Factors affecting uptake of ≥ 3 doses of Sulfadoxine-Pyrimethamine for malaria prevention in pregnancy in selected health facilities, Arusha region, Tanzania

Abstract

BackgroundTanzania adopted the revised World Health Organization policy in 2013 recommending a minimum of ≥3 doses of Intermittent Preventive Treatment during pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) to protect against malaria. A study in Tanzania in 2014 reported low (9%) uptake. We investigated health workers knowledge about IPTp-SP and factors that influenced uptake of > 3 doses of IPTp-SP among pregnant women.MethodsWe conducted a cross-sectional study in 2017 among post-delivery women and health care workers from nine randomly-selected public health facilities in three Districts of Arusha Region. Probability proportional to size methodology was used to determine number of participants per facility. We used a structured questionnaire to collect socio-demographic and obstetric data, information on doses of SP received, and knowledge of SP for IPTp. Health care workers were interviewed about their knowledge for IPTp- SP and challenges encountered in its uptake and use.ResultsWe interviewed 556 persons (median age 26 years, range 16–42 years) with the response rate of 99.3%. Of these, 484 (87.1%) had > 3 Antenatal Care (ANC) visits. A total of 402 (72.3%) were multigravida with 362 (65.1%) having given birth at least once. Of the 556 participants, 219 (39.4%) made their first ANC booking at < 17 weeks of pregnancy and 269 (48.4%) had received > 3 doses of SP-IPTp. Factors associated with uptake of > 3 doses of IPTp-SP included having secondary or higher education [Adjusted Odds Ratio (AOR) =1.6, 95%CI 1.1–2.4], attending ≥4 ANC visits [AOR = 3.1, 95%CI 2.1–4.6], having first antenatal booking at < 17 weeks [AOR = 1.8, 95%CI 1.4–2.3], and adequate knowledge on IPTp-SP [AOR = 2.7, 95%CI 1.9–3.9]. Among 36 health care workers interviewed, 29(80.6%) had adequate knowledge about IPTp-SP. SP was available in seven (87.5%) of the visited health facilities and was administered under Direct Observed Therapy (DOT) in six (75%) facilities. Health care workers reported that stock outs of SP was a challenge.ConclusionsFewer than half of the women interviewed reported uptake of > 3 doses of IPTp-SP. That is below the Tanzania national target of 80%. Making > 4 ANC visits, having secondary or higher education, making an early first ANC visit and having adequate knowledge on IPTp-SP promoted uptake of > 3 doses. Further qualitative studies are needed to explore factors that might contribute to low uptake of SP.

Determinants of the Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine Pyrimethamine in Sabatia Sub County, Western Kenya

“…The high prevalence of the optimal uptake of IPTp-SP in this study is consistent with other studies in Ghana and Sierra Leone (21,22,25). However, other studies in Uganda, Tanzania and Malawi that investigated the optimization of IPTp-SP found low uptake levels of IPTp-SP3 + doses (19,20,32). The high prevalence of optimal IPTp-SP could be attributable to the sustained efforts by the Kenyan government and development partners towards the elimination of MiP and continued investment in maternal health.…”

Factors Influencing Uptake of IPTp3+ Among Pregnant Women Attending ANC in Mawokota North Health Sub District, Mpigi District, Uganda

“…In this study it was established that knowledge in terms of awareness of signs of malaria (χ 2 = 1.890, df = 2, p = .389), knowledge of fansidar in preventing malaria (χ 2 = 1.166, df = 1, p = .280) and knowledge on effects of malaria (χ 2 = .060, df =2, p = .970) did not significantly influence IPTp3+ Uptake among pregnant mothers. This result is different from those in a study which was done in Tanzania by (Mchwampaka et al, 2019) that mothers did not like taking Fansidar because of its associated side effects such as nausea. Such contradictions could be perhaps attributed to the fact that benefits of IPTp3+ exceed the side effects if well known by the pregnant mothers themselves.…”

“…Health workers being knowledgeable, and this only benefits the women who attained ANC (15). Findings from Ghana cost of services, distance to facility, Level of education, ANC schedule (16), (17).Distance to the health facility, pregnancy disclosure is among factors that affect ANC attendance and uptake of IPT3 (9).…”

Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: further analysis of the data of the 2015–2016 Tanzania demographic and health survey and malaria indicator survey

“…It was observed that educated and wealthier women were knowledgeable about IPTp and more likely to receive the SP [ 18 ]. Also, the uptake of SP was higher for women who attended 3 to 4 ANC visits and started ANC visits in their first or second trimester compared to those who started in the third trimester [ 13 , 16 , 17 , 19 ].…”