Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria

Ogochukwu C Onwujekwe,Rebecca O Soremekun,Obinna Onwujekwe,Elvis Shu,Benjamin Uzochukwu

doi:10.1186/1756-0500-5-211

Ogochukwu C Onwujekwe, Rebecca O Soremekun + Show 3 more

Open Access

https://doi.org/10.1186/1756-0500-5-211

Copy DOI

Abstract

BackgroundMalaria in pregnancy (MIP) is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Information is required on how to improve its prevention and treatment from both the providers’ and consumers’ perspectives.MethodsThe study sites were two public and two private hospitals in Enugu, southeast Nigeria. Data was collected using a pre-tested structured questionnaire. The respondents were healthcare providers (doctors, pharmacists and nurses) providing ante-natal care (ANC) services. They consisted of 32 respondents from the public facilities and 20 from the private facilities. The questionnaire elicited information on their: knowledge about malaria, attitude, chemotherapy and chemoprophylaxis using pyrimethamine, chloroquine proguanil as well as IPTp with sulphadoxine-pyrimethamine (SP). The data was collected from May to June 2010.ResultsNot many providers recognized maternal and neonatal deaths as potential consequences of MIP. The public sector providers provided more appropriate treatment for the pregnant women, but the private sector providers found IPTp more acceptable and provided it more rationally than public sector providers (p < 0.05). It was found that 50 % of private sector providers and 25 % of public sector providers prescribed chemoprophylaxis using pyrimethamine, chloroquine and proguanil to pregnant women.ConclusionsThere is sub-optimal level of knowledge about current best practices for treatment and chemoprophylaxis for MIP especially in the private sector. Also, IPTp was hardly used in the public sector. Interventions are required to improve providers’ knowledge and practices with regards to management of MIP.

Highlights

Malaria in pregnancy (MIP) is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn
It is worthy of note that only 59.4 % of public providers and 15 % of private providers stated that MIP could lead to death of a pregnant woman
In the provision of chemotherapy, artemisinin-based combination therapy (ACT) and quinine were the most commonly used by the public providers, while SP was most commonly used in the private sector

Summary

Introduction

Malaria in pregnancy (MIP) is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Malaria infection during pregnancy has adverse consequences on the health of the mother, the foetus and the newborn. These effects include spontaneous abortion, preterm delivery, low birth weight, still-birth, congenital infection and maternal death [5]. The current recommendation to control MIP in areas of stable malaria transmission relies on prompt and effective case management of malaria, the use of intermittent preventive treatment of malaria in pregnancy (IPTp) with at least two doses of sulphadoxine-pyrimethamine (SP) and the use of insecticide treated nets (ITNS) [5]. In the context of chemotherapy, the national treatment guideline recommends the use of quinine in all trimesters and artemetherlumefantrine in second and third trimesters [2]

Methods

Results

Discussion

Conclusion