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Ogba P, Badru O, Ibhawoh B, Archer N, Baumann A. Perceptions of sulphadoxine-pyrimethamine use among pregnant women in sub-Saharan Africa: a scoping review. MALARIAWORLD JOURNAL 2023; 14:1. [PMID: 37090061 PMCID: PMC10117231 DOI: 10.5281/zenodo.7828460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Malaria is a major global public health issue that disproportionately affects pregnant women in sub-Saharan Africa. The World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) for its control. Despite its proven efficacy, drug uptake remains low. Sulphadoxine-pyrimethamine (SP) safety concerns have been cited as one of several reasons for this low uptake. Methods We conducted a scoping review using the Arksey and O'Malley framework and the health belief model to investigate perceptions of SP use among pregnant women in sub-Saharan Africa. We looked for peer-reviewed publications in five international databases. Results The review included 19 articles out of a total of 246. It showed that pregnant women in sub-Saharan Africa have a good understanding of malaria and its consequences, but this does not necessarily translate into increased IPTp-SP uptake. It is worrisome to know that some pregnant women (from 2 studies) did not believe that SP use is beneficial, and several participants (from 4 studies) were unsure or did not see the drug as an effective intervention. Many pregnant women believe SP harms them, their partners, or their unborn children. Conclusions Healthcare professionals should continue prescribing and encouraging pregnant women to use SP for malaria prevention until a better substitute becomes available.
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Affiliation(s)
- Patricia Ogba
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Oluwaseun Badru
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bonny Ibhawoh
- Department of History, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Norm Archer
- Degroote School of Business, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
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Orish VN, Puplampu PN, Lokpo SY, Kwadzokpui PK, De-Gaulle VF, Marinkovic A, Prakash S, Annan R, Okorie C, Sanyaolu A. 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. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000904. [PMID: 36962812 PMCID: PMC10021858 DOI: 10.1371/journal.pgph.0000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
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.
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Affiliation(s)
- Verner N Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Prince N Puplampu
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Sylvester Y Lokpo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Precious K Kwadzokpui
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Laboratory Department, Ho Teaching Hospital, Ho, Volta Region, Ghana
| | | | | | | | - Rochelle Annan
- School of Medicine, University of Health Sciences Antigua, Antigua
| | - Chuku Okorie
- Union County College, Plainfield Campus, Plainfield, New Jersey, United States of America
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Peters GO, Naidoo M. Factors influencing intermittent preventive treatment for malaria prevention among pregnant women accessing antenatal care in selected primary health care facilities of Bwari Area Council, Abuja Nigeria. PLoS One 2022; 17:e0277877. [PMID: 36520849 PMCID: PMC9754266 DOI: 10.1371/journal.pone.0277877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although studies in Nigeria showed the efficacy of intermittent preventive treatment using sulfadoxine-pyrimethamine (IPT-SP) in preventing malaria in pregnancy among Nigerian women there is still poor implementation of the intervention in Nigeria. METHODS A mixed method study was conducted in Bwari Area Council, Nigeria in 2018. The quantitative part of the study is presented and discussed in this paper. Pregnant women were interviewed using a validated interviewer-administered questionnaire and observations of current practice were performed. RESULTS A total of 422 pregnant women were recruited into the study (mean age, 26 years) with the majority being married women (90.3%). Most respondents (68.5%) did not know who could take IPT-SP and 58.5% of respondents did not know when and how many times IPT-SP should be taken during pregnancy. Nearly all participants (99.5%) did not take SP at the facility under direct observation of the health worker. None of the facilities had free SP and all respondents paid for SP through the Drug Revolving Fund. The knowledge of the use of SP was significantly influenced by respondents' parity, ward of residence, antenatal clinic (ANC) attendance history and education. Respondents who had tertiary and secondary education were 8.3 (95% CI: 1.01-68.27) times more likely to use IPT-SP than those without formal education. CONCLUSION Most women who attend ANC in Bwari Area council did not receive IPT-SP as per the national guidelines. The unavailability of logistics (SP, Water and Cup) on a regular basis, the cost of the SP, poor knowledge of the importance of IPT in malaria prevention, and the non-implementation of the administration of SP under direct observation were factors influencing the use of IPT-SP. Outcomes could be enhanced through the provision of measures to address identified gaps by this study.
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Affiliation(s)
- Grace Olufunke Peters
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South-Africa
| | - Mergan Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South-Africa
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It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures. Pathogens 2022; 11:pathogens11070729. [PMID: 35889975 PMCID: PMC9315856 DOI: 10.3390/pathogens11070729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Despite a decade of sustained malaria control, malaria remains a serious public health problem in the Democratic Republic of Congo (DRC). Children under five years of age and school-age children aged 5–15 years remain at high risk of symptomatic and asymptomatic malaria infections. The World Health Organization’s malaria control, elimination, and eradication recommendations are still only partially implemented in DRC. For better malaria control and eventual elimination, the integration of all individuals into the national malaria control programme will strengthen malaria control and elimination strategies in the country. Thus, inclusion of schools and school-age children in DRC malaria control interventions is needed.
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Ogba P, Baumann A, Chidwick H, Banfield L, DiLiberto DD. Barriers and facilitators to access and uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Nigeria: a scoping review. MALARIAWORLD JOURNAL 2022; 13:4. [PMID: 35813271 PMCID: PMC9242533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Malaria in pregnancy is a significant public health concern in Nigeria. It threatens pregnant women and their unborn babies and undermines the achievement of Sustainable Development Goal 3. The World Health Organization has recommended intermittent preventive treatment with sulfadoxine-pyrimethamine [IPTp-SP] for its control, but there are challenges to its access and uptake. Methods Using the Arksey and O'Malley framework and the cascade of care model, we conducted a scoping review to investigate barriers and facilitators of IPTp-SP access and uptake, including their influence on pregnant women's health-seeking behaviour for the control of malaria in pregnancy in Nigeria. We searched seven scientific databases for papers published from 2005 to date. Results We included a total of 31 out of 2149 articles in the review. Poor provider knowledge of the IPTp-SP protocol and lack of essential commodities for sulphadoxine-pyrimethamine administration in clinics are significant barriers to IPTp-SP use. Staff shortages and poor remuneration of health care professionals are obstacles to IPTp-SP utilisation. Conclusions To improve IPTp-SP access and uptake, the government should ensure a continuous supply to clinics and support the employment of additional health care professionals who should be well paid and trained on using the IPTp-SP protocol.
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Affiliation(s)
- Patricia Ogba
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada,
| | - Andrea Baumann
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Hanna Chidwick
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Deborah D. DiLiberto
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
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Aberese-Ako M, Doegah P, Acquah E, Magnussen P, Ansah E, Ampofo G, Agyei DD, Klu D, Mottey E, Balen J, Doumbo S, Mbacham W, Gaye O, Gyapong M, Owusu-Agyei S, Tagbor H. Motivators and demotivators to accessing malaria in pregnancy interventions in sub-Saharan Africa: a meta-ethnographic review. Malar J 2022; 21:170. [PMID: 35659232 PMCID: PMC9166609 DOI: 10.1186/s12936-022-04205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the introduction of efficacious interventions for malaria control, sub-Saharan Africa continues to bear the highest burden of malaria and its associated effects on vulnerable populations, such as pregnant women and children. This meta-ethnographic review contributes to literature on malaria in pregnancy interventions in sub-Saharan Africa by offering insights into the multiple factors that motivate or demotivate women from accessing MiP interventions. Methods A meta-ethnographic approach was used for the synthesis. Original qualitative research articles published from 2010 to November 2021 in English in sub-Saharan Africa were searched for. Articles focusing on WHO’s recommended interventions such as intermittent preventive treatment with sulfadoxine-pyrimethamine, long-lasting insecticidal nets and testing and treatment of Malaria in Pregnancy (MiP) were included. Selected articles were uploaded into Nvivo 11 for thematic coding and synthesis. Results Twenty-seven original qualitative research articles were included in the analysis. Main factors motivating uptake of MiP interventions were: (1) well organized ANC, positive attitudes of health workers and availability of MiP services; (2) Women’s knowledge of the effects of malaria in pregnancy, previous experience of accessing responsive ANC; (3) financial resources and encouragement from partners, relatives and friends and (4) favourable weather condition and nearness to a health facility. Factors that demotivated women from using MiP services were: (1) stock-outs, ANC charges and health providers failure to provide women with ample education on the need for MiP care; (2) perception of not being at risk and the culture of self-medication; (3) fear of being bewitched if pregnancy was noticed early, women’s lack of decision-making power and dependence on traditional remedies and (4) warm weather, long distances to health facilities and the style of construction of houses making it difficult to hang LLINs. Conclusions Health system gaps need to be strengthened in order to ensure that MiP interventions become accessible to women. Additionally, health managers need to involve communities in planning, designing and implementing malaria interventions for pregnant women. It is important that the health system engage extensively with communities to facilitate pregnant women and communities understanding of MiP interventions and the need to support pregnant women to access them.
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Affiliation(s)
| | - Phidelia Doegah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Acquah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Evelyn Ansah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gifty Ampofo
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | | - Desmond Klu
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Elsie Mottey
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Safiatou Doumbo
- University of Sciences, Techniques and Technologies of Bamako, Malaria Research and Training Center, Bamako, Mali
| | - Wilfred Mbacham
- The Fobang Institutes for Innovations in Science and Technologies & The Biotechnology Center, The Centre for Health Innovations and Translational Research, University of Yaounde I, Yaounde, Cameroon
| | - Ouma Gaye
- Faculty of Medicine, University Cheikh Anta Diop Dakar, Dakar, Senegal
| | - Margaret Gyapong
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Seth Owusu-Agyei
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Mohamoud AM, Yousif MEA, Saeed OK, Allasow MA, Abdulle YA, Ahmed AA, Iye AW, Abdi SM. Knowledge, Attitude and Practice regarding Intermittent Preventive Treatment (IPTs) of Malaria among Pregnant Women Attending for Antenatal Care in Benadir Hospital at Benadir Region, Somalia. Health (London) 2022. [DOI: 10.4236/health.2022.144031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aberese-Ako M, Magnussen P, Ampofo GD, Gyapong M, Ansah E, Tagbor H. An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context. PLoS One 2021; 16:e0257666. [PMID: 34618812 PMCID: PMC8496863 DOI: 10.1371/journal.pone.0257666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. Methods The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Results Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women’s trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Conclusion Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.
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Affiliation(s)
- Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- * E-mail: ,
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Gifty D. Ampofo
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Folarin OF, Kuti BP, Oyelami AO. Prevalence, density and predictors of malaria parasitaemia among ill young Nigerian infants. Pan Afr Med J 2021; 40:25. [PMID: 34733393 PMCID: PMC8531969 DOI: 10.11604/pamj.2021.40.25.30172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION infants in the first six months of life are relatively protected from malaria. Emerging reports from endemic regions however are showing increasing malaria susceptibility in this age group. This study set out to determine the prevalence, parasite density and predictive factors for malaria parasitaemia in ill young infants at the Wesley Guild Hospital (WGH), Ilesa, Nigeria. METHODS ill infants aged one to six months were consecutively recruited over an 11-month period in a hospital based cross-sectional study. History of illness, sociodemographic and perinatal history were obtained; clinical examination and results of venous blood for thick and thin film malaria parasite examinations were recorded and analyzed. RESULTS the mean (SD) age of the 350 infants was 3.4 (1.6) months with male: female (M: F) of 1.2: 1. The prevalence of malaria parasitaemia (all plasmodium falciparum) was 19.1% while parasite density ranged from 24.0 to 400,000 parasites/µl, median (IQR) 900 (250-4,588)/µl. Sixteen (4.6%) had heavy malaria parasitaemia (>5000/µl). Low social class (OR=2.457; 95%CI 1.404-4.300; p=0.002), suboptimal antenatal care (OR=2.226; 95%CI 1.096-4.522; p=0.027), low birth weight infants (OR=4.818; 95%CI 2.317-10.018; p=<0.001) and injudicious use of haematinics (OR=3.192; 95%CI1.731-5.886; p=<0.001) were predictors of malaria parasitaemia among the infants. CONCLUSION one-in-five ill young infants had malaria parasitaemia with heavy parasitaemia in 23.8% of infected infants. Malaria parasitaemia was associated with modifiable factors, high index of suspicion in endemic region and optimal maternal and child care services may assist to reduce the burden of malaria in this age group.
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Affiliation(s)
| | - Bankole Peter Kuti
- Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Akibu Oyeku Oyelami
- Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Adesina-Adewole B, Olusola F, Adedapo A, Falade C. PARASITE-BASED DIAGNOSIS OF MALARIA IN PREGNANT WOMEN IN A TERTIARY HOSPITAL IN SOUTHWEST NIGERIA. Ann Ib Postgrad Med 2021; 19:22-30. [PMID: 35330888 PMCID: PMC8935670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Malaria in pregnancy has significant adverse consequences for the mother, foetus and baby. Presumptive diagnosis continues despite recommendation for parasite-based diagnosis. We performed Paracheck-PfTM, an HRP-II based malaria Rapid diagnostic test (Paracheck-Pf RDT) and microscopy among pregnant women in a prospective, cross sectional study, at the University College Hospital in Ibadan, Nigeria. Methods The study was conducted between 2009-2011. Consecutive pregnant women presumptively diagnosed as having malaria >18 years were enrolled after obtaining written informed consent. Demographic information, symptoms and clinical measurements were obtained. Capillary blood was obtained by finger prick for thick blood smear and RDT evaluation. Summary statistics included mean (standard deviation) for quantitative variables and percentages for categorical variables. Chi-square, analysis of variance (ANOVA), the odds ratio (OR) and 95% confidence intervals (CI) were computed with p-value less than 0.05 considered statistically significant. Results Of the 746 pregnant women aged 30.9 ± 4.6 years enrolled, 243 (32.7%) were primigravida. The mean gestational age was 23.3 ± 9.2 weeks with about 81% in the second and third trimester. The prevalence of malaria parasitaemia by microscopy and Paracheck-PfTM were 22.8% and 24.5% respectively. The geometric mean parasite density was 2,091/µL (range 40-156,975/µL). HIV positivity rate was 8.1 % and 16.1% of patients were anaemic (PCV <30%). Women with axillary temperature >37.4°C were significantly more likely to have malaria parasitaemia [p<0.0001] by microscopy. Sensitivity and specificity of Paracheck overall were 69.9% and 88.2% respectively while those at of parasite densities ≥200/µL were 84.8% and 88.7% respectively. Positive and negative predictive values were 66.9% and over 90% respectively. Conclusion RDTs are a reasonable alternative in view of the need for parasite-based diagnosis of malaria.
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Affiliation(s)
- B. Adesina-Adewole
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan
| | - F.I. Olusola
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan
| | - A.D.A. Adedapo
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - C.O. Falade
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan., Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Faye SLB, Lugand MM. Participatory research for the development of information, education and communication tools to promote intermittent preventive treatment of malaria in pregnancy in the Democratic Republic of the Congo, Nigeria and Mozambique. Malar J 2021; 20:223. [PMID: 34011371 PMCID: PMC8136127 DOI: 10.1186/s12936-021-03765-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background To improve the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in Africa, Medicines for Malaria Venture (MMV) developed, tested and validated a new packaging of sulfadoxine–pyrimethamine (SP), as well as specific communications tools designed to improve knowledge of IPTp and the motivation of women to adhere to it, particularly if it is distributed by community health workers (CHW). Methods This article describes and analyses the results of an empirical research carried out in the Democratic Republic of the Congo (DRC), Nigeria and Mozambique, to evaluate the perception and social acceptability of SP for healthcare providers, CHW and pregnant women, and to assess the ability of the new SP packaging and the communications tools to change their perception of SP and improve their attitudes towards IPTp. Results The results indicate that SP’s new individual packaging was perceived by pregnant women and healthcare providers as a “hygienic” and “safe”, with a specific identity. The graphics used in IPTp communications tools were modified according to the respondents’ feedback to make them more culturally and socially sensitive, and then validated. However, although the new blister packaging and IPTp communications tools generated greater confidence and motivation, SP side effects as well as preconceived ideas, particularly regarding its efficacy, remain a challenge that must be addressed to improve IPTp acceptance and compliance by healthcare providers and pregnant women. Conclusion This participatory approach to social research based on ongoing feedback to the graphic designer provided more empirical evidence to improve and adapt the textual and visual content of communication tools (SP blister packaging, leaflet, user guide) to local contexts and user preferences. Tested and validated in different socio-cultural and socio-political contexts, these tools provide a good basis for the promotion of IPTp in Africa.
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Affiliation(s)
- Sylvain Landry Birane Faye
- Laboratoire de Sociologie, Anthropologie, Psychologie (LASAP), Department of Sociology, Cheikh Anta DIOP University (UCAD), Dakar, Senegal.
| | - Maud Majeres Lugand
- Social Research Manager, Access and Product Management, Medicines for Malaria Venture, Geneva, Switzerland
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Ojifinni OO, Popoola OA. Pregnancy experiences and maternal health service utilisation among female traders in Ibadan, Nigeria. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Bello OO, Oni O. Health Workers' Awareness and Knowledge of Current Recommendation of Intermittent Preventive Treatment in Pregnancy in South-Western Nigeria. Ethiop J Health Sci 2020; 30:125-134. [PMID: 32116441 PMCID: PMC7036451 DOI: 10.4314/ejhs.v30i1.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Malaria in pregnancy is of public health significance because of its associated maternal and fetal complications. This study aimed to assess health workers' awareness and knowledge of the current World Health Organisation (WHO) recommendation of intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). Methods A cross-sectional study among 148 health workers who offer obstetrics care in selected health facilities in Ibadan, Nigeria using a self-administered questionnaire to evaluate their awareness and knowledge of the current WHO IPTp-SP. Information on their socio-demographic and professional characteristics, awareness, knowledge and practice of the current IPTp recommendation were obtained. Data analysis involved descriptive and bivariate analyses using SPSS version 20.0 with level of significance set at p<0.05. Results The majority, 85(57.4%), of the health workers had been providing obstetrics care for less than 5 years with most of them, 114(77.0%), practicing at tertiary health facility. More than half, 92(62.2%), of them were aware of the current WHO IPTp-SP recommendation while about two-fifth (39.1%) had its correct knowledge. Of the health workers who were knowledgeable of the current IPTp-SP recommendation almost three-quarter, 29(72.2%) of them prescribed it. The health workers' professional cadre (p<0.001) and duration of providing obstetrics care (p=0.012) were significantly associated with their awareness and correct knowledge of the current IPTp-SP recommendation. Conclusion Most of the health workers are aware but not knowledgeable of the correct administration of the current IPTp-SP recommendation. Likewise, many of them do not prescribe it. This calls for regular training and update of health workers and institutional protocol so as to effectively reduce the prevalence of malaria in pregnancy and its complications.
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Affiliation(s)
- Oluwasomidoyin Olukemi Bello
- Urogynaecology Unit, Department of Obstetrics and Gynaecology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Olaolu Oni
- Fetomaternal Medicine, Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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Aberese-Ako M, Magnussen P, Gyapong M, Ampofo GD, Tagbor H. Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions. Malar J 2020; 19:347. [PMID: 32977827 PMCID: PMC7519547 DOI: 10.1186/s12936-020-03422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015. METHODS This ethnographic study explored how healthcare managers dealt with existing MiP policy implementation challenges and the consequences on IPTp-SP uptake and access to maternal healthcare. The study collected date using non-participant observations, conversations, in-depth interviews and case studies in eight health facilities and 12 communities for 12 months in two Administrative regions in Ghana. RESULTS Healthcare managers addressed frequent stock-outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing and prescribing drugs for women to buy from private pharmacies. This ensured that facilities had funds to pay creditors, purchase drugs and supplies for health service delivery. However, it affected their ability to enforce DOT and to monitor adherence to treatment. Women who could afford maternal healthcare and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Women who could not maternal healthcare services resorted to visiting other sources of health care, delaying ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended 5 + doses of SP, others did not obtain LLINs early and some did not obtain treatment for MiP. Healthcare providers felt frustrated whenever they could not provide comprehensive care to women who could not afford comprehensive maternal and MiP care. CONCLUSION For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, regular supply of programme drugs and medical supplies to public, faith-based and private health facilities.
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Affiliation(s)
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Margaret Gyapong
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Gifty D Ampofo
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
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15
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Rabiu OR, Dada-Adegbola H, Kosoko AM, Falade CO, Arinola OG, Odaibo AB, Ademowo OG. Contributions of malaria, helminths, HIV and iron deficiency to anaemia in pregnant women attending ante-natal clinic in SouthWest Nigeria. Afr Health Sci 2020; 20:1035-1044. [PMID: 33402949 PMCID: PMC7751510 DOI: 10.4314/ahs.v20i3.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Iron deficiency is a dominant source of anaemia in many settings. To evaluate the key cause of anaemia in the study area, the prevalence of anaemia due to major public health diseases was compared with anaemia due to iron deficiency. METHODS Pregnant women were recruited from ante-natal (n=490) and HIV clinics (n=217) with their personal data documented using a questionnaire. Microscopy of Giemsa-stained thick smears was used for detection of malaria parasites while helminths in stools were detected using direct smear method. Haematocrit values were determined by capillary method. Serum ferritin levels were determined using enzyme-linked immunosorbent assay. Data was analysed using SPSS version 22.0. RESULTS The mean age of the recruited women was 28.6±5.4 years old. There were 68.1% cases of anaemia of which 35.5% was due to infections only predominantly HIV and malaria, 14.9% from unknown sources while anaemia due to iron deficiency only was 7.1%. CONCLUSION It can safely be inferred that malaria and HIV predispose to anaemia than iron deficiency in the study area. Although pregnant women are dewormed and given IPTp for helminths and malaria treatment respectively, there should be complementary routine malaria screening at ANC visits for those with HCT values <33% and those infected with HIV.
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Affiliation(s)
- Olawunmi R Rabiu
- Department of Zoology, University of Ibadan, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Biological Sciences, Mountain Top University, Km 12, Lagos-Ibadan Expressway, Ogun State, Nigeria
| | - Hannah Dada-Adegbola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayokulehin M Kosoko
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Biochemistry, University of Ibadan, Ibadan, Nigeria
- Department of Biochemistry, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - Catherine O Falade
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olatunbosun G Arinola
- Immunology Unit, Department of Chemical Pathology, College of Medicine, University of Ibadan, Nigeria
| | | | - Olusegun G Ademowo
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
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16
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Ndu A, Mbachu C, Anitube O, Ezeoke U. Inequities in the use of sulphadoxine-pyrimethamine for malaria prophylaxis during pregnancy in Nigeria. Malawi Med J 2020; 32:45-51. [PMID: 32733659 PMCID: PMC7366158 DOI: 10.4314/mmj.v32i1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Intermittent presumptive treatment in pregnancy (IPTp) of malaria using sulfadoxine-pyrimethamine (SP) was introduced in Nigeria in 2005 to reduce the burden of malaria in pregnancy. By 2013, 23% of reproductive aged women surveyed received SP for malaria prevention in their last pregnancy of the past 5 years. This paper highlights geographic and socio-economic variations and inequities in accessing and using SP for malaria prophylaxis in pregnancy in Nigeria, as well as client-related and service delivery determinants. Methods Secondary data from 2013 Nigeria demographic and health survey (DHS) was used. Sample of 38,948 eligible women were selected for interview using stratified three-stage cluster design. Data obtained from the individual recode dataset was used for descriptive and logistic regression analysis of factors associated with SP use in pregnancy was performed. Independent variables were age, media exposure, region, place of residence, wealth index, place of antenatal care (ANC) attendance and number of visits. Results Women in the upper three wealth quintiles were 1.33 - 1.80 times more likely to receive SP than the poorest (CI: 1.15-1.56; 1.41-1.97; 1.49-2.17). Women who received ANC from public health facilities were twice as likely (inverse of OR 0.68) to use SP in pregnancy than those who used private facilities (CI: 0.60-0.76). Those who attended at least 4 ANC visits were 1.46 times more likely to get SP prophylaxis (CI: 1.31-1.63). Using the unadjusted odds ratio, women residing in rural areas were 0.86 times less likely to use SP compared to those in urban areas. Conclusions Inequities in access to and use of SP for malaria prophylaxis in pregnancy exist across sub-population groups in Nigeria. Targeted interventions on the least covered are needed to reduce existing inequities and scale-up IPTp of malaria.
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Affiliation(s)
- Anne Ndu
- Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria.,Institute of Public Health, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria
| | - Chinyere Mbachu
- Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria.,Institute of Public Health, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria.,Health Policy Research Group, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria
| | - Obiageli Anitube
- Institute of Public Health, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria.,Health Policy Research Group, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria
| | - Uche Ezeoke
- Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria.,Institute of Public Health, College of Medicine, University of Nigeria Enugu campus. PMB 01129, Enugu, Nigeria
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17
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Nkunzimana E, Babale MS. Knowledge and Utilisation of Intermittent Preventive Treatment of Malaria among Pregnant Women in Muramvya Health District, Burundi, 2018. East Afr Health Res J 2020; 4:81-91. [PMID: 34308224 PMCID: PMC8279260 DOI: 10.24248/eahrj.v4i1.625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intermittent Preventive Treatment in pregnancy (IPTp) of malaria is a key component of malaria control strategy in Burundi. Sulfadoxine-pyrimethamine (SP) is the drug of choice. Despite the evidence of the effectiveness of IPTp strategy using SP in reducing the adverse effects of malaria during pregnancy, the uptake and coverage in Burundi is low. This study was carried out to assess the knowledge and utilisation of IPTp among pregnant women of Muramvya Health District and determine factors that influence the uptake. METHODS This was a community based cross sectional study conducted from 16th to 28th September 2018. A total of 370 pregnant women were recruited from selected settlements of MURAMVYA Health District. A structured questionnaire was administered to elicit information on socio-demographic characteristics, knowledge, and utilisation of IPTp. Epi-Info 7.2.2.6 and Microsoft Excel 2016 software was used to perform univariate, bivariate and multivariate analyses. RESULTS Among the 370 pregnant women, 310 (83.8%) had taken IPTp-SP at least once in the index pregnancy. However, only 76 (24.5%) had completed the minimum required three doses. Having formal education (aOR=2.5, 95% CI [1.2-5.2], P= .016), parity (aOR=2.1, 95% CI [1.1-4.2], P = .033), and living at less than 5 km from the health facility (aOR=4.1, 95% CI [1.7-9.6], P =0.001) were found to be independent determinants of utilisation (at least one) of IPTp-SP. Also, having formal education (aOR=5.0, 95% CI [2.1-24.3], P<.001), and gestational age at first ANC visit (aOR=3.3, 95% CI [1.4-7.7], P=.005) were found to be independent determinants of taking optimal dose (three+) of IPTp-SP in Muramvya Health District. CONCLUSION The findings of this study show the low rate of pregnant women receiving the optimal dose of IPTp-SP. The study established that the major factors for IPTp-SP utilisation are; educational level, distance from home to the health facility, parity and the gestational age at the first ANC visit. It is therefore recommended that healthcare providers in Muramvya district should intensify sensitization and awareness campaign on the importance of girl child education and early ANC attendance in order to increase uptake and utilization of IPTp-SP for improved health outcomes.
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Affiliation(s)
- Edouard Nkunzimana
- Ministry of Public Health and Fight against AIDS, Department of Pharmacy, Medicine and Laboratories, Bujumbura, Burundi
| | - Mu'awiyyah Sufiyan Babale
- Ahmdadu Bello University, Faculty of Clinical Sciences, Department of Community Medicine, Zaria, Nigeria
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Searle AR, Hurley EA, Doumbia SO, Winch PJ. "They Merely Prescribe and I Merely Swallow": Perceptions of Antenatal Pharmaceuticals and Nutritional Supplements Among Pregnant Women in Bamako, Mali. Matern Child Health J 2020; 24:110-120. [PMID: 31515675 DOI: 10.1007/s10995-019-02808-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES New international guidelines for antenatal care (ANC) will likely result in an increase in nutritional supplements and preventative medications for pregnant women in low and middle-income countries. Our objective was to understand how pregnant women in Mali perceive and experience multi-drug regimens in ANC in order to reveal factors that may influence uptake and adherence. METHODS We conducted 29 semi-structured interviews and three focus groups with 21 pregnant women in two urban ANC sites in Bamako, Mali. Interviews focused on perception of purpose of ANC pharmaceuticals (particularly iron supplements, sulfadoxine-pyrimethamine as intermittent prevention of malaria and antiretroviral therapy for HIV), beliefs regarding efficacy and risk, and understanding of dosage and regimen. Transcripts were inductively coded and analyzed using the 'Framework' method. RESULTS Participant descriptions of medication purpose, understanding of dosing, and beliefs about risks and efficacy varied widely, revealing that many pregnant women lack complete information about their medications. While some were burdened by side effects or complex regimens, women generally held favorable attitudes toward ANC medications. Responses suggest major barriers to adherence lie in the health system, namely insufficient patient-provider communication and inconsistent prescribing practices. CONCLUSIONS FOR PRACTICE National health programs looking to improve maternal and child health with ANC pharmaceuticals need to place greater attention on patient counseling and consistent implementation of administration guidelines. Communication that positions pharmaceuticals as beneficial to mother and child, while presenting understandable information about purpose, dosing and potential side effects can promote uptake of multi-drug regimens and ANC services in general.
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Affiliation(s)
- Alexandra R Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Emily A Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.,Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Seydou O Doumbia
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
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Anchang-Kimbi JK, Kalaji LN, Mbacham HF, Wepnje GB, Apinjoh TO, Ngole Sumbele IU, Dionne-Odom J, Tita ATN, Achidi EA. Coverage and effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) on adverse pregnancy outcomes in the Mount Cameroon area, South West Cameroon. Malar J 2020; 19:100. [PMID: 32122339 PMCID: PMC7053117 DOI: 10.1186/s12936-020-03155-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Growing 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. Methods Consenting 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. Results Among 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. Conclusion In the Mount Cameroon area, reported uptake of IPTp with ≥ 3 SP doses did not provide observable prophylactic benefits. SP resistance efficacy studies are necessary.
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Affiliation(s)
- Judith K Anchang-Kimbi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon.
| | - Laken N Kalaji
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Harry F Mbacham
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Godlove B Wepnje
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Irene U Ngole Sumbele
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Jodie Dionne-Odom
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, USA
| | - Eric A Achidi
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
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20
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Uptake of intermittent preventive treatment in pregnancy for malaria: further analysis of the 2016 Ghana Malaria Indicator Survey. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01206-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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21
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Akpa CO, Akinyemi JO, Umeokonkwo CD, Bamgboye EA, Dahiru T, Adebowale AS, Ajayi IO. Uptake of intermittent preventive treatment for malaria in pregnancy among women in selected communities of Ebonyi State, Nigeria. BMC Pregnancy Childbirth 2019; 19:457. [PMID: 31791271 PMCID: PMC6888909 DOI: 10.1186/s12884-019-2629-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/25/2019] [Indexed: 04/15/2023] Open
Abstract
Background Malaria 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. Methods This 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. Results Mean 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. Conclusion Adequate 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.
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Affiliation(s)
- Christian Obasi Akpa
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Joshua Odunayo Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chukwuma David Umeokonkwo
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria. .,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
| | - Eniola Adetola Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tukur Dahiru
- Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - IkeOluwapo Oyeneye Ajayi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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22
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Bello F, Ayede A. PREVALENCE OF MALARIA PARASITAEMIA AND THE USE OF MALARIA PREVENTION MEASURES IN PREGNANT WOMEN IN IBADAN, NIGERIA. Ann Ib Postgrad Med 2019; 17:124-129. [PMID: 32669988 PMCID: PMC7358809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Malaria complicates up to 58.1% of pregnancies in Nigeria. Preventive measures include intermittent preventive treatment and consistent use of insecticide-treated nets. However, uptake of these interventions can often be sub-optimal. OBJECTIVE This study aimed to assess the prevalence of malaria in pregnancy in peri-urban and rural communities of Ibadan, Nigeria and its association with the use of preventive measures. METHODS In this cross-sectional study, pregnant women were recruited from selected primary health centres and blood films were taken for malaria parasites. Explanatory variables were the use of bed nets and chemoprophylaxis; the primary outcome was presence of peripheral malaria parasitaemia. RESULTS Malaria prevalence was 4.3% (67 of 1570 participants); two-thirds of women with parasitaemia had malaria symptoms. Four hundred and thirty-eight (27.9%) used prescribed sulphadoxine-pyrimethamine prophylaxis, 784 (49.9%) women reported that they consistently slept under insecticide-treated nets, and 236 (15%) complied with both interventions. Bed net use appeared more protective than chemoprophylaxis. However, the protection from malaria in those who used preventive measures was not statistically significant (p=0.075). CONCLUSION Malaria prevalence was low. No association was determined between malaria and the use of preventive measures; the lack of association may be due to the low prevalence.
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Affiliation(s)
- F.A. Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - A.I. Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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23
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Mchwampaka WM, Tarimo D, Chacky F, Mohamed A, Kishimba R, Samwel A. Factors affecting uptake of ≥ 3 doses of Sulfadoxine-Pyrimethamine for malaria prevention in pregnancy in selected health facilities, Arusha region, Tanzania. BMC Pregnancy Childbirth 2019; 19:440. [PMID: 31775686 PMCID: PMC6880562 DOI: 10.1186/s12884-019-2592-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/11/2019] [Indexed: 01/28/2023] Open
Abstract
Background Tanzania adopted the revised World Health Organization policy in 2013 recommending a minimum of ≥3 doses of Intermittent Preventive Treatment during pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) to protect against malaria. A study in Tanzania in 2014 reported low (9%) uptake. We investigated health workers knowledge about IPTp-SP and factors that influenced uptake of > 3 doses of IPTp-SP among pregnant women. Methods We conducted a cross-sectional study in 2017 among post-delivery women and health care workers from nine randomly-selected public health facilities in three Districts of Arusha Region. Probability proportional to size methodology was used to determine number of participants per facility. We used a structured questionnaire to collect socio-demographic and obstetric data, information on doses of SP received, and knowledge of SP for IPTp. Health care workers were interviewed about their knowledge for IPTp- SP and challenges encountered in its uptake and use. Results We interviewed 556 persons (median age 26 years, range 16–42 years) with the response rate of 99.3%. Of these, 484 (87.1%) had > 3 Antenatal Care (ANC) visits. A total of 402 (72.3%) were multigravida with 362 (65.1%) having given birth at least once. Of the 556 participants, 219 (39.4%) made their first ANC booking at < 17 weeks of pregnancy and 269 (48.4%) had received > 3 doses of SP-IPTp. Factors associated with uptake of > 3 doses of IPTp-SP included having secondary or higher education [Adjusted Odds Ratio (AOR) =1.6, 95%CI 1.1–2.4], attending ≥4 ANC visits [AOR = 3.1, 95%CI 2.1–4.6], having first antenatal booking at < 17 weeks [AOR = 1.8, 95%CI 1.4–2.3], and adequate knowledge on IPTp-SP [AOR = 2.7, 95%CI 1.9–3.9]. Among 36 health care workers interviewed, 29(80.6%) had adequate knowledge about IPTp-SP. SP was available in seven (87.5%) of the visited health facilities and was administered under Direct Observed Therapy (DOT) in six (75%) facilities. Health care workers reported that stock outs of SP was a challenge. Conclusions Fewer than half of the women interviewed reported uptake of > 3 doses of IPTp-SP. That is below the Tanzania national target of 80%. Making > 4 ANC visits, having secondary or higher education, making an early first ANC visit and having adequate knowledge on IPTp-SP promoted uptake of > 3 doses. Further qualitative studies are needed to explore factors that might contribute to low uptake of SP.
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Affiliation(s)
| | - Donath Tarimo
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Frank Chacky
- Tanzania National Malaria Control Programme (NMCP), Dar es Salaam, Tanzania
| | - Ahmed Mohamed
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
| | - Rogath Kishimba
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dar es Salaam, Tanzania
| | - Angela Samwel
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
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Vandy AO, Peprah NY, Jerela JY, Titiati P, Manu A, Akamah J, Maya ET, Torpey K. Factors influencing adherence to the new intermittent preventive treatment of malaria in pregnancy policy in Keta District of the Volta region, Ghana. BMC Pregnancy Childbirth 2019; 19:424. [PMID: 31747927 PMCID: PMC6868834 DOI: 10.1186/s12884-019-2544-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/30/2019] [Indexed: 02/05/2023] Open
Abstract
Background About 25% of pregnant women in malaria-endemic areas are infected with malaria and this accounts for about 15% of maternal deaths globally. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is one of the main strategies for prevention of malaria in pregnancy. A new recommendation was made by the World Health Organization (WHO) that at least three doses of IPTp-SP should be administered before delivery. This study sought to determine the factors influencing adherence to the new IPTp-SP policy in Keta District, Volta region, Ghana. Methods A cross-sectional quantitative study among 375 nursing mothers at four selected health facilities in Keta district, Ghana was conducted using a structured questionnaire to interview participants. Sampling proportionate to the size of facility was used to determine the number of nursing mothers from each facility based on the caseload. For each facility systematic random sampling was used to select eligible nursing mothers. Data was analyzed using STATA 15. Chi-square was used to test bivariate association between categorical variables and adherence. Logistic regression analysis was used to examine sociodemographic, individual and institutional factors influencing adherence to IPTp-SP. Result About 82.1% of participants adhered to the WHO policy recommendations of at least three doses of IPTp-SP. However, only 17.1% received Ghana’s five dose coverage recommendation. The proportion of IPTp-SP coverage for IPTp1 was 98.9%; IPTp2 95.5%; IPTp3 80.8%; IPTp4 39.5%; IPTp5 17.1%. Conclusion Adherence to IPTp-SP was satisfactory according to WHO’s policy recommendation, however, majority of the participants had less than the five doses recommended in Ghana. Number of Antenatal Care (ANC) visits and knowledge of malaria were the main determinants of adherence to IPTp-SP.
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Affiliation(s)
- Alren O Vandy
- University of Ghana College of Health Sciences, Accra, Ghana
| | - Nana Yaw Peprah
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | | | | | - Abubakar Manu
- University of Ghana College of Health Sciences, Accra, Ghana
| | - Joseph Akamah
- University of Ghana College of Health Sciences, Accra, Ghana
| | - Ernest T Maya
- University of Ghana College of Health Sciences, Accra, Ghana
| | - Kwasi Torpey
- University of Ghana College of Health Sciences, Accra, Ghana.
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Olugbade OT, Ilesanmi OS, Gubio AB, Ajayi I, Nguku PM, Ajumobi O. Socio-demographic and regional disparities in utilization of intermittent preventive treatment for malaria in pregnancy - Nigeria demographic health survey 2013. Pan Afr Med J 2019; 32:13. [PMID: 30949287 PMCID: PMC6441474 DOI: 10.11604/pamj.supp.2019.32.1.13345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/20/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction malaria in pregnancy can lead to medical emergencies. Utilization of intermittent preventive treatment for prevention of malaria in pregnancy with Sulphadoxine- Pyrimethamine (IPTp-SP) has remained low in developing countries in sub-Saharan Africa. This study aimed to identify the factors determining uptake of IPTp-SP in Nigeria using the 2013 Nigeria Demographic Health Survey. Methods we conducted a secondary analysis of data extracted from the National Demographic Health Survey 2013 which used a three stage stratified sampling method to select respondents. Independent variables considered were age, marital status, the level of education of respondents and their spouses, region, location of residence, wealth-index and birth order. The dependent variable was the use of two or more doses of SP for IPTp in the two years before the survey. Descriptive statistics for socio-demographic and selected characteristics was done. Chi-square test was used to test associations between sociodemographic characteristics and IPTp-SP uptake. Multiple logistic regressions at 95% confidence interval were used to determine predictors of IPTp utilization using STATA version14 software. Results of the 38,948 women interviewed 12,473 (32%) had given birth two years preceding the survey and 15% used at least two doses of SP for IPTp. Women aged 30 years and above [aOR 1.4, C.I:1.1-1.7], in the middle class or higher wealth index [aOR 1.5, CI: 1.1-2.0], with two or more ANC visits [aOR 4.2, CI: 1.4 - 12.5], were more likely to use IPTp. Conclusion late initiation of IPTp after the second trimester was a contributory factor for poor SP utilization. Interventions targeted at ensuring pregnant women attend ANC and use of IPTp-SP after quickening should be promoted.
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Affiliation(s)
| | | | - Aishatu Bintu Gubio
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Ikeoluwapo Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Patrick Mboya Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
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Odjidja EN, Duric P. Evaluation of demand and supply predictors of uptake of intermittent preventive treatment for malaria in pregnancy in Malawi. MALARIAWORLD JOURNAL 2017; 8:20. [PMID: 34532243 PMCID: PMC8415061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The intermittent preventive treatment (IPTp) policy of Malawi (2002) stipulates that IPTp is administered during antenatal care as a direct observation therapy (DOT). The policy further recommends that IPT should be administered monthly after 16 weeks of pregnancy until delivery. This study assessed both the demand and supply factors contributing to higher dropout of IPT after the first dose. Optimal number of doses was pegged at a minimum of three in accordance with WHO recommendation. MATERIALS AND METHODS Data were analysed from the Malawi multiple indicator cluster survey (2015) and the service provision assessment (2014) of 6637 women (aged 15- 49 yrs), 763 facilities and 2105 health workers. The sample was made up of pregnant women, health facilities and workers involved in routine antenatal services across all regions of Malawi. A composite indicator was constructed to report integration of IPTp with ANC services and administration of IPTp-SP as DOT. Multivariate and logistic regression were conducted to determine associations. RESULTS Regression analysis found that: 1. Age of women (women 35-49 yrs, AOR 1.98; 95% CI 1.42 - 2.13, number of children as well as the number of ANC visits were associated with optimal uptake of IPTp. 2. Administering IPT as DOT was higher in facilities in rural areas (AOR 1.86; 95% CI 1.54 - 1.92) than in urban areas. 3. Administration of IPTp as DOT was relatively lower in across all facilities with highest being facilities managed by CHAM (72.8%, AOR 1.40; 95% CI 1.22 - 1.54). CONCLUSION Health system bottlenecks were found to present the main cause of low coverage with optimal doses of IPTp. Incorporating these results into strategic policy IPTp formulation could help improve coverage to desired levels. This study could serve as plausible evidence for government and donors when planning malaria in pregnancy interventions, especially in remote parts of Malawi.
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Affiliation(s)
- Emmanuel N. Odjidja
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom,*
| | - Predrag Duric
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
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Monitoring Compliance and Acceptability of Intermittent Preventive Treatment of Malaria Using Sulfadoxine Pyrimethamine after Ten Years of Implementation in Tanzania. Malar Res Treat 2017; 2017:9761289. [PMID: 28465859 PMCID: PMC5390590 DOI: 10.1155/2017/9761289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 02/06/2017] [Accepted: 03/19/2017] [Indexed: 11/27/2022] Open
Abstract
Intermittent preventive treatment using SP (IPTp-SP) is still a superior interventional approach to control malaria during pregnancy. However its rate of use has gone down tremendously in malaria endemic areas. This study forms part of a larger study aimed at monitoring the compliance of IPTp-SP policy in malaria endemic areas of Tanzania. Two cross-sectional studies were conducted in Dar es Salaam and Njombe Regions of Tanzania. Overall, 540 pregnant women and 21 healthcare workers were interviewed using structured questionnaires. This study revealed that 63% of women were not willing to take SP during pregnancy while 91% would only take it if they tested positive for malaria during antennal visits. 63% of the interviewed women did not know the recommended dose of SP required during pregnancy, despite the fact that 82% of the women were aware of the adverse effect of malaria during pregnancy. It was found out that 54% of pregnant women (30–40 weeks) took single dose, 34% took two doses, and 16% did not take SP at the time of interview. It was also found that SP was not administered under direct observed therapy in 86% of women. There was no significant relationship between number of doses received by pregnant women and antenatal clinic (ANC) start date (r2 = 0.0033, 95% CI (−0.016 to 0.034)). However positive correlation between drug uptake and drug availability was revealed (p = 0.0001). Knowledge on adverse effects of placental malaria among pregnant women was significantly associated with drug uptake (OR 11.81, 95% CI (5.755–24.23), p = 0.0001). We conclude that unavailability of drugs in ANC is the major reason hindering the implementation of IPTp-SP.
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Wanzira H, Katamba H, Okullo AE, Rubahika D. The challenge of using intermittent preventive therapy with sulfadoxine/pyrimethamine among pregnant women in Uganda. Malar J 2016; 15:401. [PMID: 27506609 PMCID: PMC4979112 DOI: 10.1186/s12936-016-1462-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Uganda National Malaria Control Programme recommends the use of intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine (SP) to prevent malaria, however, there is overwhelming evidence of low uptake of this intervention. This study, therefore, sought to examine the factors associated with taking two or more doses of therapy among women who had had the most recent live birth. METHODS This was a secondary data analysis of the 2014 Malaria Indicator Survey dataset. The outcome was the use of two or more doses of SP for the most recent live birth while independent variables included; age, highest education attained, residence (rural and urban), use of radio and community health teams for malaria related messages, knowledge of taking SP and use of LLINS to prevent malaria, household wealth, skilled attendant seen at ANC and number of children the woman has. RESULTS Of the 1820 women included in the final analysis, 822 (45.16 %) women took two or more doses of SP. Women who knew that this therapy was used to prevent malaria and those who had been seen by a skilled attendant were 10.72 times [Adjusted OR (95 % CI): 10.72 (7.62-15.08), p-value = 0.001] and 3.19 times [Adjusted OR (95 % CI): 3.19 (1.26-8.07), p-value = 0.015] more likely to take at least two doses as compared to those who did not know about this therapy and those seen by unskilled attendants, respectively. CONCLUSION This study shows that knowledge among women that SP is a medication used for malaria prevention during pregnancy increases the uptake of two or more doses of this therapy among pregnant women. This highlights the importance of behaviour change communication focused on IPTp uptake that can be complemented by having skilled personnel attending to pregnant women at the antenatal clinic.
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Affiliation(s)
- Humphrey Wanzira
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda.
| | - Henry Katamba
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Allen Eva Okullo
- School of Public Health, Fellowship Program, Makerere University, Kampala, Uganda
| | - Denis Rubahika
- National Malaria Control Programme, Ministry of Health, Kampala, Uganda
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Ameh S, Owoaje E, Oyo-Ita A, Kabiru CW, Akpet OEO, Etokidem A, Enembe O, Ekpenyong N. Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2016; 16:99. [PMID: 27147109 PMCID: PMC4857401 DOI: 10.1186/s12884-016-0883-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women's compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria. METHODS A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Binary logistic regression was used to determine the factors associated with the use of SP-IPTp in the study population. RESULTS Use of SP-IPTp was self-reported by 41% of the total respondents. Lack of autonomy in the households to receive sulfadoxine-pyrimethamine (SP) during ANC was the main barrier to use of IPTp (83%). Other barriers were stock-outs of free SP (33%) and poor supervision of SP ingestion by directly observed treatment among those who obtained SP from ANC clinics (36/110 = 33%). In the multivariate logistic regression, the odds of using SP-IPTp was increased by the knowledge of the use of insecticide treated nets (ITNs) (OR = 2.13, 95% CI: 1.70-3.73) and SP (OR = 22.13, 95% CI: 8.10-43.20) for the prevention of MIP. Use of ITNs also increased the odds of using SP-IPTp (OR = 2.38, 95% CI: 1.24-12.31). CONCLUSIONS Use of SP-IPTp was low and was associated with knowledge of the use of ITNs and SP as well as the use of ITNs for the prevention of MIP. There is a need to strengthen PHC systems and address barriers to the usage of SP-IPTp in order to reduce the burden of MIP.
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Affiliation(s)
- Soter Ameh
- />Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State Nigeria
- />Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eme Owoaje
- />Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
| | - Angela Oyo-Ita
- />Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State Nigeria
| | | | - Obaji E. O. Akpet
- />Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State Nigeria
| | - Aniekan Etokidem
- />Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State Nigeria
| | - Okokon Enembe
- />Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State Nigeria
| | - Nnette Ekpenyong
- />Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State Nigeria
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Kibusi SM, Kimunai E, Hines CS. Predictors for uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Tanzania. BMC Public Health 2015; 15:540. [PMID: 26049737 PMCID: PMC4458339 DOI: 10.1186/s12889-015-1905-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/03/2015] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Tanzania adopted Intermittent-preventive treatment of malaria in pregnancy (IPTp) policy in 2000; the guidelines at the time of the study recommended the timing of the first dose of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) (IPTp-SP) at 20-24 weeks and the timing of the second dose at 28-32 weeks. The aim of this study was to identify factors that are responsible for the uptake of IPTp among pregnant Tanzanian women. Further, this study aims to justify the need for appropriate interventions that would strengthen the Tanzanian IPTp program towards the realization of the Roll Back Malaria (RBM) targets. METHODS Data were analyzed from the 2011-2012 Tanzania HIV and Malaria Indicators Survey (THMIS) of 1,616 women aged 15-49 years who had a live birth in the 2 years prior to the survey and received antenatal care (ANC) services. RESULTS Logistic regression analysis results showed that (1) being in the age groups 30-34 and 35-39 versus other age groups and being married or living with partner versus those who reported as never married or divorced/separated were associated with high uptake of IPTp; (2) women pregnant with their first or second child versus those who already have had two or more children had higher odds of completing the recommended number of IPTp dosage; and (3) being a resident from the Eastern Zone versus Lake Zone as well as having the first antenatal visit in the first or second trimester versus third trimester were associated with higher uptake of IPTp. CONCLUSION Applying these results could contribute to positive social change by helping providers, clinics, and organizations seeking to increase IPTp uptake among ANC attendees and providing health education programs to women, especially those residing in rural areas. This study could also help achieve United Nations Millennium Development Goals (MDG) 6 (combat HIV/AIDS, Malaria and Other Diseases).
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Affiliation(s)
- Stephen M Kibusi
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | - Eunice Kimunai
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | - Courtney S Hines
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
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Odongo CO, Bisaso RK, Byamugisha J, Obua C. Intermittent use of sulphadoxine-pyrimethamine for malaria prevention: a cross-sectional study of knowledge and practices among Ugandan women attending an urban antenatal clinic. Malar J 2014; 13:399. [PMID: 25306431 PMCID: PMC4210552 DOI: 10.1186/1475-2875-13-399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/07/2014] [Indexed: 12/02/2022] Open
Abstract
Background The WHO recommends supervised administration of sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment for malaria (IPTp) during pregnancy. Logistical constraints have however favoured unsupervised intake of SP-IPTp, casting doubts whether recent guidelines requiring more frequent intake can be effectively implemented. To propose strategies for enhancing compliance under limited supervision, this study sought to identify pregnant women’s knowledge and practices gaps as well as determine predictors of compliance with SP-IPTp, given under limited supervision. Methods A cross-sectional study of 700 women used exit interviews at an urban clinic in Uganda to obtain a descriptive summary of demographic and obstetric characteristics, including knowledge, practice and experiences with SP. Predictors of compliance with SP intake instructions were explored using logistic regression. Results Median age of respondents was 25 (IQR 22–28) and median parity was two (IQR one to three) while median number of antenatal clinic (ANC) visits was 3.0 (IQR three to four). Most women had completed primary (36%) or ordinary secondary education (25.6%) while 16.1% had not completed primary education. Awareness about SP was high (99.4%) although correct knowledge regarding its use in pregnancy was low (57%), with 15.4% thinking it was used to treat malaria and 26.7% lacking any idea about its use. Correct knowledge on SP use during pregnancy significantly predicted compliance with SP-IPTp instructions (OR 1.98, C.I. 1.12-3.55), while age, education level, parity, number of ANC visits, or history of unwanted effects with SP did not. SP was mostly accessed from hospitals (64.4%) followed by private clinics (16.9%) both for preventive and treatment purposes. SP was considered safe by most women, who were willing to take it again in future, without supervision. Conclusion Despite high awareness, knowledge of SP as an intervention for malaria prevention in pregnancy was low. Correct knowledge on use of SP predicted compliance with SP-IPTp intake instructions. Focused malaria-related education during ANC visits may improve compliance with SP intake amidst limited supervision. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-399) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charles O Odongo
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
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Rabiu KA, Davies NO, Nzeribe-Abangwu UO, Adewunmi AA, Akinlusi FM, Akinola OI, Ogundele SO. Malaria prevention and treatment in pregnancy: survey of current practice among private medical practitioners in Lagos, Nigeria. Trop Doct 2014; 45:6-11. [PMID: 25253668 DOI: 10.1177/0049475514550061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied the practice of malaria prevention and treatment in pregnancy of 394 private medical practitioners in Lagos State, Nigeria using a self-administered pre-tested structured questionnaire. Only 39 (9.9%) respondents had correct knowledge of the World Health Organization (WHO) strategies. Malaria prophylaxis in pregnancy was offered by 336 (85.3%), but only 98 (24.9%) had correct knowledge of recommended chemoprophylaxis. Of these, 68 (17.3%) had correct knowledge of first trimester treatment, while only 41 (10.4%) had knowledge of second and third trimester treatment. Only 64 (16.2%) of respondents routinely recommended use of insecticide-treated bed nets. The most common anti-malarial drug prescribed for chemoprophylaxis was pyrimethamine (43.7%); chloroquine was the most common anti-malarial prescribed for both first trimester treatment (81.5%) and second and third trimester treatment (55.3%). The study showed that private medical practitioners have poor knowledge of malaria prophylaxis and treatment in pregnancy, and the practice of most do not conform to recommended guidelines.
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Affiliation(s)
- Kabiru Afolarin Rabiu
- FWACS FMCOG, Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Nosimot Omolola Davies
- MB;BS MPH, Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Ugochi O Nzeribe-Abangwu
- MB;BS FWACS, Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Adeniyi Abiodun Adewunmi
- FWACS FICS, Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Fatimat Motunrayo Akinlusi
- MB;ChB FWACS, Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Oluwarotimi Ireti Akinola
- FWACS FICS, Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Sunday O Ogundele
- MSc FMCP, Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
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Diala CC, Pennas T, Marin C, Belay KA. Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria. Malar J 2013; 12:342. [PMID: 24059757 PMCID: PMC3849531 DOI: 10.1186/1475-2875-12-342] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/13/2013] [Indexed: 12/04/2022] Open
Abstract
Background Malaria during pregnancy is dangerous to both mother and foetus. Intermittent preventive treatment of malaria in pregnancy (IPTp) is a strategy where pregnant women in malaria-endemic countries receive full doses of sulphadoxine-pyrimethamine (SP), whether or not they have malaria. The Nigerian government adopted IPTp as a national strategy in 2005; however, major gaps affecting perception, uptake, adherence, and scale-up remain. Methods A cross-sectional study was conducted in peri-urban and rural communities in Nasarawa and Cross River States in Nigeria. Study instruments were based on the socio-ecological model and its multiple levels of influences, taking into account individual, community, societal, and environmental contexts of behaviour and social change. Women of reproductive age, their front-line care providers, and (in Nasarawa only) their spouses participated in focus group discussions and in-depth individual interviews. Facility sampling was purposive to include tertiary, secondary and primary health facilities. Results The study found that systems-based challenges (stockouts; lack of provider knowledge of IPTp protocols) coupled with individual women’s beliefs and lack of understanding of IPT contribute to low uptake and adherence. Many pregnant women are reluctant to seek care for an illness they do not have. Those with malaria often prefer to self-medicate through drug shops or herbs, though those who seek clinic-based treatment trust their providers and willingly accept medicine prescribed. Conclusions Failing to deliver complete IPTp to women attending antenatal care is a missed opportunity. While many obstacles are structural, programmes can target women, their communities and the health environment with specific interventions to increase IPTp uptake and adherence.
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Affiliation(s)
- Chamberlain C Diala
- FHI360, C-Change Project, Global Health Population and Nutrition Division, 1825 Connecticut Avenue, Washington DC, NW 20009, USA.
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Esu E, Effa E, Udoh E, Oduwole O, Odey F, Chibuzor M, Oyo-Ita A, Meremikwu M. Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria. Res Rep Trop Med 2013; 4:29-35. [PMID: 30890873 PMCID: PMC6065562 DOI: 10.2147/rrtm.s47677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria. Methods A clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC) visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp) doses was obtained using an audit checklist. Results A total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76%) of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1), 24.2% had two doses of IPTp (IPTp2), while 3.1% had three doses of IPTp (IPTp3). The overall utilization of two doses or more of IPTp (IPTp2+) was 30.7%. Conclusion There was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state.
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Affiliation(s)
- Ekpereonne Esu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Emmanuel Effa
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Ekong Udoh
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Olabisi Oduwole
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Friday Odey
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Moriam Chibuzor
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria,
| | - Angela Oyo-Ita
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Martin Meremikwu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
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Haile ZT, Gurka KK, Chertok IRA, Sambamoorthi U. Factors associated with utilization of sulphadoxine-pyrimethamine during pregnancy among women in Kenya: a cross-sectional study. Matern Child Health J 2013; 18:1104-13. [PMID: 23912315 DOI: 10.1007/s10995-013-1340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The effectiveness of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment during pregnancy for malaria is well established. However, adherence to recommended guidelines remains poor. This study examines factors related to receipt of SP among pregnant women in Kenya. Descriptive and inferential statistics for complex survey data were utilized using the 2008-2009 Kenya Demographic and Health Survey. With the exception of women residing in Nyanza, women who reside in other provinces were more likely to receive one dose of SP versus none compared to women living in Nairobi. Women receiving antenatal care from a nurse or midwife and women who owned a bed net were almost twice as likely to receive one dose of SP versus none (aOR 1.92, 95% CI 1.28, 2.86 and aOR 1.79; 95% CI 1.12, 2.78; respectively); whereas, women who received other anti-malarial drugs were over 90% less likely to receive one dose of SP versus none (aOR 0.08; 95% CI 0.02, 0.26). Among women who receive any SP, increased numbers of antenatal care visits were associated with receipt of two or more doses of SP (aOR 1.16; 95% CI 1.02, 1.32-per additional visit), while women living in the western province were nearly 75% less likely to receive two or more doses compared to women in Nairobi (aOR 0.27; 95% CI 0.08, 0.94). Receipt of the recommended ≥2 doses of SP is associated with predisposing and enabling characteristics. Further research is needed to identify barriers to receiving SP during pregnancy.
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Affiliation(s)
- Zelalem T Haile
- Department of Epidemiology, West Virginia University School of Public Health, Robert C. Byrd Health Sciences Center, 1 Medical Center Drive, PO Box 9190, Morgantown, WV, 26505-9190, USA,
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Hill J, Hoyt J, van Eijk AM, D'Mello-Guyett L, Ter Kuile FO, Steketee R, Smith H, Webster J. Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med 2013; 10:e1001488. [PMID: 23935459 PMCID: PMC3720261 DOI: 10.1371/journal.pmed.1001488] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/13/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Iliyasu Z, Gajida AU, Galadanci HS, Abubakar IS, Baba AS, Jibo AM, Aliyu MH. Adherence to intermittent preventive treatment for malaria in pregnancy in urban Kano, northern Nigeria. Pathog Glob Health 2013. [PMID: 23182135 DOI: 10.1179/2047773212y.0000000037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Malaria in pregnancy is associated with substantial risk of maternal and fetal morbidity and mortality. The uptake of preventive antimalarials is low in malaria endemic countries, including Nigeria. Using a crosssectional study design, we assessed factors associated with uptake and adherence to intermittent preventive treatment for malaria in pregnancy (IPTp) among antenatal attendees in primary health centers in Kano, northern Nigeria (n5239). A total of 137 respondents (57.3%) reported receiving preventive antimalarials, but only 88 respondents (36.8%) [95% confidence interval (CI): 30.7–43.3%] reported ingesting pills in the clinic under supervision. Factors associated with adherence to IPTp after adjustment for potential confounding included: advanced maternal age [adjusted odds ratio (AOR) (95%CI)52.1 (1.3–6.37)], higher educational attainment [AOR (95%CI)53.2 (1.32–6.72)], higher parity [AOR (95%CI)51.6 (1.07–3.94)], lower gestational age at booking [AOR (95% CI)51.72 (1.24–3.91)], and use of insecticidetreated nets [AOR (95%CI)52.03 (1.13–3.26)]. There is a need for strengthening health systems and addressing cultural factors that impede efforts at expanding coverage of malaria prevention strategies in Nigeria.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
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Tobin-West CI, Asuquo EO. Utilization of intermittent preventive treatment of malaria by pregnant women in rivers state, Nigeria. Int J Prev Med 2013; 4:63-71. [PMID: 23412963 PMCID: PMC3570914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/17/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study was conducted to assess the level of intermittent preventive treatment of malaria in pregnancy (IPTp) in Rivers State, Nigeria, to identify obstacles prohibiting utilization in order to make recommendations for improved uptake and malaria control in general. METHODS A cross-sectional study was carried out in November 2008 among 339 pregnant women and those who had delivered children in the last 1 year, using a multistage sampling method. Data were analyzed using the Epi-Info version 6.04d statistical software package and hypothesis tests were conducted to compare summary statistics at 95% significance level. RESULTS Most of the respondents (76.4%) had knowledge that malaria was caused by mosquitoes and was harmful in pregnancy. Although majority of the pregnant women (80.8%) attended antenatal care clinics, knowledge of the correct use of SP was low (32.6%) and only 62.8% took malaria preventive treatment. Of these, 58.4% took SP, while nearly a third, 31.8%, took chloroquine. Only 16.4% took their SP at the health facility directly observed by health workers according to the national guidelines. The commonest reason for not preventing malaria was that they were not sick during the period of pregnancy. CONCLUSIONS Misconceptions about IPTp persist among women known to have attended antenatal care clinics, resulting in only a minority of pregnant women receiving IPTp as recommended by national guidelines. Efforts directed at awareness creation on the new malaria prevention and treatment policy are therefore necessary to enhance the uptake of IPT in pregnancy in Rivers State. Further studies are however, needed to evaluate the knowledge and practices of health care workers on the new malaria treatment policy.
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Affiliation(s)
- Charles I Tobin-West
- Department of Preventive and Social Medicine, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria,Correspondence to: Dr. Charles I. Tobin-West, Department of Preventive and Social Medicine, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria. E-mail:
| | - Eme O Asuquo
- Department of Preventive and Social Medicine, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria
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Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu BS. Sub-optimal delivery of intermittent preventive treatment for malaria in pregnancy in Nigeria: influence of provider factors. Malar J 2012; 11:317. [PMID: 22958539 PMCID: PMC3468404 DOI: 10.1186/1475-2875-11-317] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022] Open
Abstract
Background The level of access to intermittent preventive treatment for malaria in pregnancy (IPTp) in Nigeria is still low despite relatively high antenatal care coverage in the study area. This paper presents information on provider factors that affect the delivery of IPTp in Nigeria. Methods Data were collected from heads of maternal health units of 28 public and six private health facilities offering antenatal care (ANC) services in two districts in Enugu State, south-east Nigeria. Provider knowledge of guidelines for IPTp was assessed with regard to four components: the drug used for IPTp, time of first dose administration, of second dose administration, and the strategy for sulphadoxine-pyrimethamine (SP) administration (directly observed treatment, DOT). Provider practices regarding IPTp and facility-related factors that may explain observations such as availability of SP and water were also examined. Results Only five (14.7%) of all 34 providers had correct knowledge of all four recommendations for provision of IPTp. None of them was a private provider. DOT strategy was practiced in only one and six private and public providers respectively. Overall, 22 providers supplied women with SP in the facility and women were allowed to take it at home. The most common reason for doing so amongst public providers was that women were required to come for antenatal care on empty stomachs to enhance the validity of manual fundal height estimation. Two private providers did not think it was necessary to use the DOT strategy because they assumed that women would take their drugs at home. Availability of SP and water in the facility, and concerns about side effects were not considered impediments to delivery of IPTp. Conclusion There was low level of knowledge of the guidelines for implementation of IPTp by all providers, especially those in the private sector. This had negative effects such as non-practice of DOT strategy by most of the providers, which can lead to low levels of adherence to IPTp and ineffectiveness of IPTp. Capacity development and regular supportive supervisory visits by programme managers could help improve the provision of IPTp.
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Affiliation(s)
- Chima A Onoka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
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Onwujekwe OC, Soremekun RO, Uzochukwu B, Shu E, Onwujekwe O. Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria. BMC Res Notes 2012; 5:211. [PMID: 22551039 PMCID: PMC3392746 DOI: 10.1186/1756-0500-5-211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/02/2012] [Indexed: 11/16/2022] Open
Abstract
Background 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. Information is required on how to improve its prevention and treatment from both the providers’ and consumers’ perspectives. Methods The 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. Results Not 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. Conclusions There 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.
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Affiliation(s)
- Ogochukwu C Onwujekwe
- Department of Pharmacy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
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Cardoso MDO, Vieira-da-Silva LM. Avaliação da cobertura da atenção básica à saúde em Salvador, Bahia, Brasil (2000 a 2007). CAD SAUDE PUBLICA 2012; 28:1273-84. [DOI: 10.1590/s0102-311x2012000700006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 03/13/2012] [Indexed: 11/22/2022] Open
Abstract
Com o objetivo de testar abordagem metodológica para avaliação da cobertura dos serviços de atenção básica em Salvador, Bahia, Brasil (2000 a 2007), foi realizado um estudo de agregados espacial e temporal, tendo como unidades de análise o município e seus 12 Distritos Sanitários. Foram estimadas as coberturas real e potencial de diversos procedimentos realizados na atenção básica. Para a estimativa das coberturas, além do padrão ministerial, foi elaborado um segundo padrão com o objetivo de estabelecer uma aproximação com as necessidades de saúde da população. Os dados foram obtidos do Sistema de Informações Ambulatoriais do Sistema Único de Saúde (SIA-SUS). Foram encontradas baixas coberturas assistenciais no período analisado, a despeito da ampliação discreta verificada tanto na cobertura real de consultas médicas (7,8%), quanto na produção de ações básicas de enfermagem (66,7%). Já as consultas odontológicas apresentaram redução em 40%. Foram discutidas tanto as possibilidades de uso da metodologia para o monitoramento da cobertura, como as suas limitações tendo em vista as deficiências dos sistemas de informação.
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Aluko JO, Oluwatosin AO. Utilization of insecticide treated nets during pregnancy among postpartum women in Ibadan, Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2012; 12:21. [PMID: 22458645 PMCID: PMC3352125 DOI: 10.1186/1471-2393-12-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 03/29/2012] [Indexed: 11/11/2022] Open
Abstract
Background Pregnant women are susceptible to symptomatic malaria due to invasion of the placenta by plasmodium. Malaria increases the risk of adverse pregnancy outcomes for mothers, the foetuses and newborns. The effective use of Insecticide Treated Nets (ITNs) would be of benefit to these vulnerable women. Previous studies have focused on prenatal-women but this study sought to explore the actual trend of utilization of the proven strategy across all the pregnancy stages among postpartum women in Ibadan. Methods This cross-sectional survey utilized a validated structured questionnaire for data collection. A calculated sample of 335 postpartum women was proportionately recruited from three fee-paying facilities within Ibadan, Nigeria using a simple random sampling technique. These hospitals have high client flow for maternity cases and are known for provision of care under traditional ANC model. The data collected were analyzed using descriptive and inferential statistics by means of Statistical Package of Social Sciences (SPSS) version 15. The level of significance was set at = 0.05. Results The women's age ranged between 18 and 47 years, mean age was 29.4 ± 0.8 years. Various irregularities marked the traditional model of ANC provided at the settings and no exposure to preconception care. Also, 276 (82.4%) had heard of ITNs. Antenatal clinics formed the major source of information. Low utilization and compliance rates were observed. One hundred and twenty-seven (37.9%) of the women had high knowledge of Malaria in Pregnancy (MIP) but only 70 (20.9%) demonstrated positive attitude towards the use of ITNs. Participants' educational status, family types, employment and residential areas significantly influenced ITNs utilization. Conclusions The women knew and learned about ITNs from ANC visits. Majority of the women did not own ITNs because of lack of access to free distribution. The existing traditional model of ANC was marked by irregularities and none of the women was exposed to preconception care. In addition, negative attitude in spite of increased knowledge of MIP was observed among the women. Therefore, evaluation of free distribution of ITNs is recommended. Integration of focused ANC and preconception care are advocated to promote early access to health information.
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Affiliation(s)
- Joel O Aluko
- Nurse/Midwife/Public Health Nurse Tutors Programme, University College Hospital, Orita-mefa, Ibadan, Nigeria.
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Onoka CA, Hanson K, Onwujekwe OE. Low coverage of intermittent preventive treatment for malaria in pregnancy in Nigeria: demand-side influences. Malar J 2012; 11:82. [PMID: 22443266 PMCID: PMC3364889 DOI: 10.1186/1475-2875-11-82] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/23/2012] [Indexed: 11/29/2022] Open
Abstract
Background Nigeria instituted intermittent preventive treatment for malaria (IPTp) using sulphadoxine-pyrimethamine (SP) for pregnant women in 2001, but coverage remains low. This study examined the influence of demand side factors on IPTp coverage. Methods Data were collected using a household survey from 1307 women who were delivered of a live baby within the one-year period preceding the study and through an exit poll from 146 women attending antenatal clinics (ANC). Data analysis examined coverage based on the national and WHO guidelines for IPTp delivery which differ with regards to use of IPTp in the last month of pregnancy. Focus group discussions (FGDs) were undertaken to further explain demand side constraints to coverage. Results From the household survey, 96.1% of respondents attended ANC, with most having five or more visits. Overall IPTp coverage for the first and second doses was 13.7% and 7.3% respectively. The coverage was higher in the urban areas compared to rural areas (p < 0.01). Amongst women who could have received IPTp based on the timing of their attendance, only 14.1% and 14.3% were offered the first dose based on national and WHO guidelines, while 7.7% and 7.5% were offered the second dose respectively giving significant missed opportunities. Amongst ANC attendees offered first and second doses, 98.9% and 96.9% respectively took the medicine. Only 13.6% and 21.5% of these clients reported taking the drug under direct observation. The low level of coverage was confirmed by exit survey data, which found coverage of 11.6% and 3.0% for the first and second doses. The FGDs revealed that women do not have many concerns about side effects, but they take drugs providers give them because they believe such drugs must be safe. Conclusion This study found low coverage of IPTp and high levels of missed opportunities supporting findings that high ANC attendance does not guarantee high IPTp coverage. Demand side factors such as ANC attendance, appropriate timing of attendance, and perceptions about side effects were not constraining factors to increased coverage, raising the need to examine supply side factors.
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Affiliation(s)
- Chima A Onoka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu campus, Nigeria.
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Offianan AT, Penali LK, Coulibaly M, Tiacoh N, Ako A, Adji E, Coulibaly B, Koffi D, Sarr D, Jambou R, Kone M. Comparative efficacy of uncontrolled and controlled intermittent preventive treatment during pregnancy (IPTp) with combined use of LLTNs in high resistance area to sulfadoxine-pyrimethamine in Côte d'Ivoire. Infect Drug Resist 2012; 5:53-63. [PMID: 22442633 PMCID: PMC3308704 DOI: 10.2147/idr.s27450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction In recent years, intermittent preventive treatment for pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) has become policy in much of sub-Saharan Africa. But resistance to SP has been spreading across sub-Saharan Africa and thus the effectiveness of IPTp-SP has been questioned. The present study therefore sought to assess the incidence of placental malaria, low birth weight, and anemia of two IPTp-SP approaches (directly observed treatment scheme versus no directly observed treatment) in Anonkoua-Kouté and Samo, Côte d’Ivoire where the reported prevalence of dfr single mutant 108 was 62% and 52.2%, respectively. Methods The study was a longitudinal design involving pregnant women and was conducted in Anonkoua-Kouté, a suburban area, and Samo, a rural area, from January 2008 through March 2009. Women of a pregnancy less than 28 weeks duration were randomized to receive SP (1.5 g/0.075 g SP) in a single intake twice and were followed up monthly until delivery. Doses were administered under supervision in the controlled IPTp group, while SP was given free to women in the uncontrolled IPTp group with a recommendation to take it at home. The primary end point was the proportion of low birth weight infants (body weight < 2500 g) and the secondary end point was the rate of severe anemia and placental malaria detected at delivery. Results A total of 420 pregnant women were enrolled (212 and 208, respectively, in the controlled and uncontrolled groups). Delivery outcome was available for 378 women. In the modified intention-to-treat analysis, low birth weight infants were born from 15.5% of women of the uncontrolled IPTp group and from 11.9% of women in the controlled IPTp group (P = 0.31). The per-protocol population analysis showed consistent results. The proportion of women with placental malaria infection, moderate anemia (hemoglobin < 11 g/dL), and severe anemia (hemoglobin < 8 g/dL) at delivery were similar between the two groups (P > 0.05). Conclusion The study showed that the two approaches were equivalent, suggesting that unsupervised IPTp-SP free of charge should be used in areas where implementation of the directly observed treatment scheme suffers from many constraints.
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Efunshile M, Amoo AOJ, Akintunde GB, Ojelekan OD, König W, König B. Use and effects of malaria control measures in pregnancy in Lagos, Nigeria. THE KOREAN JOURNAL OF PARASITOLOGY 2012; 49:365-71. [PMID: 22355203 PMCID: PMC3279674 DOI: 10.3347/kjp.2011.49.4.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/23/2022]
Abstract
In Nigeria, malaria causes up to 11% of maternal mortality. Our main aim was to find out the most common mosquito control measures employed by the pregnant women in Lagos and their effects on malaria infection. The study was carried out over a period of 6 months during which trained interviewers administered questionnaires to 400 pregnant women. The prevalence of malaria was 8.4%. There was no significant association between the prevalence of malaria and age, level of education, or occupation of the participants. Pregnant women in the age range 26-30 had the mean parasite density (409.9 ± 196.80). Insecticide spray (32.8%), mosquito coil (27.5%), and insecticide-treated nets (ITN) (15.5%) were the major mosquito control measures employed by the participants while the prevalence of infection among them were 2.3%, 6.2%, and 3.2%, respectively (P<0.05). Only 18.3% of the women had taken more than one dose of intermittent preventive treatment (IPT), while another 11.8% had taken a single dose. The infection rate among them was 4.1% and 6.4%, respectively. Malaria prevalence was highest among those who had not received any dose of IPT (10%). This study showed that the use of ITN and IPT among the pregnant women were still unacceptably low. It also showed that the use of insecticide spray which was the most common malaria control measure adopted by the participants was effective despite the fact that it is not a National Malaria Control Policy. We recommend that a sustained integrated mosquito management and public education should be strengthened in Nigeria.
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Oladokun A, Oladokun RE, Adesina OA. Knowledge and utilization of malaria control measures by pregnant and newly delivered mothers in Ibadan, Nigeria. Afr Health Sci 2011; 11:573-577. [PMID: 22649437 PMCID: PMC3362970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The World Health Organisation (WHO) guidelines for the control of malaria during pregnancy include prompt and effective case management of malaria combined with prevention of infection by insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp). Despite this the uptake is poor. OBJECTIVE To describe the malaria prevention measures utilized by these women in this environment. METHODS Information was obtained from consented pregnant and newly delivered women on their socio-demographic characteristics, knowledge and use of malaria chemoprophylaxis RESULTS One Thousand three hundred thirty (1330) pregnant and newly delivered women in 132 facilities within the Ibadan metropolis were surveyed. The mean age of the respondents was 29. 67 years (±5.21). The modes of prevention most commonly reported as being effective were the use of insecticide spray, window nets and ITN. Only 28.2% were using ITNs in the index pregnancy, and 67.2% of the women had had a drug administered for prophylactic purposes in the index pregnancy. CONCLUSION This study demonstrates awareness but poor use of control measures. Additionally, there is poor use of the recommended agent for IPT. The factors militating against the use of these preventive measures need to be urgently explored and addressed.
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Affiliation(s)
- A Oladokun
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
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Bello FA, Morhason-Bello IO, Olayemi O, Adekunle AO. Patterns and predictors of self-medication amongst antenatal clients in Ibadan, Nigeria. Niger Med J 2011; 52:153-7. [PMID: 22083501 PMCID: PMC3213744 DOI: 10.4103/0300-1652.86124] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Self-medication is widely practiced in the study area, as many drugs are available over-the-counter, in addition to the use of local herbal preparations. Also, apprehension about the dangers of drug use in pregnancy appears to affect the compliance of prescribed medication. This study assess the drug use profile of an antenatal population. Materials and Methods: This was a questionnaire-based descriptive study of 410 antenatal clients attending primary, secondary and tertiary centers in Ibadan, Nigeria. The variables analysed were demographic data of respondents and level of health care received. Outcome measures were use of prescribed drugs, self-medication or herbal preparations. Chi-tests and logistic regression were used for statistical analysis. Results: All patients on prescribed medication for medical conditions claimed to be compliant with their drugs. Exactly 19.2% admitted to self-medication, mostly hematinics and pain-relieving pills (acetaminophen). No one admitted to alcohol or tobacco use, but 46.3%, especially attendees of the rural center (OR 5.79; 95% CI 2.56-13.10), ingested herbal concoctions while pregnant. Married women (OR 0.2; 95% CI 0.05-0.75) or those whose spouses had higher education (OR 0.43; 95% CI 0.21-0.89) were less likely to practice self-medication, while hypertensive women were more likely to practice it (OR 22.54; 95% CI 3.81-133.49). Conclusions: Social support has a role in safe drug use practices. This should be used to advantage by encouraging partners’ attendance at antenatal sessions. Patients need counseling on the dangers of procuring their usual prescription drugs without consultation. Use of herbal concoctions needs to be explored in the community.
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Affiliation(s)
- Folasade A Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Scaling up of intermittent preventive treatment of malaria in pregnancy using sulphadoxine-pyrimethamine: prospects and challenges. Matern Child Health J 2011; 15:542-52. [PMID: 20425139 DOI: 10.1007/s10995-010-0608-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTpSP) is one of the major strategies of malaria control in most African countries where malaria is endemic. The use of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy was adopted when proof of its superiority to weekly prophylactic dosing with either chloroquine or pyrimethamine became evident from studies in different malaria endemic countries. The administration of 2 and 3 treatment doses of SP for HIV-negative and HIV-positive pregnant women respectively, given after quickening and at an interval not less than 4 weeks was recommended. The prospects of this control strategy lies on the efficacy of SP, convenient treatment dose and high compliance rate. However, the implementation of this strategy and the efficacy of SP are faced with challenges such as: timing of SP administration, rising levels of parasite resistance to SP in the general population, effect of folate supplementation, adequacy of the recommended doses with regards to malaria endemicity and HIV status, interactions between SP and antiretroviral drugs and low coverage in the bid to scale-up its use. This review highlights the prospects and challenges of scaling up IPTp-SP.
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Mens PF, Scheelbeek PF, Al Atabbi H, Enato EF. Peer education: the effects on knowledge of pregnancy related malaria and preventive practices in women of reproductive age in Edo State, Nigeria. BMC Public Health 2011; 11:610. [PMID: 21801460 PMCID: PMC3162527 DOI: 10.1186/1471-2458-11-610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/01/2011] [Indexed: 11/25/2022] Open
Abstract
Background There is limited uptake of measures to prevent malaria by pregnant women in Nigeria which is often related to the lack of knowledge on Malaria in Pregnancy (MIP) and its effects on mother and foetus. This study, explored peer to peer education as a tool in raising knowledge of MIP among women of child bearing age. Methods 1105 women of child bearing age were interviewed in their households using a structured questionnaire about their knowledge of malaria in general, MIP and use of preventive measures. Thereafter, a peer education campaign was launched to raise the level of knowledge in the community. The interviews were repeated after the campaign and the responses between the pre- and post-intervention were compared. Results In the pre-assessment women on average answered 64.8% of the question on malaria and its possibility to prevent malaria correctly. The peer education campaign had a significant impact in raising the level of knowledge among the women; after the campaign the respondents answered on average 73.8% of the questions correctly. Stratified analysis on pre and post assessment scores for malaria in general (68.8 & 72.9%) and MIP (61.7 & 76.3%) showed also significant increase. Uptake of bed nets was reported to be low: 11.6% Conclusion Peer education led to a significant increase in knowledge of malaria and its prevention but we could not asses its influence on the use of preventive measures.
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Affiliation(s)
- Petra F Mens
- Koninklijk Instituut voor de Tropen (KIT)/Royal Tropical Institute, KIT Biomedical Research, AZ Amsterdam, The Netherlands.
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The combined effect of determinants on coverage of intermittent preventive treatment of malaria during pregnancy in the Kilombero Valley, Tanzania. Malar J 2011; 10:140. [PMID: 21599999 PMCID: PMC3126755 DOI: 10.1186/1475-2875-10-140] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/21/2011] [Indexed: 11/29/2022] Open
Abstract
Background Intermittent preventive treatment during pregnancy (IPTp) at routine antenatal care (ANC) clinics is an important and efficacious intervention to reduce adverse health outcomes of malaria infections during pregnancy. However, coverage for the recommended two IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage. Methods Data on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Women's timing of ANC visits and health worker's timing of IPTp delivery were analyzed in relation to the different national IPTp schedules and the outcome on IPTp coverage was modelled. Results Among all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. Less than 1% of women started ANC attendance after 32 weeks of gestation. During the second IPTp delivery period health workers delivered IPTp to significantly less women than during the first one (55% vs. 73%) contributing to low second dose coverage. Simplified IPTp guidelines for front-line health workers as recommended by WHO could lead to a 20 percentage point increase in IPTp coverage. Conclusions This study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. To maximize the benefit of the IPTp intervention, revision of existing guidelines is needed. Training on simplified IPTp messages should be consolidated as part of the extended antenatal care training to change health workers' delivery practices and increase IPTp coverage. Pregnant women's knowledge about IPTp and the risks of malaria during pregnancy should be enhanced as well as their ability and power to demand IPTp and other ANC services.
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