Uptake of Intermittent Preventive Treatment for Malaria and Birth Outcomes in Selected Health Facilities in the Brong Ahafo Region of Ghana

Abstract

Background Malaria in pregnancy is a public health problem especially in sub-Saharan Africa. “Intermittent Preventive Treatment in pregnancy using Sulfadoxine-Pyrimethamine” (IPTp-SP) is one of the proven interventions for preventing malaria in pregnancy. The WHO policy on IPTp-SP recommends a universal coverage of four or more doses per pregnancy. However, in 2014, only 17% of eligible pregnant women received three or more doses of IPTp-SP in the Brong Ahafo region of Ghana. Malaria in pregnancy and its complications have devastating effects on the mother, fetus and the infant. These include anaemia, preterm birth, low birth weight, stillbirth, intrauterine growth retardation, growth and learning disabilities of the infant. Uptake of recommended doses of IPTp-SP reduces the risk of adverse birth outcomes. Presently, there is scarcity of data on IPTp-SP4+ uptake and birth outcomes in the Brong Ahafo region. The purpose of this study was therefore to assess the uptake of IPTp-SP4+ and pregnancy outcomes in the Brong Ahafo region. Methods This study was a quantitative, cross-sectional and hospital based which included 443 pregnant women delivering in three hospitals in the Brong Ahafo region from April to July, 2017. A structured questionnaire was used to interview participants. Birth weight of babies, haemoglobin level and other relevant data were retrieved from the antenatal care records card and the delivery register. Blood was taken from the intervillous space of the placenta for the detection of placental malaria. Data was analyzed with StataMP 13 and Microsoft Excel 2013. Results The average age of mothers was 27.2 years (SD=6.6). The mean haemoglobin level checked at 36 weeks was 10.2g/dl (SD=2.7) and the mean birth weight was 3.0kg (SD=0.5). Majority (79.2%) of respondents were married and marital status was not different among urban and rural dwellers. Ownership of insecticide treated mosquito net was 73.0% while utilization was 49.8%. Uptake of IPTp-SP1 and IPTp-SP4+ were 80.9% and 19.8% respectively. The prevalence of low birth weight (LBW), preterm birth and stillbirth were 12.2%, 5.3% and 2.0% respectively. The prevalence of maternal anaemia at 36 weeks was 3.2%. Pregnant women who had higher doses of IPTp-SP (4+) had reduced odds of LBW (OR; 0.59, 95% CI; 0.47-0.74), preterm birth (OR; 0.59, 95% CI; 0.43-0.82) and anaemia (OR; 0.87, 95% CI; 0.57-1.31). Conclusion The uptake of IPTp-SP4+ was 19.8% in the Brong Ahafo region which was statistically higher than the 2016 national average of 16.7%. Higher doses of IPTp-SP had lower risk of LBW, preterm birth, anaemia and stillbirth. The association between higher doses of IPTp-SP (4+) and stillbirth or anaemia was not statistically significant.