Abstract
BackgroundThe WHO recommends supervised administration of sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment for malaria (IPTp) during pregnancy. Logistical constraints have however favoured unsupervised intake of SP-IPTp, casting doubts whether recent guidelines requiring more frequent intake can be effectively implemented. To propose strategies for enhancing compliance under limited supervision, this study sought to identify pregnant women’s knowledge and practices gaps as well as determine predictors of compliance with SP-IPTp, given under limited supervision.MethodsA cross-sectional study of 700 women used exit interviews at an urban clinic in Uganda to obtain a descriptive summary of demographic and obstetric characteristics, including knowledge, practice and experiences with SP. Predictors of compliance with SP intake instructions were explored using logistic regression.ResultsMedian age of respondents was 25 (IQR 22–28) and median parity was two (IQR one to three) while median number of antenatal clinic (ANC) visits was 3.0 (IQR three to four). Most women had completed primary (36%) or ordinary secondary education (25.6%) while 16.1% had not completed primary education. Awareness about SP was high (99.4%) although correct knowledge regarding its use in pregnancy was low (57%), with 15.4% thinking it was used to treat malaria and 26.7% lacking any idea about its use. Correct knowledge on SP use during pregnancy significantly predicted compliance with SP-IPTp instructions (OR 1.98, C.I. 1.12-3.55), while age, education level, parity, number of ANC visits, or history of unwanted effects with SP did not. SP was mostly accessed from hospitals (64.4%) followed by private clinics (16.9%) both for preventive and treatment purposes. SP was considered safe by most women, who were willing to take it again in future, without supervision.ConclusionDespite high awareness, knowledge of SP as an intervention for malaria prevention in pregnancy was low. Correct knowledge on use of SP predicted compliance with SP-IPTp intake instructions. Focused malaria-related education during ANC visits may improve compliance with SP intake amidst limited supervision.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-399) contains supplementary material, which is available to authorized users.
Highlights
The World Health Organization (WHO) recommends supervised administration of sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment for malaria (IPTp) during pregnancy
Intermittent preventive treatment of malaria during pregnancy (IPTp), with sulphadoxinepyrimethamine (SP) is a key component of the WHO’s strategy to mitigate the adverse impact of malaria on pregnancies in Africa [3]
Data for this study were collected as part of a wider cross-sectional study whose objectives included exploration of pregnant women’s knowledge and experiences with malaria during pregnancy, determination of their anti-malarial drug sources and use patterns during pregnancy, exploration of their knowledge and practices regarding SP-IPTp and description of their previous experiences with SP-IPTp
Summary
The WHO recommends supervised administration of sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment for malaria (IPTp) during pregnancy. Malaria continues to be an important public health problem in Africa where it contributes significantly to adverse pregnancy outcomes [1]. Over 30 million pregnancies at risk of malaria occur in Africa each year [1]. Intermittent preventive treatment of malaria during pregnancy (IPTp), with sulphadoxinepyrimethamine (SP) is a key component of the WHO’s strategy to mitigate the adverse impact of malaria on pregnancies in Africa [3]. Because the efficacy requirement for prevention is less than that for treatment of clinical malaria, technical reviews have consistently shown that SP-IPTp is still beneficial, even where prevalence of resistance is considerably high [9,10,11]
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