Intermittent use of sulphadoxine-pyrimethamine for malaria prevention: a cross-sectional study of knowledge and practices among Ugandan women attending an urban antenatal clinic

Knowledge, attitude and practices on intermittent preventive treatment in pregnant women with malaria: a mixed method facility-based study in Western Kenya

Introduction

intermittent preventive treatment remains a core strategy for malaria prevention in pregnancy. Sulfadoxine-pyrimethamine is recommended for all pregnant women in malaria-prone zones. It is scheduled monthly at each antenatal care visit for up to 36 weeks. Here, we sought to assess the knowledge, attitude, and practices of intermittent preventive treatment among pregnant women with malaria in Webuye Hospital.

Methods

a total of 140 participants aged between 18 and 49 years and at approximately 16 weeks of gestation were enrolled in this study, which utilized a mixed qualitative-quantitative method. Before enrollment, malaria testing was conducted using microscopy, and participants were divided into two cohorts: malaria-positive and malaria-negative. Close-ended and open-ended questionnaires were used. Qualitative-quantitative data analyses were performed.

Results

our analysis revealed a significant difference between the proportion of mothers in the negative and positive groups in terms of their knowledge about side effects (p ≤ 0.001) and different doses (p ≤ 0.012) of intermittent preventive treatment. The proportion of mothers who knew side effects and different doses was higher among the malaria-positive group as compared to malaria-negative group with 37(52.9%, n=70) versus 18(25.7%, n=70) and 14(20.0%, n=70) versus 4(5.7%, n=70) respectively. Additionally, there was also a significant difference in knowledge about intermittent preventive treatment before administration (p ≤ 0.003) between the two groups.

Conclusion

good knowledge, attitude and practices on intermittent preventive treatment (IPT) benefits, side effects, safety, doses and other prior information should be leveraged to empower pregnant women in malaria-endemic zones.

Experiences of young mothers with the uptake of Sulfadoxine-Pyrimethamine for intermittent preventive treatment of malaria in pregnancy: a cross-sectional study in the Lake endemic region, Kenya

Background

A substantial proportion of the world population is affected by malaria with 241 million malaria cases reported globally. Intermittent Preventive Treatment in pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP) is an effective chemotherapy but its utilisation has not been optimised. Few studies focus on young mothers and their experiences regarding the optimal uptake of IPTp-SP.

Methods

The study design was cross-sectional with data derived from six focus group discussions with mothers aged 15-24 years who had a pregnancy and gave birth to a live baby within the last two years in Kisumu and Migori counties, Kenya. Inductive analysis was used to identify themes and patterns.

Results

Young mothers were motivated to take IPTp-SP during pregnancy if they had prior knowledge about SP and its associated benefits and if they were knowledgeable about the consequences of malaria infection during pregnancy. Perceived side effects of SP, lack of awareness of SP as a malaria prevention therapy, lack of knowledge on the benefits of SP, dosage and frequency of uptake, poor communication by health providers towards young mothers, and inconsistent supply of SP at health facilities inhibited young mothers from attaining the recommended 3+ doses of IPTp-SP.

Conclusions

There is a need for health literacy programmes that focus on increasing knowledge of IPTp-SP dosage, timing and benefits for both the young pregnant mother and her foetus. Community engagement through dialogue with mentor mothers and male partners will be an important complementary approach in establishing a support system for young women for positive health outcomes including attaining the recommended 3+ doses of IPTp-SP.

Perceptions of sulphadoxine-pyrimethamine use among pregnant women in sub-Saharan Africa: a scoping review

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.

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

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.

Prevention of Malaria in Pregnancy: What Do the Pregnant Women of Nigeria Know and Do about It?

Objective

We assessed knowledge, attitude, and practice regarding two malaria prevention measures (long-lasting impregnated mosquito nets, LLINs, and intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP)) among pregnant women in Nigeria.

Methods

Pregnant women selected from among the four communities of Nnewi were interviewed by using a semistructured, interviewer-administered questionnaire on the respondents' demography, knowledge of the cause, consequences, and malaria prevention methods. Also, a total of 48 focused group discussions, 24 key informant interviews, and 24 in-depth interviews were held among women leaders, village heads, pregnant women, community health workers, husbands of pregnant wives, and drug and insecticide-treated net sellers.

Results

A total of 384 women (88.0% third trimester, 90.0% literate, and 41.1% primigravidae) participated. About 80.0% suffered from malaria during their current pregnancy. The majority was aware of the cause of malaria, local name of malaria, mode of transmission, risk of malaria among pregnant women, etc. However, their knowledge and attitude were inadequate regarding the symptomatology and complications of malaria in pregnancy, benefits of sleeping under the net or taking chemoprophylactic doses, or the concurrent use of both. About 80.0% had LLINs, yet only 41.5% slept under it the previous night. Only 31.0% had IPTp-SP doses under direct observation. Only 35.9% had a good understanding of IPTp-SP during pregnancy.

Conclusion

Our work presents important practice gaps associated with the prevention of malaria during pregnancy. The pregnant women seemed to be aware of the basic concepts related to malaria but that does not translate into adequate attitude and practice necessary for malaria reduction.

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

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.

Health Workers' Awareness and Knowledge of Current Recommendation of Intermittent Preventive Treatment in Pregnancy in South-Western Nigeria

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.

Knowledge and Utilisation of Intermittent Preventive Treatment of Malaria among Pregnant Women in Muramvya Health District, Burundi, 2018

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.

Household and maternal risk factors for malaria in pregnancy in a highly endemic area of Uganda: a prospective cohort study

Background

Malaria in pregnancy is a major public health challenge, but its risk factors remain poorly understood in some settings. This study assessed the association between household and maternal characteristics and malaria among pregnant women in a high transmission area of Uganda.

Methods

A nested prospective study was conducted between 6th September 2016 and 5th December 2017 in Busia district. 782 HIV uninfected women were enrolled in the parent study with convenience sampling. Socioeconomic and house construction data were collected via a household survey after enrolment. Homes were classified as modern (plaster or cement walls, metal or wooden roof and closed eaves) or traditional (all other homes). Maternal and household risk factors were evaluated for three outcomes: (1) malaria parasitaemia at enrolment, measured by thick blood smear and qPCR, (2) malaria parasitaemia during pregnancy following initiation of IPTp, measured by thick blood smear and qPCR and (3) placental malaria measured by histopathology.

Results

A total of 753 of 782 women were included in the analysis. Most women had no or primary education (75%) and lived in traditional houses (77%). At enrolment, microscopic or sub-microscopic parasitaemia was associated with house type (traditional versus modern: adjusted risk ratio (aRR) 1.29, 95% confidence intervals 1.15–1.45, p < 0.001), level of education (primary or no education versus O-level or beyond: aRR 1.13, 95% confidence interval 1.02–1.24, p = 0.02), and gravidity (primigravida versus multigravida: aRR 1.10, 95% confidence interval 1.02–1.18, p = 0.009). After initiation of IPTp, microscopic or sub-microscopic parasitaemia was associated with wealth index (poorest versus least poor: aRR 1.24, 95% CI 1.10–1.39, p < 0.001), house type (aRR 1.14, 95% CI 1.01–1.28, p = 0.03), education level (aRR 1.19, 95% CI 1.06–1.34, p = 0.002) and gravidity (aRR 1.32, 95% CI 1.20–1.45, p < 0.001). Placental malaria was associated with gravidity (aRR 2.87, 95% CI 2.39–3.45, p < 0.001), but not with household characteristics.

Conclusions

In an area of high malaria transmission, primigravid women and those belonging to the poorest households, living in traditional homes and with the least education had the greatest risk of malaria during pregnancy.

Malaria-related ideational factors and other correlates associated with intermittent preventive treatment among pregnant women in Madagascar

Background

The Malagasy Ministry of Health aimed to achieve 80% coverage of intermittent preventive treatment of malaria among pregnant women (IPTp) in targeted districts by 2015. However, IPTp coverage rates of have remained fairly static over the past few years.

Methods

During a cross-sectional household survey, mothers of children under the age of 2 years were asked about their most recent pregnancy. The primary outcome of interest was a mother receiving two or more doses of sulfadoxine–pyrimethamine (SP) (IPTp2) during their last pregnancy, at least one of which was obtained from a health provider. Multilevel analysis was used to account for community-level factors. Correlates included exposure to communication messages, the number of antenatal care (ANC) visits made by the woman, her household wealth, and other sociodemographic characteristics.

Results

Over one-tenth (11.7%) of women received two or more doses of SP, at least one of which was obtained during an ANC visit. Two-thirds (68.3%) of women who consulted a health provider but did not take IPTp attributed this to not being offered the medication by their health provider. The odds of a woman receiving IPTp2 varied with her knowledge, attitudes, and perceived social norms related to IPTp and ANC and exposure to malaria messages. General malaria ideation, specifically the perceived severity of and perceived susceptibility to malaria, however, was not associated with increased odds of receiving IPTp2. A large variation in the odds of receiving IPTp2 was due to community-level factors that the study did not examine.

Conclusions

Health communication programmes should aim to improve IPTp/ANC-specific ideation, particularly the norms of seeking regular care during pregnancy and taking any prescribed medication. While ANC attendance is necessary, it was not sufficient to meet IPTp2 coverage. Women surveyed in Madagascar rely on health providers to prescribe SP according to national policy. At the same time, stock-outs prevent health providers from prescribing SP. The large observed community-level variation in IPTp2 coverage is likely due to supply-side factors, such as SP availability and health-provider ideation and practices.

Uptake of intermittent preventive treatment and pregnancy outcomes: health facilities and community surveys in Chókwè district, southern Mozambique

Background

Malaria in pregnancy leads to serious adverse effects on the mother and the child and accounts for 75,000–200,000 infant deaths every year. Currently, the World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) at each scheduled antenatal care (ANC) visit. This study aimed to assess IPTp-SP coverage in mothers delivering in health facilities and at the community. In addition, factors associated with low IPTp-SP uptake and malaria adverse outcomes in pregnancy were investigated.

Methods

A community and a health facility-based surveys were conducted in mothers delivering in Chókwè district, southern Mozambique. Social-demographic data, malaria prevention practices and obstetric history were recorded through self-report and antenatal records. For women delivering at health facilities, a clinical examination of mother and child was performed, and malaria infection at delivery was determined by rapid diagnostic test, microscopy, quantitative PCR and placental histology.

Results

Of 1141 participants, 46.6, 30.2, 13.5 and 9.6% reported taking ≥ 3, two, one and none SP doses, respectively. Low IPTp uptake (< 3 doses) was associated with non-institutional deliveries (AOR = 2.9, P < 0.001), first ANC visit after week 28 (AOR = 5.4, P < 0.001), low awareness of IPTp-SP (AOR = 1.6, P < 0.002) and having no or only primary education (AOR = 1.3, P = 0.041). The overall prevalence of maternal malaria (peripheral and/or placental) was 16.8% and was higher among women from rural areas compared to those from urban areas (AOR = 1.9, P < 0.001). Younger age (< 20 years; AOR = 1.6, P = 0.042) and living in rural areas (AOR = 1.9, P < 0.001) were predictors of maternal malaria at delivery. Being primigravidae (AOR = 2.2, P = 0.023) and preterm delivery (AOR = 2.6, P < 0.001) predicted low birth weight while younger age was also associated with premature delivery (AOR = 1.4, P = 0.031).

Conclusion

The coverage for two and ≥ 3 doses of IPTp-SP is moderately higher than estimates from routine health facility records in Gaza province in 2015. However, this is still far below the national target of 80% for ≥ 3 doses. Ongoing campaigns aiming to increase the use of malaria prevention strategies during pregnancy should particularly target rural populations, increasing IPTp-SP knowledge, stimulate early visits to ANC, improve access to health services and the quality of the service provided.

Electronic supplementary material

The online version of this article (10.1186/s12936-018-2255-z) contains supplementary material, which is available to authorized users.

Midwives' provision of antimalaria services to pregnant women in Uganda

OBJECTIVES

malaria causes complications during 80% of all pregnancies in Uganda. However, only 48% of Ugandan pregnant women took one dose of intermittent preventive therapy while merely 27% took the second dose during 2011. This study investigated midwives' provision of anti-malaria services in the Buikwe District of Uganda.

DESIGN

a quantitative exploratory descriptive design was used.

SETTING

prenatal clinics (n=16) in the Buikwe District of Uganda RESPONDENTS: questionnaires were completed by 40 (out of a population of 45) midwives.

FINDINGS

midwives' provision of malaria-preventive services to pregnant women were associated with the midwives' education level and professional experience as well as by the availability of safe drinking water and drugs for intermittent preventive treatment. Midwives who provided frequent health education to pregnant women, cooperated with village health team members and received in-service training were likely to provide effective anti-malaria services to pregnant women.

KEY CONCLUSIONS

regular audits of midwives' records should identify strengths and weaknesses related to the prevention of malaria during pregnancy. Relevant in- service education should be provided. Drugs for intermittent preventive therapy and clean drinking water must be available at all prenatal clinics so that pregnant women can take these drugs under direct observation of the midwives.

IMPLICATIONS FOR PRACTICE

malaria-related health education should be provided during every prenatal clinic visit, and every pregnant women should take two doses of intermittent preventive therapy drugs during every pregnancy (as prescribed by Uganda's Ministry of Health) in order to reduce the reported impact of malaria on 80% of pregnancies in Uganda.

Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala

Intermittent preventive treatment of malaria in pregnancy with sulphadoxine-pyrimethamine (SP-IPTp) is widely used to reduce the incidence of adverse pregnancy outcomes. As a monitor for continued effectiveness of this intervention amidst SP resistance, we aimed to assess malaria burden among pregnant women who use or do not use SP-IPTp. In a descriptive cohort study at Mulago Hospital, Kampala, 87 women who received two supervised doses of SP-IPTp were followed up until delivery. Controls were pregnant women presenting in early labour without history of SP-IPTp. Histopathological investigation for placental malaria (PM) was performed using the Bulmer classification criterion. Thirty-eight of the 87 women returned for delivery and 33 placentas were successfully collected and processed along with 33 placentas from SP nonusers. Overall, 12% (4/33) of the users had evidence of PM compared to 48% (16/33) of nonusers. Among nonusers, 17/33, 8/33, 2/33, and 6/33 had no placental infection, active infection, active-chronic infection, and past-chronic infection, respectively. Among users, respective proportions were 29/33, 2/33, 0/33, and 2/33. No difference in birth weights was apparent between the two groups, probably due to a higher proportion of infections occurring later in pregnancy. Histological evidence here suggests that SP continues to offer substantial benefit as IPTp.

The challenge of using intermittent preventive therapy with sulfadoxine/pyrimethamine among pregnant women in Uganda

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.

Is there a distinction between malaria treatment and intermittent preventive treatment? Insights from a cross-sectional study of anti-malarial drug use among Ugandan pregnant women

Background

In Uganda, treatment of clinical malaria and intermittent preventive treatment with sulphadoxine-pyrimethamine (SP) are common during pregnancy. As a result, both formal and informal reports from antenatal sources suggest possible misuse of SP for malaria treatment among pregnant women. The objective of this study was to investigate anti-malarial drug use patterns among women who had recently suffered malaria illness before and during pregnancy.

Methods

A cross-sectional study in which a structured questionnaire (interviewer-administered) was used to collect data from pregnant women attending an urban antenatal clinic. Details of medicines used to treat malaria episodes suffered before and during pregnancy were captured. A first order Markov probability model was used to estimate probabilities of transitioning between treatment choices made before and during pregnancy. Logistic regression was used to explore whether demographic and obstetric characteristics were associated with transition patterns.

Results

Seven hundred women were interviewed among whom 428 had suffered malaria in both instances. Three hundred thirty of these could recall the medicines used in both instances. Women who used ACT/QNN (correct choice) before pregnancy had higher probabilities of transitioning to SP than staying on ACT/QNN during pregnancy (0.463 versus 0.451). Access of medicines from private outlets (clinics and pharmacies) were more than nine times predictive of receiving correct medicines (p=0.035 and p=0.039 respectively). Access of medicines from clinics was 5.9 times protective against receiving SP for malaria treatment (p=0.033). Among those who used SP before pregnancy, there was a 0.75 probability of staying on it during pregnancy. None of the factors explored could explain this observation.

Conclusion

Use of SP for malaria treatment is common during pregnancy. This may be contributing to adverse pregnancy outcomes. Antenatal care providers should endeavour to emphasize the distinction between treatment and prevention of malaria during pregnancy.

Electronic supplementary material

The online version of this article (doi:10.1186/s12936-015-0702-7) contains supplementary material, which is available to authorized users.

[Morbidity and risk factors for neonatal mortality in Douala Referral Hospital]

Introduction

Cette étude avait pour but d’étudier la mortalité néonatale hospitalière et les facteurs associés, dans un hôpital de référence de la ville de Douala au Cameroun.

Méthodes

Il s'agit d'une étude de cohorte prospective qui s'est déroulée du 1er janvier au 31 avril 2014 dans l'unité de néonatologie de l'hôpital Laquintinie de Douala. Les nouveau-nés de 0 à 28 jours étaient concernés. Les données sociodémographiques, cliniques et l’évolution hospitalière ont été enregistrées. La durée moyenne d'hospitalisation était de 9,9± 6,9. Les tests du Chi2, de Student et une analyse bivariée ont permis de mesurer les associations entre variables. A l'aide de la régression multivariée les facteurs associés à la mortalité ont été déterminés. Le taux de significativité était de 0,05.

Résultats

Au total,350 nouveau-nés ont été inclus, avec un taux de mortalité de 20,3%. L'hyperthermie était le principal motif de consultation avec 102 (29%) patients. Les principales affections associées au décès étaient: les infections 39 (54,9%) (p = 0,0001), la prématurité 31 (43,6%) (p < 0,05), les troubles de l'adaptation 23 (32,4%) (p < 0,005), les encéphalopathies 5 (7%) (p < 0,005) et le paludisme 5 (7%) (p = 0,03). L'on notait comme facteurs associés à cette mortalité, la naissance hors de l'hôpital 51(71,8%) (p< 0,005), la présentation de siège (p = 0,02), l’âge gestationnel < 0,005), l’âge < 1500g (p < 0,005).

Conclusion

Le contrôle des facteurs associés à la mortalité peut conduire à une réduction de la mortalité néonatale.