Intermittent preventive treatment comparing two versus three doses of sulphadoxine pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: A cross-sectional study

Yaa Nyarko Agyeman,Ellis Owusu-Dabo,Sam Newton,Raymond Boadu Annor,Adrian J.F Luty

doi:10.1371/journal.pone.0250350

Yaa Nyarko Agyeman, Ellis Owusu-Dabo + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0250350

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Abstract

In 2012 the World Health Organisation (WHO) revised the policy on Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine (IPTp-SP) to at least three doses for improved protection against malaria parasitaemia and its associated effects such as anaemia during pregnancy. We assessed the different SP dosage regimen available under the new policy to determine the dose at which women obtained optimal protection against anaemia during pregnancy. A cross-sectional study was conducted among pregnant women who attended antenatal clinic at four different health facilities in Ghana. The register at the facilities served as a sampling frame and simple random sampling was used to select all the study respondents; they were enrolled consecutively as they kept reporting to the facility to receive antenatal care to obtain the required sample size. The haemoglobin level was checked using the Cyanmethemoglobin method. Multivariable logistic regression was performed to generate odds ratios, confidence intervals and p-values. The overall prevalence of anaemia among the pregnant women was 62.6%. Pregnant women who had taken 3 or more doses of IPTp-SP had anaemia prevalence of 54.1% compared to 66.6% of those who had taken one or two doses IPTp-SP. In the multivariable logistic model, primary (aOR 0.61; p = 0.03) and tertiary education (aOR 0.40; p = <0.001) decreased the odds of anaemia in pregnancy. Further, pregnant women who were anaemic at the time of enrollment (aOR 3.32; p = <0.001) to the Antenatal Care clinic and had malaria infection at late gestation (aOR 2.36; p = <0.001) had higher odds of anaemia in pregnancy. Anaemia in pregnancy remains high in the Northern region of Ghana. More than half of the pregnant women were anaemic despite the use of IPTp-SP. Maternal formal education reduced the burden of anaemia in pregnancy. The high prevalence of anaemia in pregnancy amid IPTp-SP use in Northern Ghana needs urgent attention to avert negative maternal and neonatal health outcomes.

Highlights

The fundamental aim of malaria interventions in pregnancy is to prevent the adverse effect of malaria in women and the unborn baby [1]
Pregnant women in Ghana are anaemic regardless of malaria infection [6], anaemia is an important consequence of malaria infection during pregnancy [8, 9]
Anaemia decreases with increasing age except among those who were 35 years and above

Summary

Introduction

The fundamental aim of malaria interventions in pregnancy is to prevent the adverse effect of malaria in women and the unborn baby [1]. Malaria has been identified as important contributor to high prevalence of anaemia in pregnant women [2, 3]. Malaria-related anaemia compromises maternal health, foetal development and result in infant death [4,5,6]. Pregnant women in Ghana are anaemic regardless of malaria infection [6], anaemia is an important consequence of malaria infection during pregnancy [8, 9]. The direct cause of anaemia in African pregnant women are multi-factorial, in malaria endemic regions, placental malaria is responsible for greater proportions of maternal anaemia during pregnancy [9]. Malaria-related maternal anaemia affects thiamine levels and results in late infant deaths [10]

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