Abstract
BackgroundGhana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012. The uptake of higher doses of SP since the implementation of the new policy in 2016, has been low across the country. The current study determined factors that can be improved to increase uptake of SP for intermittent preventive treatment of malaria in pregnancy (IPTp-SP).MethodsA cross-sectional analytical study was carried out among women who had just delivered in selected health facilities in the Sekondi-Takoradi Metropolis of Ghana. Participants were enrolled from the lying-in wards of the study facilities after delivery. Data including time of initiating antenatal care (ANC), number of visits, time of first dose of SP and number of doses were collected. ANC books were also reviewed. Logistic and ordered logistic regression analysis were done to determine respondent factors associated with uptake of IPTp-SP using Stata 15.ResultsOut of the 496 mothers who participated in the study, 370 (74.60%) initiated ANC during the first trimester, 123 (24.80%) during the second, with only three (0.60%) starting during the third trimester. Majority (463/496, 93.35%) made > 4 visits. Uptake of at least one dose of SP was 98.79% (490/496), ≥ 2 doses was 92.75 (460/496), ≥ 3 doses was 80.65% (400/496) and ≥ 4 doses was 40.32% (200/496). Uptake of IPTp 5 was very low (6.65%, 33/490).A unit increase of one ANC visit was associated with 20% higher odds of receiving 3-4 doses of SP with respect to receiving 1-2 doses (p < 0.001). The probability of receiving 5 or more doses of SP with respect to 1-2 doses was 26% higher with a unit increase of one ANC visit.ConclusionUptake of 3-4 doses and ≥ 5 doses of SP were associated with making more ANC visits. Encouraging and motivating expectant mothers to make more ANC visits can improve uptake of ≥5 doses of SP.
Highlights
Ghana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012
Malaria infection during pregnancy is of public health concern as the disease poses significant risk to the pregnant woman, and to her fetus and the newborn child [1]
In high-transmission areas, the levels of acquired immunity tend to be high and so P. falciparum infection is usually asymptomatic in pregnancy [8].Due to the high adverse impact of malaria on pregnancy, the WHO recommends the use of long-lasting insecticidal nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp) with sulfadoxinepyrimethamine (SP), as part of antenatal care services in all areas with moderate to high malaria transmission in Africa
Summary
Ghana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012. The current study determined factors that can be improved to increase uptake of SP for intermittent preventive treatment of malaria in pregnancy (IPTp-SP). In high-transmission areas, the levels of acquired immunity tend to be high and so P. falciparum infection is usually asymptomatic in pregnancy [8].Due to the high adverse impact of malaria on pregnancy, the WHO recommends the use of long-lasting insecticidal nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp) with sulfadoxinepyrimethamine (SP), as part of antenatal care services in all areas with moderate to high malaria transmission in Africa. Intermittent preventive treatment of malaria in pregnancy is a full therapeutic course of antimalarial medicine given to pregnant women at routine antenatal care visits, regardless of whether the recipient is infected with malaria parasites or not [9]. Majority of the mothers (93.35%) made > 4 ANC visits before delivery and half of the study participants (50.40%) reported sleeping under an ITN the night before the study (Table 1)
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