Low Uptake Of Intermittent Preventive Treatment (IPT) For Malaria Among Pregnant Women In Selected Health Facilities In Shai-Osudoku District, Greater Accra, Ghana.

Abstract

Background: Malaria remains a global public health issue despite increased efforts to control is transmission. In sub-Saharan Africa where malaria is endemic, incident malaria infecction during pregnancy has been reported to account for 20% of stillbirths and about 11% of the deaths of newborns. Since October 2012, Sulphadoxine-Pyrimethamine has been recommended by the World Health Organization for treatment of malaria infection during pregnancy usisg the intermittent preventive treatment (IPT) approach. Despite its effectiveness, uptake of Intermittent Preventive Treatment of Malaria in Pregnancy using Sulphadoxine-Pyrimethamine (IPTp-SP) is usually low. In the Shai-Osudoku District where the current study was conducted, uptake of three doses of IPT (IPT3) in pregnant women was as low as 37.9% with only 6.4% of registred ANC attendants receiving five doses of IPTp-SP in 2018. The present study therefore sought to evaluate the factors underpinning the prevailing low rates of IPTp-SP uptake in selected health facilities in the Shai-Osudoku. Methods: A cross-sectional study was conducted and included 400 registered mothers who had their anatenatal care (ANC) in the four selected health facilities. Health staff stationed at the ANC clinics were also included in the study. Between July and August 2019, data was collected from ANC records for all nursing mothers included in the study and a strucutred questionnaire was used to assess participants’ knowledge on IPTp-SP. Univariate analysis was conducted using the Chi-Square tests and logistic regression models were fitted to assess the association of predictor variables (factors) with low IPTp-SP uptake. Results Of the 400 registered mothers included in the study, only 11% received five doses of SP during the recent pregnancy as recommended by the Ghana Health Service whiles less than 61% received a minimum of three doses. In the adjusted logistic regression model, results showed that women who initiated ANC late in pregnancy or had fewer number of visits, experienced untoward effects after taking the medication and resides in urban areas had increased odds of low IPTp-SP uptake. Major predictors of low uptake of SP identified in this study were, knowledge on SP-IPTp, previous experience of side effects of SP-IPTp, age of pregnancy at ANC initiation and total number of ANC visits. A high proportion of nursing mothers in the study sample showed ’very good’ knowledge of malaria (75%, 95% CI: 70.7% -79.4%) with an even higher proportion (81.7%, 95% CI: 77.2%-85.6%) having ’good’ knowledge. For ANC health staff, 85.7% showed ’very good’ knowledge on the effects of incident malaria in pregnant women. Over 57% knew the meaning of IPTp-SP but all knew that Sulphadoxine-Pyrimethamine is the recommended drug for preventing malaria infection during pregnancy. Conclusion: Only 11% of the registered mothers in the present study received the recommended five doses of SP during pregnancy. Such a low rate of uptake could have severe consequences given the effects incident malaria infection during pregnancy. Though the findings of this study suggest that knowledge on malaria and IPTp-SP is high among women and ANC helath staff, efforts have to be intensified to rectify the disconnect between what is known and what is practiced.