IPTp Uptake Research Articles

Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-for-profit health facilities in Kasese district.

Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6-56.4). Being married (aPR = 1.35, 95% CI = 1.06-1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09-1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39-0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57-0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.

Enhancing IPTp Program Implementation: Provider Practices, Challenges, and Malaria Prevalence among Pregnant Women in Uganda

Malaria remains a formidable public health threat, particularly in sub-Saharan Africa, where pregnant women face heightened vulnerability. Intermittent Preventive Treatment in pregnancy with Sulfadoxine Pyrimethamine (IPTp-SP) stands as a pivotal strategy in malaria prevention efforts. However, its full potential is hindered by challenges in implementation. This study, conducted at Bushenyi Health Centre IV in Uganda, scrutinized provider practices, challenges encountered, and malaria prevalence among pregnant women attending antenatal care services. Through a descriptive cross-sectional approach involving 151 pregnant mothers and 15 antenatal care providers, analysis revealed noteworthy insights. While a majority of pregnant women received IPTp-SP, adherence to WHO guidelines regarding administration timing and frequency was suboptimal. Notably, over half of the providers reported stockouts of IPTp-SP, leading to significant delays in replenishment and impeding service delivery. Moreover, providers identified a crucial link between women's knowledge and IPTp uptake. The study also uncovered a malaria prevalence of 7.9% among pregnant women. These findings underscore the urgent need to address implementation challenges, particularly in supply chain management and health education, to fortify malaria prevention strategies for pregnant women in Uganda. Keywords: Malaria, Pregnant women, IPTp-SP, Antenatal care, Implementation challenges, Supply chain management, Health education, Uganda.

Assessment of Implementation of Malaria Control Strategies among Pregnant Mothers Attending Antenatal Care at Bumanya Health Centre IV in Kaliro District

Although a high proportion of pregnant women had an antenatal care (ANC) visit at least once during pregnancy, the coverage level of intermittent preventive treatment of malaria in pregnancy (IPTp-SP) and insecticide-treated bednets (ITNs) remains low in Sub-Saharan Africa. A hospital-based descriptive cross-sectional study was carried out. The outcome of the survey revealed that the majority of participants, 79%, were above 20 years old, with a mean (+/-SD) age of 25.6 (+/-SD) years. The survey also revealed that 62.67% of the participants knew about IPTp; the biggest number of participants (86.67%) reported utilizing IPTp during their current pregnancy, while 13.33% did not take IPTp. Occupation, gestational age, several ANC visits, and information about IPTp were significantly associated with IPTp uptake. The current study explored malaria IPTp uptake among pregnant women attending ANC at Bumanya HCIV. It established that an increased number of ANC visits, providing IPTp information to pregnant women, and the gestational age of pregnancy resulted in increased uptake of IPTp and thus reduced incidences of malaria cases. Keywords: Pregnancy, Women, ANC, IPTp, Malaria, Gestational age.

Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis

ABSTRACT Background Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda. Methods An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models. Results From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries. Conclusions In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries. Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.

Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo

IntroductionMalaria in pregnancy is a major driver of maternal and infant mortality in sub-Saharan Africa. The WHO recommends the administration of intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) at antenatal...

A scoping review of the factors that influence the uptake of IPTp among pregnant women informed by the socio-ecological model

A scoping review of the factors that influence the uptake of IPTp among pregnant women informed by the socio-ecological model

Trends in malaria prevention and vector control intervention among pregnant women and children under 5 years in Nigeria

Abstract Background: Malaria is a severe public health issue in more than 91 nations around the world, with 80% of the illness burden falling on sub-Saharan Africa. The rationale behind this study is to know the level at which malaria prevention and vector control intervention are utilized in the four selected states. Thus, this study examines the trends in the utilization of malaria prevention and vector control intervention among pregnant women and children under 5 years in Nigeria from 2017 to 2019. Materials and Methods: This is a cross-sectional study conducted in four states in Nigeria (Akwa Ibom, Cross River, Ebonyi, and Oyo). The study used secondary data from the Demographic and Health Survey (DHS) and National Malaria Indicator Survey for 2017–2019. We compared the findings across the study years and the 2013 Nigeria DHS report. Data were exported and analyzed using IBM-SPSS version 25. Results: An overall rate of 59% of pregnant women received intermittent preventive treatment (IPTp1) across the four states. Akwa-Ibom had the highest rate (73%) with the lowest dropout. There was a general decline in the rate of pregnant women provided with long-lasting insecticide-treated nets (LLIN) across the four states, with an overall rate of 44% between 2017 and 2019. Furthermore, there was an increase in women who received 2+ doses and 3+ doses of IPTp across the four states between 2013 and 2018. However, only Cross River recorded a marginal improvement of 2+ IPTp coverage of 75% compared to 12% in the 2013 DHS report. There was a slightly higher prevalence of fever among under-5years children in 2018 compared to the 2013 DHS report. Conclusion: Malaria prevention and vector control among pregnant women and children under 5 years between 2017 and 2019 are relatively low. Efforts should be made to improve the uptake and stockout of IPTP and LLIN in facilities.

Uptake of Intermittent Preventive Treatment of Malaria Among Pregnant Women Attending Selected Primary Healthcare Centers in Ogun State, Nigeria

Background: Malaria in pregnancy is a major public health concern and one of the leading causes of maternal morbidity and mortality which poses intrauterine and maternal complications during pregnancy. This study assessed the uptake of intermittent preventive treatment of malaria among pregnant women attending primary health care centers in Ikenne Local Government Area. Methods: A quantitative descriptive survey design was employed for this study; researcher-structured questionnaires were used for data collection and a multi-stage sampling technique was used to select one hundred and fifty-one mothers from the primary health centers. Result: It showed that the majority (62.5%) of the participants had average knowledge of malaria in pregnancy, and 54.6% of the participants utilized IPTP. The study found no significant relationship between respondents’ knowledge of malaria in pregnancy and the uptake of IPTP (p-value = 0.888&gt;0.05). Moreso, findings revealed no significant relationship between the time of antenatal initiation and the uptake of intermittent preventive treatment of malaria in pregnancy p-value = 0.281&gt;0.05 (1, X2 = 1.163). In the same vein, no significant relationship was further revealed between the level of education and the uptake of intermittent preventive treatment of malaria in pregnancy p-value = 0.842&gt;0.05 (1, X2 = 0.040). Conclusion: Generally, in Nigeria, the uptake of intermittent preventive treatment for malaria is still low irrespective of the level of the mother's knowledge. Therefore, an increase in awareness and education of women on IPTp with direct observation under uptake was hereby recommended.

Assessing nursing mothers' knowledge, perceptions and uptake of Sulphadoxine Pyrimethamine (IPTp-SP) during pregnancy in the Ho Teaching Hospital of the Volta Region of Ghana.

Intermittent preventive therapy during pregnancy with Sulphadoxine Pyrimethamine (IPTp-SP) is one of the potent strategies for preventing malaria in pregnancy (MiP). Factors such as the pregnant woman's knowledge and very importantly perception or belief about IPTp-SP remains key determinant of IPTp-SP uptake. This study assessed the knowledge and perception of nursing mothers and their uptake of IPTp-SP during pregnancy in the Ho Teaching Hospital. We administered a close-ended questionnaire to 303 nursing mothers and obtained their sociodemographic details as well as information on their knowledge and perception of IPTp-SP utilization. We also reviewed the nursing mothers' antenatal care (ANC) booklets to ascertain the number of times IPTp-SP was taken during pregnancy. Pearson chi-square was used to determine the association between the sociodemographic variable and the categories of knowledge, perception, and uptake of IPTp-SP. Analysis, was done using SPSS, and the p-value of less than 5% was considered statistically significant. Of the 303 nursing mothers sampled in this study, 265(87.5%) had heard about IPTp-SP of which 138(52.1%) had average knowledge of IPTp-SP. A total of 168(63.4%) had poor perception, and 168(64.6%) had adequate uptake (3-4 doses) of IPTp. Education was significantly associated with perception and uptake, with the majority of women who demonstrated excellent perception were those who had tertiary education (7, 6.35%, p = 0.05), and the majority who demonstrated excellent uptake (5 completed doses) were women who had tertiary education (47, 37.9%, p = 0.01). While knowledge was average, perception of IPTp-SP was poor for the majority of the nursing mothers which might have hampered their uptake of IPTp-SP during pregnancy. It is important that continuous assessment of the individual factors affecting the uptake of IPTp-SP be done regularly to curb the negative influences on the uptake of IPTp-SP.

Malaria health seeking practices for children, and intermittent preventive treatment in pregnancy in Wakiso District, Uganda.

Timely health care among children with suspected malaria, and intermittent preventive treatment (IPTp) in pregnancy avert related morbidity and mortality in endemic regions especially in sub-Saharan Africa. Malaria burden has steadily been declining in endemic countries due to progress made in scaling up of such important interventions. The study assessed malaria health seeking practices for children under five years of age, and IPTp in Wakiso district, Uganda. A structured questionnaire was used to collect data from 727 households. Chi-square and Fisher's exact tests were performed in STATA to ascertain factors associated with the place where treatment for children with suspected malaria was first sought (government versus private facility) and uptake of IPTp. Among caretakers of children with suspected malaria, 69.8% sought care on the day of onset of symptoms. The place where treatment was first sought for the children (government versus private) was associated with participants' (household head or other adult) age (p < 0.001), education level (p < 0.001) and household income (p = 0.011). Among women who had a child in the five years preceding the study, 179 (63.0%) had obtained two or more IPTp doses during their last pregnancy. Uptake of two or more IPTp doses was associated with the women's education level (p = 0.006), having heard messages about malaria through mass media (p = 0.008), knowing the recommended number of IPTp doses (p < 0.001), and knowing the drug used in IPTp (p < 0.001). There is need to improve malaria health seeking practices among children and pregnant women particularly IPTp through programmes aimed at increasing awareness among the population.

Determinants of uptake of intermittent preventive treatment for malaria with sulfadoxine pyrimethamine in pregnancy: a cross-sectional analytical study in the Sekondi-Takoradi Metropolis of Ghana

BackgroundGhana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012. The uptake of higher doses of SP since the implementation of the new policy in 2016, has been low across the country. The current study determined factors that can be improved to increase uptake of SP for intermittent preventive treatment of malaria in pregnancy (IPTp-SP).MethodsA cross-sectional analytical study was carried out among women who had just delivered in selected health facilities in the Sekondi-Takoradi Metropolis of Ghana. Participants were enrolled from the lying-in wards of the study facilities after delivery. Data including time of initiating antenatal care (ANC), number of visits, time of first dose of SP and number of doses were collected. ANC books were also reviewed. Logistic and ordered logistic regression analysis were done to determine respondent factors associated with uptake of IPTp-SP using Stata 15.ResultsOut of the 496 mothers who participated in the study, 370 (74.60%) initiated ANC during the first trimester, 123 (24.80%) during the second, with only three (0.60%) starting during the third trimester. Majority (463/496, 93.35%) made > 4 visits. Uptake of at least one dose of SP was 98.79% (490/496), ≥ 2 doses was 92.75 (460/496), ≥ 3 doses was 80.65% (400/496) and ≥ 4 doses was 40.32% (200/496). Uptake of IPTp 5 was very low (6.65%, 33/490).A unit increase of one ANC visit was associated with 20% higher odds of receiving 3-4 doses of SP with respect to receiving 1-2 doses (p < 0.001). The probability of receiving 5 or more doses of SP with respect to 1-2 doses was 26% higher with a unit increase of one ANC visit.ConclusionUptake of 3-4 doses and ≥ 5 doses of SP were associated with making more ANC visits. Encouraging and motivating expectant mothers to make more ANC visits can improve uptake of ≥5 doses of SP.

Improving malaria preventive practices and pregnancy outcomes through a health education intervention: A randomized controlled trial

BackgroundThe prevalence of malaria in pregnancy and its complications, remain very high in Nigeria. This study aimed to determine the effects of a malaria health educational intervention based on the information-motivation-behavioural skills (IMB) model on malaria preventive practices and pregnancy outcomes.MethodsThe study was a randomized controlled parallel-group study, where 372 randomly selected antenatal care attendees were randomly assigned to one of either two groups after collecting baseline data. The intervention group then received a four-hour health education intervention in Hausa language, which was developed based on the IMB model, while the control group received a similarly designed health education on breastfeeding. Follow up data were then collected from the participants at a first (2 months post-intervention) and second (4 months post-intervention) follow up, and at the end of their pregnancies.ResultsFor both groups, reported ITN use had increased from baseline (Intervention: Often–14.0%, Almost always–9.1; Control: Often–12.4%; Almost always 16.1%) to the time of second follow up (Intervention: Often –28.10%, Almost always–24.5; Control: Often–17.2%; Almost always 19.5%). Reported IPTp uptake at second follow up was also higher for the intervention group (Intervention: Two doses–59.0%, Three doses 22.3%; Control group: Two doses–48.4%, Three doses–7.0%). The drop in the haematocrit levels was greater for the control group (32.42% to 30.63%) compared to the intervention group (33.09% to 31.93%). The Generalized Linear Mixed Models (GLMM) analysis revealed that the intervention had significantly improved reported ITN use, reported IPTp uptake, and haematocrit levels, but had no significant effect on the incidence of reported malaria diagnosis or babies’ birth weights.ConclusionsThe intervention was effective in improving ITN use, IPTp uptake, and haematocrit levels. It is, therefore, recommended for the modules to be adopted and incorporated into the routine antenatal care programmes in health centres with predominantly Hausa speaking clients.Trial registration: Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, www.pactr.org.

Malaria Preventive Practices among Pregnant Women in the Niger Delta Region of Nigeria: A Comparative Study

Background: Malaria has a deleterious effect on pregnancy leading to serious pregnancy complications and adverse pregnancy outcomes. Use of effective malaria preventive practices during pregnancy mitigates the harmful effect of the disease on pregnancy. Aim: To determine the malaria preventive practices used by pregnant women in three states (Rivers, Delta, Akwa Ibom) of the Niger Delta region of Nigeria. Materials and Methods: A cross-sectional study was carried out in public health facilities in three states of the Niger Delta, Nigeria to assess the preventive practices of pregnant women over a six month period. A total of six health facilities was selected from each state giving eighteen health facilities from the three states. Approximately 100 to 200 consenting pregnant women were recruited over a period of one to two weeks from each facility. Information was obtained with pretested questionnaires by trained personnel with the aid of Open Data Kit (ODK) on android phones. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 22 and results were presented in prose and frequency tables. A p-value of <0.05 was considered statistically significant. Results: There were 2,960 participants (mean age 29.6 ± 4.93) with 2844 (96.08%) being married. Over half 53.01% (1569) had tertiary education, majority 35.37% (1047) of them were traders and business women. Preventive practices employed included window nets use 42.3% (2059), insecticides 28.9% (1411), bed nets 27.9% (1360), and others. There were 59.14% (1100) that received medications for prevention out of which 79.83% (918) received IPTp-SP. Only 33.6% (993) slept under the net the night before the interview. Conclusion: In the Niger Delta region, uptake of IPTp is above 70% and provided a significant prophylactic benefit compared to those that did not take. However ITN use was very low in the area whereas IRS was not in use at all. The need for continuous enlightenment and awareness of the importance of these practices especially ITN use in the study area is very imperative.

Impact of Health Systems on the Implementation of Intermittent Preventive Treatment for Malaria in Pregnancy in Sub-Saharan Africa: A Narrative Synthesis.

Malaria in pregnancy is a public health challenge with serious negative maternal and newborn consequences. Intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine is recommended for the control of malaria during pregnancy within endemic areas, but coverage for the recommended ≥3 doses IPTp regimen has remained suboptimal. We searched PubMed, Cochrane library, and HINARI database from 1 January 2010 to 23 May 2020, for studies investigating the effect of the health system on IPTp implementation. Data extraction was independently performed by two investigators and evaluated for quality and content. Health system barriers and facilitators were explored using thematic analysis and narrative synthesis. Thirty-four out of 1032 screened articles were included. Key health system issues affecting the provision and uptake of IPTp were the ambiguity of policy and guidelines for IPTp administration, human resource shortages, drug stock-outs, conflicting policy implementation on free IPTp provision, hidden costs, unclear data recording and reporting guidelines, and poor quality of care. Factors affecting the supply and demand for IPTp services involve all pillars of the health system across different countries. The success of health programs such as IPTp will thus depend on how well the different pillars of the health system are articulated towards the success of each program.

Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015\u20132016

BackgroundMalawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp with SP among pregnant women in Malawi after the adoption and operationalisation of updated WHO IPTp-SP policy.MethodsThe 2015–16 Malawi Demographic and Health Survey dataset was analysed. Of 1219 women aged 15–49 years who had live births and the children were born after the date of July 2015, 1069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account a complex survey sample design.ResultsOf the 1069 women, 447 (42, 95% CI: 38.1–45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR = 0.71, 95% CI 0.49–1.02) and (AOR = 0.12, 95% CI 0.06–0.21) respectively.ConclusionsTo achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. Moreover, there is limited effectiveness of an increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp with SP doses during pregnancy.

Coverage and effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine\u2013pyrimethamine (IPTp-SP) on adverse pregnancy outcomes in the Mount Cameroon area, South West Cameroon

BackgroundGrowing concerns about the waning efficacy of IPTp-SP warrants continuous monitoring and evaluation. This study determined coverage of IPTp-SP and compared the effectiveness of the 3-dose to 2-dose regimen on placental malaria (PM) infection and low birth weight (LBW) in the Mount Cameroon area.MethodsConsenting pregnant women were enrolled consecutively through a cross-sectional survey at delivery at four antenatal clinics, two each from semi-rural and semi-urban settings from November 2016 to December 2017. Reported IPTp-SP use, demographic and antenatal clinic (ANC) data of the mothers and neonate birth weights were documented. Maternal haemoglobin concentration was measured using a haemoglobinometer and PM infection diagnosed by placental blood microscopy. Logistic regression analysis was used to model study outcomes.ResultsAmong the 465 parturient women enrolled, 47.0% (203), 34.7% (150), 18.3% (79) and 7.1% (33) reported uptake of ≥ 3, 2.1 dose(s) and no SP, respectively. Uptake of ≥ 3 doses varied significantly (p < 0.001) according to type of medical facility, timing of ANC initiation and number of ANC visits. The prevalence of PM was 18.5% where uptake of ≥ 3 SP doses (AOR = 2.36: 95% CI 1.41–4.87), primiparity (AOR = 2.13: 95% CI 1.19–3.81), semi-rural setting (AOR = 1.85: 95% CI 1.12–3.04) increased odds of infection. Also, three or more dosing was associated (p < 0.001) with increased PM density notably among women from semi-urban areas. Compared with third trimester, ANC initiation in the second trimester (AOR: 0.39: 95% CI 0.20–0.74) lower odds of infection. The prevalence of LBW infants was 7.3% and were generally those of anaemic (AOR: 4.6: 95% CI 1.03–20.57) and semi-rural (AOR: 5.29: 95% CI 1.73–16.15) women. Although ≥ 3 (AOR: 0.31: 95% CI 0.11–0.87) and 2 (AOR: 0.32: 95% CI 0.11–0.93) doses of SP was associated with lower odds of LBW, ≥ 3 doses were not associated with additional increase in birth weight nor maternal haemoglobin levels when compared with 2 doses.ConclusionIn the Mount Cameroon area, reported uptake of IPTp with ≥ 3 SP doses did not provide observable prophylactic benefits. SP resistance efficacy studies are necessary.

Effect of group versus individual antenatal care on uptake of intermittent prophylactic treatment of malaria in pregnancy and related malaria outcomes in Nigeria and Kenya: analysis of data from a pragmatic cluster randomized trial

BackgroundEvery year, malaria in pregnancy contributes to approximately 20% of stillbirths in sub-Saharan Africa and 10,000 maternal deaths globally. Most eligible pregnant women do not receive the minimum three recommended doses of intermittent preventive treatment with Sulfadoxine–pyrimethamine (IPTp-SP). The objective of this analysis was to determine whether women randomized to group antenatal care (G-ANC) versus standard antenatal care (ANC) differed in IPTp uptake and insecticide-treated nets (ITN) use.MethodsProspective data were analysed from the G-ANC study, a pragmatic, cluster randomized, controlled trial that investigated the impact of G-ANC on various maternal newborn health-related outcomes. Data on IPTp were collected via record abstraction and difference between study arms in mean number of doses was calculated by t test for each country. Data on ITN use were collected via postpartum interview, and difference between arms calculated using two-sample test for proportions.ResultsData from 1075 women and 419 women from Nigeria and Kenya, respectively, were analysed: 535 (49.8%) received G-ANC and 540 (50.2%) received individual ANC in Nigeria; 211 (50.4%) received G-ANC and 208 (49.6%) received individual ANC in Kenya. Mean number of IPTp doses received was higher for intervention versus control arm in Nigeria (3.45 versus 2.14, p < 0.001) and Kenya (3.81 versus 2.72, p < 0.001). Reported use of ITN the previous night was similarly high in both arms for mothers in Nigeria and Kenya (over 92%). Reported ITN use for infants was higher in the intervention versus control arm in Nigeria (82.7% versus 75.8%, p = 0.020).ConclusionsG-ANC may support better IPTp-SP uptake, possibly related to better ANC retention. However, further research is needed to understand impact on ITN use.Trial registration Pan African Clinical Trials Registry, May 2, 2017 (PACTR201706002254227).

Uptake of intermittent preventive treatment for malaria in pregnancy among women in selected communities of Ebonyi State, Nigeria

BackgroundMalaria in pregnancy has adverse effects on maternal and child health. Intermittent preventive treatment (IPTp) with three doses of Sulfadoxine/Pyrimethamine is an effective preventive measure for malaria in pregnancy. However, 24.0% of women use this prophylactic regimen in Ebonyi State. Previous studies have focused on the level of uptake with less attention given to factors influencing uptake. Therefore, we examined the predictors of IPTp uptake in the last pregnancy among women in Ebonyi State, Nigeria.MethodsThis was a community-based cross-sectional study among 340 women of reproductive age selected using multistage sampling technique. A semi-structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics of respondents, IPTp uptake and reasons for not taking IPTp. Adherence was judged adequate if three or more doses of IPTp were taken, otherwise inadequate. Data were analyzed using descriptive statistics, Chi- square test and logistic regression model at 5% level of significance.ResultsMean age of respondents was 28.8 ± 5.2 years, 96.5% were married, 19.4% had tertiary education, and 11.2% were from polygamous family. Uptake of IPTp was 74.2%. The level of IPTp uptake was 12.5 and 41.0% among women with no formal and tertiary education respectively. A similar pattern of IPTp uptake was observed among women from monogamous (38.0%) and polygamous (39.5%) families. Women education, husband education and family type were associated with uptake of IPTp, however only husband education remained a predictor of uptake. Women whose husband had secondary education (aOR = 4.1, 95%CI: 1.66–10.06) and tertiary education (aOR = 4.8, 95%CI: 1.76–12.90) were more likely to have IPTp uptake than those whose husbands had below secondary education.ConclusionAdequate IPTp uptake among women in their last pregnancy was below WHO recommendation. Intervention aimed at improving couple’s education could facilitate increase in IPTp uptake in Ebonyi State.

Assessing the Impact of Group Antenatal Care on IPTp Uptake in Tanzania

Assessing the Impact of Group Antenatal Care on IPTp Uptake in Tanzania

Effects of a health educational intervention on malaria knowledge, motivation, and behavioural skills: a randomized controlled trial

BackgroundThe levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information–motivation–behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria.MethodsThis was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values.ResultsThe intervention was significant in achieving a 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) higher total knowledge, motivation, and behavioural skills scores respectively, for the intervention group over the control group. The sensitivity analysis revealed no great differences in the effect sizes, even when missing data were not replaced.ConclusionThe intervention module was effective in improving knowledge, motivation and behavioural skills. It is as such recommended to be adopted and incorporated into the routine antenatal health education schedules. It is also recommended that booster doses of the module be given say 2 months after the first dose to sustain levels of motivation and behavioural skills.Trial registration Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, http://www.pactr.org