Accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania

Abstract

BackgroundUniversal access to and utilization of malaria prevention measures is defined as every person at malaria risk sleeping under a quality insecticide-treated mosquito net (ITN) and every pregnant woman at risk receiving at least two doses of sulfadoxine-pyrimethamine (SP). This study aimed to determine factors affecting accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania.MethodsWomen of reproductive age with children <5 years old or those who had been pregnant during the past 5 years were included in the study. A structured questionnaire was used to seek information on malaria knowledge, accessibility and utilization of malaria interventions during pregnancy.ResultsA total of 297 women (mean age=29±6.8 years) were involved. Seventy percent of the women had attained primary school education. About a quarter of women had two children of <5 years while over 58% had ≥3 children. Most (71.4%) women had medium general knowledge on malaria while only eight percent of them had good knowledge on malaria in pregnancy. A significant proportion of women were not aware of the reasons for taking SP during pregnancy (35%), timing for SP (18%), and the effect of malaria on pregnancy (45.8%). Timing for first dose of SP for intermittent preventive treatment in pregnancy (IPTp) was 1-3 months (28.4%) and 4-6 months (36.8%). Some 78.1% were provided with SP under supervision of the health provider. Knowledge on malaria in pregnancy had a significant association with levels of education (p=0.024). Ninety-eight percent had an ITN, mostly (87.1%) received free from the government. All women attended the ANC during their last pregnancy. The coverage of IPT1 was 53.5% and IPTp2 was 41.1%. The proportion of women making more ANC visits decreased with increasing parity.ConclusionThis study showed that the knowledge of the pregnant women on malaria in pregnancy and IPTp was average and is likely to have an impact on the low IPTp coverage. Campaigns that provide educational massages on the risk of malaria during pregnancy and the usefulness of IPTp need to be emphasised.

Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions

“…Visiting multiple sources for health care can result in low compliance to medication including anti-malarials, missing scheduled ANC visits and the recommended 5 doses of SP and seeking maternal healthcare late. The current study's nding has been corroborated by other studies [36,86]. Rumisha [36] and Hill [86], found that due to high cost of maternal health care, women sought alternative care such as self-medicating, using leftover medicine and using herbal medicine.…”

“…The current study's nding has been corroborated by other studies [36,86]. Rumisha [36] and Hill [86], found that due to high cost of maternal health care, women sought alternative care such as self-medicating, using leftover medicine and using herbal medicine. Another study in Nigeria found that family members and social networks encouraged women to take herbs and to patronize herbal centres [23].…”

“…Also, studies in other parts of sub-Saharan Africa reported that high cost of MiP and maternal healthcare services demotivated women from accessing them [5,80,86,87,88]. Nevertheless, other studies suggested that limited knowledge on the relevance of IPTp, preference to bring their own cups to fetch water to take the SP drug and worries about side-effects of SP contributed to low uptake [35,36]. Failure to recognize early signs of pregnancy contributed to late ANC attendance [37] and women with high parity of more than one child visited ANC less often than those with one child [36].…”

“…Nevertheless, other studies suggested that limited knowledge on the relevance of IPTp, preference to bring their own cups to fetch water to take the SP drug and worries about side-effects of SP contributed to low uptake [35,36]. Failure to recognize early signs of pregnancy contributed to late ANC attendance [37] and women with high parity of more than one child visited ANC less often than those with one child [36]. Surprisingly, perceived poor attitudes of health workers contributed to early ANC attendance [37].…”

Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

“…In the case of malaria, a systematic review found that the general lack of awareness among women of why they were being given IPTp, as well as its safety, regimen or benefit, was a key barrier to the implementation of IPTp into ANC services [40, 69]. Illness, shyness, low social position and lack of partner support were also identified as social barriers that prevented or delayed ANC attendance and IPTp adherence [40, 70–72].…”