Abstract
BackgroundIn Uganda, treatment of clinical malaria and intermittent preventive treatment with sulphadoxine-pyrimethamine (SP) are common during pregnancy. As a result, both formal and informal reports from antenatal sources suggest possible misuse of SP for malaria treatment among pregnant women. The objective of this study was to investigate anti-malarial drug use patterns among women who had recently suffered malaria illness before and during pregnancy.MethodsA cross-sectional study in which a structured questionnaire (interviewer-administered) was used to collect data from pregnant women attending an urban antenatal clinic. Details of medicines used to treat malaria episodes suffered before and during pregnancy were captured. A first order Markov probability model was used to estimate probabilities of transitioning between treatment choices made before and during pregnancy. Logistic regression was used to explore whether demographic and obstetric characteristics were associated with transition patterns.ResultsSeven hundred women were interviewed among whom 428 had suffered malaria in both instances. Three hundred thirty of these could recall the medicines used in both instances. Women who used ACT/QNN (correct choice) before pregnancy had higher probabilities of transitioning to SP than staying on ACT/QNN during pregnancy (0.463 versus 0.451). Access of medicines from private outlets (clinics and pharmacies) were more than nine times predictive of receiving correct medicines (p=0.035 and p=0.039 respectively). Access of medicines from clinics was 5.9 times protective against receiving SP for malaria treatment (p=0.033). Among those who used SP before pregnancy, there was a 0.75 probability of staying on it during pregnancy. None of the factors explored could explain this observation.ConclusionUse of SP for malaria treatment is common during pregnancy. This may be contributing to adverse pregnancy outcomes. Antenatal care providers should endeavour to emphasize the distinction between treatment and prevention of malaria during pregnancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0702-7) contains supplementary material, which is available to authorized users.
Highlights
In Uganda, treatment of clinical malaria and intermittent preventive treatment with sulphadoxinepyrimethamine (SP) are common during pregnancy
Demographic characteristics of respondents Seven hundred respondents were interviewed in order to identify 428 women who had suffered malaria before as well as during pregnancy
When asked to mention the sources of medicines used for treatment of malaria episodes suffered during pregnancy, 50.0% (n=165) reported accessing medicines from a private clinic while 29.1% accessed from a hospital
Summary
In Uganda, treatment of clinical malaria and intermittent preventive treatment with sulphadoxinepyrimethamine (SP) are common during pregnancy. The World Health Organization (WHO) recommends a combination of measures to mitigate the adverse impact of malaria during pregnancy. These include; use of insecticide-treated bed nets, early case detection and treatment (with an effective anti-malarial medicine) as well as intermittent preventive treatment during pregnancy (IPTp) [1]. More than thirty million pregnancies at risk of malaria occur in Africa [2] and of these, Uganda accounts for a considerable proportion mainly for two reasons; First, Ugandan women have the third highest fertility rate in the world [3]. While recent efforts to control malaria in Uganda have registered remarkable gains, this dual burden most likely predisposes Ugandan women to high tendencies to consume anti-malarial medicines
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