Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: a cross-sectional study

Steven Chifundo Azizi,Charles Michelo,Gershom Chongwe,Helen Chipukuma,Jessy Zgambo,Choolwe Jacobs

doi:10.1186/s12884-018-1744-y

Steven Chifundo Azizi, Charles Michelo + Show 4 more

Open Access

https://doi.org/10.1186/s12884-018-1744-y

Copy DOI

Abstract

BackgroundMalaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Zomba district IPTp uptake falls far below the national average. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district after adoption of new IPTp-SP policy in 2014.MethodsThis was a cross-sectional survey. Two public health facilities (HFs) were randomly selected from urban and rural areas in Zomba district. Study participants were postpartum women selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire. Bivariate and multiple logistic regression was used in data analysis.ResultsOut of all the enrolled participants (n = 463), 92% women had complete information for analysis. Of these, (n = 426) women, 127 (29.8%, 95% CI: 25.6%–34.3%) received three or more doses of SP, 299 (70.2%, 95% CI: 65.7%–74.4%) received two or less doses. Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR = 0.31, 95% CI 0.13–0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR = 0.29, 95% CI 0.18–0.48); not taking SP under direct observation therapy (DOT) (AOR = 0.18, 95% CI (0.05–0.63).ConclusionsThere is low utilisation of at least three doses of SP in this population and this seems to be associated with the number of ANC visits and use of DOTs. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.

Highlights

Malaria in pregnancy causes adverse birth outcomes
Study design and study settings A cross sectional study was conducted in two health facilities in Zomba district, which is located in the southern region of Malawi between November 23, 2016 and January 27, 2017
Of 426 women, 127 (29.8%, 95% confidence interval (CI): 25.6%–34.3%) received three or more doses of Sulphadoxine Pyrimethamine (SP), 299 (70.2%, 95% CI: 65.7%–74.4%) received two or less doses

Summary

Introduction

Malaria in pregnancy causes adverse birth outcomes. Malaria in pregnancy (MiP) is a significant cause of maternal morbidity and poor birth outcomes yet is preventable and treatable [1,2,3,4]. Plasmodium falciparum infections in pregnancy contributes to approximately 11% (100, 000) of neonatal deaths due to low birth weight in areas of Africa where malaria is endemic (LBW) [7,8,9]. Infection with malaria in pregnancy predisposes women to increased risk of severe anaemia, intra-uterine growth retardation, intrauterine death, stillbirth, pre-term delivery, low birth weight (LBW), maternal death and placental malaria; and there is increased risk to unborn baby from miscarriage, stillbirth and LBW [10,11,12]

Objectives

Methods

Results

Discussion

Conclusion