Factors influencing utilization of intermittent preventive treatment of malaria during pregnancy among mothers of under-one children in rural Lilongwe, Malawi
Keywords:
Antenatal care, Intermittent Preventive Treatment, Malaria, Pregnancy, Sulphadoxine Pyrimethamine, MalawiAbstract
Purpose - Routine administration of Sulphadoxine Pyrimethamine (SP) for intermittent preventive treatment (IPTp) of malaria during pregnancy leads to improvement of maternal health and pregnancy outcomes. This study explored determinants for IPTp-SP utilization among pregnant women in rural Lilongwe, Malawi.
Design/methodology/approach - A multi-stage sampling method was used to recruit 355 mothers of under-one children. Face-to-face interview was conducted. Bivariate and multivariate statistical models were executed in analyzing data.
Findings - Overall, 84.0% of the mothers attended at least 3 antenatal care (ANC) visits, effectively positioning themselves to the likelihood of receiving optimal IPTp-SP (3+ doses). Only 24.8% of the mothers received the recommended doses; 52.7% and 22.5% took partial and nil doses. Factors associated with IPTp-SP utilization included knowledge, attitudes, timing of ANC visit, frequency of ANC visits, health education, and perceived benefits of IPTp-SP. Client satisfaction with ANC services (AOR 1.94; 95% CI 1.07-3.51), and receipt of SP under health worker’ observation (AOR 6.96; 95% CI 2.04-23.71) increased the likelihood of optimal utilization.
Originality/value - Despite high ANC attendance rate, optimal IPTp-SP utilization area is low. Apart from the identified client-level factors, this low coverage can be attributed to health workers’ non-adherence to IPTp-SP guidelines leading to missing opportunities. Program efforts should aim at addressing the identified knowledge gaps and reinforcing community trust in the intervention. Operational research is recommended to explore bottlenecks limiting effective coverage of the intervention.
References
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34. Azizi SC, Chongwe G, Chipukuma H, Jacobs C, Zgambo J, Michelo C. Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: a cross-sectional study. BMC Pregnancy Childbirth. 2018 Apr; 18(1): 108. doi: 10.1186/s12884-018-1744-y
35. Kibusi SM, Kimunai E, Hines CS. Predictors for uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Tanzania. BMC Public Health. 2015 Jun; 15(1): 540. doi: 10.1186/s12889-015-1905-0
36. Mbonye AK, Neema S, Magnussen P. Preventing malaria in pregnancy: a study of perceptions and policy implications in Mukono district, Uganda. Health Policy Plan. 2006 Jan; 21(1): 17-26. doi: 10.1093/heapol/czj002
37. Mpogoro FJ, Matovelo D, Dosani A, Ngallaba S, Mugono M, Mazigo HD. Uptake of intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria during pregnancy and pregnancy outcomes: a cross-sectional study in Geita district, North-Western Tanzania. Malar J. 2014 Nov; 13(1): 455. doi: 10.1186/1475-2875-13-455
38. Okoronkwo I, Okoye H. Factors influencing utilization of intermittent preventive treatment and long lasting insecticide treated bed nets by pregnant women in Anambra State, Nigeria. International Journal of Advanced Scientific Research and Management. 2016; 1(7): 229-37.
39. de Jongh TE, Gurol-Urganci I, Allen E, Zhu NJ, Atun R. Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review. J Glob Health. 2016 Jun; 6(1): 010403. doi: 10.7189/jogh.06.010403
40. Mubyazi GM, Bygbjerg IC, Magnussen P, Olsen O, Byskov J, Hansen KS, et al. Prospects, achievements, challenges and opportunities for scaling-up malaria chemoprevention in pregnancy in Tanzania: the perspective of national level officers. Malar J. 2008 Jul; 7(1): 135. doi: 10.1186/1475-2875-7-135
41. Uzochukwu BS, Onwujekwe OE, Akpala CO. Community satisfaction with the quality of maternal and child health services in southeast Nigeria. East Afr Med J. 2004 Jun; 81(6): 293-9.
42. Ogaji DS, Giles S, Daker-White G, Bower P. Systematic review of patients' views on the quality of primary health care in sub-Saharan Africa. SAGE Open Med. 2015; 3: 2050312115608338. doi: 10.1177/2050312115608338
43. Ministry of Health [MoH], ICF International. Malawi Service Provision Assessment (MSPA) 2013-14. Lilongwe, Malawi, and Rockville, Maryland, USA: MoH and ICF International; 2014.
2. World Health Organization [WHO]. World malaria report 2017. Geneva: WHO; 2017.
3. Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg. 2001 Jan-Feb; 64(1-2 Suppl): 28-35. doi: 10.4269/ajtmh.2001.64.28
4. Guyatt HL, Snow RW. Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2001 Nov-Dec; 95(6): 569-76. doi: 10.1016/S0035-9203(01)90082-3
5. Menendez C, Bardaji A, Sigauque B, Sanz S, Aponte JJ, Mabunda S, et al. Malaria prevention with IPTp during pregnancy reduces neonatal mortality. PLoS One. 2010 Feb; 5(2): e9438. doi: 10.1371/journal.pone.0009438
6. McGready R, Lee SJ, Wiladphaingern J, Ashley EA, Rijken MJ, Boel M, et al. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study. Lancet Infect Dis. 2012 May; 12(5): 388-96. doi: 10.1016/S1473-3099(11)70339-5
7. Guyatt HL, Snow RW. Impact of malaria during pregnancy on low birth weight in sub-Saharan Africa. Clin Microbiol Rev. 2004 Oct; 17(4): 760-9. doi: 10.1128/CMR.17.4.760-769.2004
8. Malaria in Pregnancy Consortium [MIP]. Mission statement. [cited 2018 March]. Available from: http://www.mip-consortium.org/about_us/mission.htm
9. World Health Organisation [WHO]. WHO evidence review group: Intermittent Preventive Treatment of malaria in pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP). Geneva: WHO; 2012.
10. World Health Organisation [WHO]. WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Geneva: WHO; 2013.
11. Mwendera CA, de Jager C, Longwe H, Phiri K, Hongoro C, Mutero CM. Changing the policy for intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy in Malawi. Malar J. 2017 Feb; 16(1): 84. doi: 10.1186/s12936-017-1736-9
12. Ministry of Health [MoH]. Malaria strategic plan (2017 - 2022). Lilongwe, Malawi: National Malaria Control Program; 2017.
13. Ministry of Health [MoH], ICF. Malawi malaria indicator survey 2017. Lilongwe, Malawi, and Rockville, Maryland, USA: MoH and ICF; 2018.
14. Ministry of Health [MoH], ICF International. Malawi malaria indicator survey 2014. Lilongwe, Malawi, and Rockville, Maryland, USA: MoH and ICF International; 2015.
15. National Statistical Office [NSO], ICF. Malawi demographic and health survey 2015-16. Zomba, Malawi, and Rockville, Maryland, USA: NSO and ICF; 2017.
16. Roll Back Malaria. The Abuja declaration on roll back malaria in Africa by African Heads of States and Governments. Roll Back Malaria; 2000.
17. Hill J, Kazembe P. Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges. Trop Med Int Health. 2006 Apr; 11(4): 409-18. doi: 10.1111/j.1365-3156.2006.01585.x
18. Pell C, Straus L, Andrew EV, Menaca A, Pool R. Social and cultural factors affecting uptake of interventions for malaria in pregnancy in Africa: a systematic review of the qualitative research. PLoS One. 2011; 6(7): e22452. doi: 10.1371/journal.pone.0022452
19. Sikambale C, Halwindi H, Baboo KS. Factors influencing utilization of intermittent presumptive treatment of malaria (IPTp) services by pregnant women in Sesheke district of Western province Zambia. Med J Zambia. 2013; 40(1): 24-32.
20. National Statistical Office [NSO]. Malawi MDG endline survey 2014. Zomba, Malawi: NSO; 2015.
21. Hill J, Hoyt J, van Eijk AM, D'Mello-Guyett L, Ter Kuile FO, Steketee R, et al. 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(7): e1001488. doi: 10.1371/journal.pmed.1001488
22. Odjidja EN, Duric P. Evaluation of demand and supply predictors of uptake of intermittent preventive treatment for malaria in pregnancy in Malawi. Malariaworld J. 2017; 8(20): 1-7.
23. Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008 Feb; 61(3): 244-60. doi: 10.1111/j.1365-2648.2007.04532.x
24. Exavery A, Mbaruku G, Mbuyita S, Makemba A, Kinyonge IP, Kweka H. Factors affecting uptake of optimal doses of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy in six districts of Tanzania. Malar J. 2014 Jan; 13(1): 22. doi: 10.1186/1475-2875-13-22
25. Champion VL, Skinner CS. The health belief model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p.45-65.
26. Chuma J, Okungu V, Ntwiga J, Molyneux C. Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya. BMC Public Health. 2010 Mar; 10(1): 137. doi: 10.1186/1471-2458-10-137
27. Mushi AK, Schellenberg J, Mrisho M, Manzi F, Mbuya C, Mponda H, et al. Development of behaviour change communication strategy for a vaccination-linked malaria control tool in Southern Tanzania. Malar J. 2008 Sep; 7(1): 191. doi: 10.1186/1475-2875-7-191
28. Mubyazi G, Bloch P, Kamugisha M, Kitua A, Ijumba J. Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe district, North-Eastern Tanzania. Malar J. 2005 Jul; 4: 31. doi: 10.1186/1475-2875-4-31
29. Ministry of Health [MoH]. District implementation plan (Lilongwe) 2017- 2018. Lilongwe, Malawi: MoH; 2017.
30. Ministry of Health [MoH]. Malawi health sector strategic plan II (2017 - 2022). Lilongwe, Malawi: MoH; 2017.
31. The president's malaria initiative: Eleventh annual report to congress, April 2017. Washington, DC: USAID; 2017.
32. Abuja declaration on HIV/AIDS, tuberculosis and other related infectious diseases. [updated 2001 April 27; cited 2018 January]. Available from: http://www.un.org/ga/aids/pdf/abuja_declaration.pdf
33. Cochran WG. Sampling techniques. New York: John Wiley & Sons; 2007.
34. Azizi SC, Chongwe G, Chipukuma H, Jacobs C, Zgambo J, Michelo C. Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: a cross-sectional study. BMC Pregnancy Childbirth. 2018 Apr; 18(1): 108. doi: 10.1186/s12884-018-1744-y
35. Kibusi SM, Kimunai E, Hines CS. Predictors for uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Tanzania. BMC Public Health. 2015 Jun; 15(1): 540. doi: 10.1186/s12889-015-1905-0
36. Mbonye AK, Neema S, Magnussen P. Preventing malaria in pregnancy: a study of perceptions and policy implications in Mukono district, Uganda. Health Policy Plan. 2006 Jan; 21(1): 17-26. doi: 10.1093/heapol/czj002
37. Mpogoro FJ, Matovelo D, Dosani A, Ngallaba S, Mugono M, Mazigo HD. Uptake of intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria during pregnancy and pregnancy outcomes: a cross-sectional study in Geita district, North-Western Tanzania. Malar J. 2014 Nov; 13(1): 455. doi: 10.1186/1475-2875-13-455
38. Okoronkwo I, Okoye H. Factors influencing utilization of intermittent preventive treatment and long lasting insecticide treated bed nets by pregnant women in Anambra State, Nigeria. International Journal of Advanced Scientific Research and Management. 2016; 1(7): 229-37.
39. de Jongh TE, Gurol-Urganci I, Allen E, Zhu NJ, Atun R. Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review. J Glob Health. 2016 Jun; 6(1): 010403. doi: 10.7189/jogh.06.010403
40. Mubyazi GM, Bygbjerg IC, Magnussen P, Olsen O, Byskov J, Hansen KS, et al. Prospects, achievements, challenges and opportunities for scaling-up malaria chemoprevention in pregnancy in Tanzania: the perspective of national level officers. Malar J. 2008 Jul; 7(1): 135. doi: 10.1186/1475-2875-7-135
41. Uzochukwu BS, Onwujekwe OE, Akpala CO. Community satisfaction with the quality of maternal and child health services in southeast Nigeria. East Afr Med J. 2004 Jun; 81(6): 293-9.
42. Ogaji DS, Giles S, Daker-White G, Bower P. Systematic review of patients' views on the quality of primary health care in sub-Saharan Africa. SAGE Open Med. 2015; 3: 2050312115608338. doi: 10.1177/2050312115608338
43. Ministry of Health [MoH], ICF International. Malawi Service Provision Assessment (MSPA) 2013-14. Lilongwe, Malawi, and Rockville, Maryland, USA: MoH and ICF International; 2014.
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Published
2018-12-21
How to Cite
Mafuleka, T., & Cheumchit, M. (2018). Factors influencing utilization of intermittent preventive treatment of malaria during pregnancy among mothers of under-one children in rural Lilongwe, Malawi. Journal of Health Research, 32(Suppl.1), S62-S75. Retrieved from https://he01.tci-thaijo.org/index.php/jhealthres/article/view/164653
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