Abstract
BackgroundMalaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000–200,000 infant deaths every year. Currently, the World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) at each scheduled antenatal care (ANC) visit. This study aimed to assess IPTp-SP coverage in mothers delivering in health facilities and at the community. In addition, factors associated with low IPTp-SP uptake and malaria adverse outcomes in pregnancy were investigated.MethodsA community and a health facility-based surveys were conducted in mothers delivering in Chókwè district, southern Mozambique. Social-demographic data, malaria prevention practices and obstetric history were recorded through self-report and antenatal records. For women delivering at health facilities, a clinical examination of mother and child was performed, and malaria infection at delivery was determined by rapid diagnostic test, microscopy, quantitative PCR and placental histology.ResultsOf 1141 participants, 46.6, 30.2, 13.5 and 9.6% reported taking ≥ 3, two, one and none SP doses, respectively. Low IPTp uptake (< 3 doses) was associated with non-institutional deliveries (AOR = 2.9, P < 0.001), first ANC visit after week 28 (AOR = 5.4, P < 0.001), low awareness of IPTp-SP (AOR = 1.6, P < 0.002) and having no or only primary education (AOR = 1.3, P = 0.041). The overall prevalence of maternal malaria (peripheral and/or placental) was 16.8% and was higher among women from rural areas compared to those from urban areas (AOR = 1.9, P < 0.001). Younger age (< 20 years; AOR = 1.6, P = 0.042) and living in rural areas (AOR = 1.9, P < 0.001) were predictors of maternal malaria at delivery. Being primigravidae (AOR = 2.2, P = 0.023) and preterm delivery (AOR = 2.6, P < 0.001) predicted low birth weight while younger age was also associated with premature delivery (AOR = 1.4, P = 0.031).ConclusionThe coverage for two and ≥ 3 doses of IPTp-SP is moderately higher than estimates from routine health facility records in Gaza province in 2015. However, this is still far below the national target of 80% for ≥ 3 doses. Ongoing campaigns aiming to increase the use of malaria prevention strategies during pregnancy should particularly target rural populations, increasing IPTp-SP knowledge, stimulate early visits to ANC, improve access to health services and the quality of the service provided.
Highlights
Malaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000–200,000 infant deaths every year
Ongo‐ ing campaigns aiming to increase the use of malaria prevention strategies during pregnancy should target rural populations, increasing intermittent preven‐ tive treatment for pregnant women (IPTp)-SP knowledge, stimulate early visits to antenatal care (ANC), improve access to health services and the quality of the service provided
malaria in pregnancy (MiP) is associated with increased risk of both maternal and neonatal adverse outcomes including maternal anaemia, delivery of low birth weight (LBW) infants, premature delivery, stillbirth and increased perinatal and infant mortality [4, 5]
Summary
Malaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000–200,000 infant deaths every year. MiP is associated with increased risk of both maternal and neonatal adverse outcomes including maternal anaemia (which leads to increased maternal mortality), delivery of low birth weight (LBW) infants, premature delivery, stillbirth and increased perinatal and infant mortality [4, 5]. Women in their first pregnancy are at high risk of infection due to lack of specific immunity against the Plasmodium falciparum variant surface antigen VAR2csa, that mediates specific sequestration of parasites to placental tissue [6, 7]. Women that have non-institutional deliveries (deliveries at home) may be more likely to benefit less from health care including prenatal consultations and receive less IPTp-SP doses [16, 17]
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