Abstract
BackgroundTo reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Tanzania has recently adopted a policy of intermittent presumptive treatment for pregnant women using sulphadoxine-pyrimethamine (IPTp-SP). In addition, there is strong national commitment to increase distribution of insecticide treated nets (ITNs) among pregnant women. This study explores the determinants of uptake for both ITNs and IPTp-SP by pregnant women and the role that individual knowledge and socio-economic status has to play for each.Methods293 women were recruited post-partum at Kibaha District Hospital on the East African coast. The haemoglobin level of each woman was measured and a questionnaire administered.ResultsUse of both interventions was associated with a reduced risk of severe anaemia (Hb<8 g/dL) compared to women who had used neither intervention (OR 0.31, 95% CI 0.14–0.67). In a logistic regression model it was found that attendance at MCH health education sessions was the only factor that predicted IPTp-SP use (OR 1.8, 95% CI 1.1–2.9) while high knowledge of malaria predicted use of ITNs (OR 2.3, 95% CI 1.1–4.9).ConclusionIndividual knowledge of malaria was an important factor for ITN uptake, but not for IPTp-SP use, which was reliant on delivery of information by MCH systems. When both these interventions were used, severe anaemia postpartum was reduced by 69% compared to use of neither, thus providing evidence of effectiveness of these interventions when used in combination.
Highlights
To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Tanzania has recently adopted a policy of intermittent presumptive treatment for pregnant women using sulphadoxine-pyrimethamine (IPTp-SP)
Plasmodium falciparum malaria in pregnancy poses a substantial risk to pregnant women and their offspring: it has been estimated that malaria in pregnancy is the primary cause of up to 10,000 maternal anaemia-related deaths in sub-Saharan Africa annually [1]
Malaria in pregnancy increases the risk of an infant being born with low birth weight (LBW) and is responsible for up to 35% of preventable LBW in malaria-endemic areas[2]
Summary
To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Tanzania has recently adopted a policy of intermittent presumptive treatment for pregnant women using sulphadoxine-pyrimethamine (IPTp-SP). This study explores the determinants of uptake for both ITNs and IPTp-SP by pregnant women and the role that individual knowledge and socio-economic status has to play for each. Over the last decade a body of evidence has accumulated which supports the use of both ITNs and IPTp-SP to reduce the adverse effects of malaria during pregnancy [1,3,4] and both these interventions are currently recommended by WHO [5]. This study set out to explore the determinants of uptake for both ITNs and IPTp-SP by pregnant women, with particular regard to knowledge of malaria and socioeconomic status, and to estimate the impact that reported use of either of these interventions had on the prevalence of severe anaemia in the post-partum period
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