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

Abstract

BackgroundMalaria infection during pregnancy is associated with adverse outcomes in sub-Saharan Africa (SSA). For this reason, the World Health Organization currently recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) at each scheduled antenatal care (ANC) visit. In Tanzania, the revised IPTp policy was adopted in 2013 but the level of uptake and its association with pregnancy outcomes remains unknown.MethodsA cross-sectional study was conducted among singleton pregnant women who delivered in two selected health facilities of Geita district, northwestern Tanzania. Self-reported uptake of SP was verified using the ANC card and was recorded. Placental and peripheral blood was collected for diagnosis of malaria by microscopy and rapid diagnostic tests (RDTs). Gestational age was estimated based on last menstrual period or Ballard score. Infant birth weights were recorded within 24 hours of delivery.ResultsOf 431 participants, 167 (38.75%), 134 (31.09%), 104 (24.23%), and 26 (6.03%) reported taking none, one, two, and ≥ three doses of SP during pregnancy, respectively. The uptake of ≥ three doses of IPTp-SP among delivering women at Geita hospital and Katoro health centre was 9.06% and 1.2%, respectively. The overall prevalence of malaria in pregnancy by RDT, peripheral and placental smears was 19.5%, 29.7% and 37.6% respectively. The prevalence of placental parasitaemia was higher for women who delivered at Katoro Health Centre (41.57%) than those who delivered at Geita hospital (35.09%). The uptake of ≥ three doses of SP was associated with reduced odds of having placental malaria (adjusted odds ratio (AOR) = 0.31, p = 0.039) compared to < three doses. Women with placental parasitaemia were five times more likely to have delivered pre-term (AOR = 4.67, p = 0.002) and had lower mean birth weight infants than their uninfected counterparts (mean difference = 82 g, p = 0.039).ConclusionsThe uptake of ≥ three doses of IPTp-SP is low in the present study area. Placental parasitaemia is prevalent and is associated with adverse birth outcomes. Receipt of ≥ three doses of IPTp-SP reduced the odds of placental parasitaemia. Thus, increased efforts towards scale-up and continuous evaluation of IPTp-SP efficacy is recommended.

Monitoring Compliance and Acceptability of Intermittent Preventive Treatment of Malaria Using Sulfadoxine Pyrimethamine after Ten Years of Implementation in Tanzania

“…Additionally this study establishes a link between low supply of SP in ANC, knowledge about impact of placental malaria by pregnant women, and uptake of SP. These results support the observations by Marchant et al, 2008, Mpogoro et al, 2014, and Mubyazi and Bloch, 2014, who observed SP unavailability and low uptake of SP among women in Tanzania [13, 18, 19]. Low uptake of SP may increase risk of malaria parasitaemia and therefore placental malaria prevalence among pregnant women in endemic areas.…”

Predictors of the use of interventions to prevent malaria in pregnancy in Cameroon

“…IPT-SP is recommended for prophylaxis during pregnancy in Cameroon and has been available at no cost since 2006 [15]. SP has efficacy for 4–6 weeks after a single dose and improved outcomes are seen with repeated dosing [16–18]. Based on this data and concerns about emerging resistance, WHO recommends provision of at least three doses of SP in ANC clinic; Cameroon transitioned from a 2-dose to a 3-dose recommendation for IPT-SP in 2012 [19–21].…”

Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

“…This estimate is reflected in a study by Nkoka et al that used MDHS dataset [31]. Globally, studies have revealed that uptake of at least two doses of IPTp-SP is associated with number of ANC visits [5,22,[30][31][32][33][34][35][36][37][38][39], directly observed therapy (DOT) [5,30,38,40,41], residential area [22,30,42], age of woman [42], education level and socioeconomic status [43], parity [5,42], timing of initial ANC visit [5,31,44], knowledge about malaria/IPTp-SP [5,38] and stockouts of the commodity [5,38,45].…”

“…In 2004, WHO recommended a minimum of two doses of IPTp with SP along side other malaria prevention and control approaches during pregnancy [19,20]. In October 2012, however, WHO updated the policy to at least three doses after acknowledgement from Evidence Review Group (ERG) that reviewed research evidence on efficacy of IPTp-SP and its adverse outcomes in preventing MiP [21][22][23][24][25][26]. The updated policy further says that IPTp with SP should be administered at each antenatal visit, with the first dose given early in the second trimester and successive doses administered at monthly intervals until the time of delivery [27].…”