)ConclusionsThis study has found high IPTp-SP optimal uptake in the study area. Efforts should be directed towards early and more frequent ANC visits. Intensive and targeted health education is required. It’s fundamental to adequately stock and consistently administer SP. Future studies considering larger samples and health workers’ perspectives of the health system delivery factors are recommended.Graphical abstract
Highlights
125.2 million pregnant women worldwide risk contracting malaria, including 30.3 million and 1.5 million in Sub-Saharan Africa and Kenya respectively
Of the 372 women, 79.6%, 95% Confidence interval (CI) 75.5%–83.7% received optimal Intermittent preventive treatment of malaria in pregnancy (IPTp)-sulphadoxine pyrimethamine (SP) dose while (76, 20.4%) took sub-optimal IPTp-SP dose
In line with other studies in Uganda, Tanzania, Malawi, Sierra Leone and Ghana, this study found that ≥ 4 antenatal care (ANC) visits predicts optimal IPTp-SP uptake [17,18,19,20, 23, 24, 30]
Summary
125.2 million pregnant women worldwide risk contracting malaria, including 30.3 million and 1.5 million in Sub-Saharan Africa and Kenya respectively. 125.2 million pregnant women risk contracting malaria yearly, including 30.3 million in stable malaria transmission zones of Sub-Saharan Africa (SSA) [5]. 40% of all pregnancies in SSA would experience Plasmodium falciparum placental infection in the absence of MiP preventive interventions causing 900 000 LBW deliveries annually [6]. In Africa, about 10 000 women and 75 000 to 200 000 infants die yearly due to MiP while LBW from P. falciparum infections during pregnancy causes nearly 100 000 neonatal deaths [2]. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine pyrimethamine (SP) is recommended by World Health Organization (WHO) for controlling MiP [8]
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