Factors Influencing Health Workers’ Adherence To The Who Intermittent Preventive Treatment For Malaria In Pregnancy Recommendation, Northern Region, Ghana

Abstract

Background: Although IPTp-SP is a lifesaving WHO recommended preventive intervention for pregnant women in malaria endemic regions, two-thirds of pregnant women do not receive the IPTp-SP doses during their visits to ANC units globally. Optimal health worker adherence to IPTp- SP recommended guidelines can reduce malaria cases, deaths and poor birth outcomes. Assessing the extent of adherence and its associated factors will generate useful pointers to be targeted at the program level. The study determined the factors influencing health workers adherence to the WHO IPTp-SP recommended guidelines in the Northern Region. Methods: A cross-sectional study among 315 health workers in the Northern region was conducted. Data was collected on health workers adherence to the recommended practices through observation using a checklist. A semi-structured questionnaire was used to collect data on health workers’ sociodemographic characteristics, facility-based factors and knowledge level. Facility observations were also conducted using a checklist. Crude and adjusted logistic regression were used at a 5% significance level to determine predictors of the health workers’ adherence, adjusting for clustering. Results: Of the 315 health workers studied, the median age was 29 years (26 – 34 years). Overall, 56.2% (CI 51.0 – 62.0) were adequately adhering to the recommended guidelines. Lower levels of adherence were recorded in health centers 15.6% (5.0 - 33.0) and CHPS compounds 21.2% (11.0 - 35.0). The factors associated with adherence included health workers’ knowledge (aOR 7.31, 95%CI 3.00 – 17.83, p<0.001), job satisfaction (aOR 6.13, 95%CI 4.95 - 7.60, p<0.001), in-service training (aOR 7.01, 95%CI 2.40 - 20.43, p<0.001), supervision (aOR 5.62, 95%CI 3.10 - 10.20, p<0.001), availability of job aids (aOR 3.79, 95%CI 2.82 - 5.10, p<0.001), health workers III experience (aOR 3.01, 95%CI 1.97 – 4.58, p<0.001) and educational level attained (aOR 2.53, 95%CI 1.12 – 5.71, p<0.025). Conclusion: Adherence to the recommended IPTp-SP guidelines is suboptimal in the region, with lower health facilities recording the least adherence levels. Health centers and CHPS facilities should be prioritized in the distribution of limited resources to improve health worker quality of care for antenatal care clients.