Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria

Reproductive Health, Volume 9, No. 1, Year 2012

Interpretation

Background: Malaria infection in pregnancy is a major risk factor for maternal and child death, and substantially increases the risk of miscarriage, stillbirth and low birthweight. The aim of this study therefore is to assess the prevalence and determinants of Intermittent preventive treatment of Malaria [IPTp] utilization by pregnant women in a rural town in Western Nigeria. Methods: This study is an analytical cross-sectional study. All pregnant women that were due for delivery and were attending the three primary health care center in Sagamu town, Nigeria within a 2 months period were recruited into the study. A semi- structured questionnaire was used to collect relevant information. Results: A total of 255 pregnant women were recruited into the study. The mean age of respondents was 28.07 ± 5.12 years. The mean parity and booking age was 2.7 ± 1.67 and 4.42 ± 1.7 months respectively. The prevalence of Malaria attack in the last 3 months was 122(47.8%). Only 107/255 (40.4%) practice IPTp for malaria prevention during the current pregnancy, with only 14.6% of them taking the second dose during pregnancy as recommended. Chloroquine [27.1%] was the most frequently used medication for the treatment of Malaria in Pregnancy. Early booking age [OR = 1.11, C.I = 0.61-2.01], adverse last pregnancy outcome [OR = 1.23, C.I = 0.36-4.22], and parity [OR = 1.87, C.I = 0.25-16.09] were not statistically significantly associated with IPTp utilization. The only predictor of IPTp use was the knowledge of prophylaxis for malaria prevention [OR = 2.47, C.I = 1.06-3.52] using multivariate analysis. Conclusion: The study concludes that most women who attend ANC in rural areas in Nigeria do not receive IPTp as expected. A major determinant of utilization of IPTp among the study population was the knowledge of prophylaxis for malaria prevention. This study highlights the importance of health education of the pregnant women in increasing IPTp uptake despite the regular drug stock out at the facility level in rural areas in low resource countries. © 2012 Amoran et al.; licensee BioMed Central Ltd. This was a analytical cross-sectional study that sought to determine the pattern of IPTp utilization by pregnant women in Sagamu, Nigeria. All consenting pregnant women who attended antenatal clinic at least twice and were due for delivery were eligible to participate in the study. The study was carried out in Sagamu, the biggest town in Sagamu Local Government Area (LGA) located about midway between Lagos the commercial nerve center of Nigeria and Ibadan, the largest city in West Africa. It has an estimated land area of 20.05 km2. It is bounded on the West by Obafemi |Owode Local Government Area, on the east by Ikenne Local Government and by Ogijo town on the South. Sagamu has a population of 135,000 inhabitants projected from the 1991 census figure and consists mainly of Remo-speaking people of Ogun State. An estimated 40,000 of the women are of child bearing age. There are 15 political wards in the Local Government. Eleven of these are within Sagamu metropolis. Health facilities in the town include a Teaching Hospital, 42 private hospitals majority of which provide ante natal care services, 12 maternity homes and 30 registered birth attendants. Although the Local Government contains seven centres for primary health care services, only three within the metropolis were providing ANC activities at the time of the study. The others were not providing ANC due to organizational and logistic problems. The minimum sample size required for the study was estimated to be 246 using the formula N = P (1 − P)(Zα/D)2 where n is the sample size, Zα is the standard normal deviate, set at 1.96 (for 95% confidence level), d is the desired degree of accuracy (taken as 0.05) p, is the estimate of the proportion of pregnant women who practice IPTp = 6.5% [15]. A total of 47 women was calculated. All women [a total of 255 women] who have had at least two antenatal visits and were due for delivery at the three designated primary health care centres over the period of study were eligible for the study were recruited into the study within a 2 months period. Women who consented to partake in the survey were interviewed using a structured questionnaire, which was administered by four trained interviewers between February and March 2008. The interviewers were all female and had assisted in similar studies in the past. The data were collected on antenatal clinic days by the interviewers at the respective health care facilities. Completed questionnaires were scrutinized on the spot and at the end of daily field sessions for immediate correction of erroneous entry. The questionnaire was pretested among 20 women receiving antenatal care at similar health care facilities in Abeokuta. Appropriate adjustments were then made to the questionnaire to improve its internal validity. The instrument was a structured questionnaire which contained 39 items and was divided into 6 sections, namely socio-demographic; Knowledge of malaria prophylaxis was determined by assessing the correct answer given to a set of 4 simple questions about the cause, transmission, consequences’ and the need for prophylaxis to prevent Malaria in pregnancy such as What is the cause of Malaria? Can Malaria be transmitted to unborn child during pregnancy? What are the consequencies of Malaria in pregnancy [with options]? Can sulphadoxine-pyrimethamine [fansidar] be used to prevent Malaria in pregnancy? 100% was taken as having a good knowledge of Malaria prophylaxis in pregnancy. IPTp use was defined as those that used SP for at least once in pregnancy for prevention of Malaria. Information and counseling on malaria during pregnancy, use of malaria prevention treatment, experience of malaria disease during pregnancy and use of insecticide treated nets were also assessed. The socio-demographic section included information on socio-demographic data such as age, marital status, parity, number of living children, occupation of the woman and her husband, educational level completed. Others were duration of pregnancy at the time of interview, duration of pregnancy at the first antenatal visit. The other sections explored women’s knowledge and access to information on malaria. · Have had at least one antenatal clinic visit before the interview. This was used as proof that they have been registered in that facility. · Only pregnant women that were due for delivery were interviewed. · Registering for the first time in the health facility. · Disabilities that disallowed responses to questionnaire. · Refusal to partake in study. Ethical clearance was obtained from the Olabisi Onabanjo Teaching Hospital Ethics Board. Confidentiality on candidate’s information was maintained. Permission of the State Ministry of Health was obtained before the commencement of the study. At each of the selected study site, the matron and medical officer in-charge were informed for consent and antenatal clinic day(s) before the commencement of the study. The purpose, general content and nature of the study were explained to each respondent to obtain verbal and written consent before inclusion into the study. The data were coded and entered into a computer database using EPI INFO 2002 statistical software (CDC and WHO 2002). Percentages or means and standard deviations were computed for baseline characteristics of women interviewed. Cross tabulations that identify important relationships between variables were done. The relationship between socio-demographic characteristics of the women and their use or non-use of intermittent preventive treatment of malaria during pregnancy was examined through bivariate analysis, by computing odds ratio at 95% confidence level. A p-value < 0.05 was considered as statistical significance.

AI Digest

Study Justification:

– Malaria infection during pregnancy is a significant risk factor for maternal and child death, as well as other adverse outcomes such as miscarriage, stillbirth, and low birthweight.
– Understanding the prevalence and determinants of Intermittent Preventive Treatment of Malaria (IPTp) utilization among pregnant women is crucial for improving maternal and child health outcomes.
– This study aims to assess the pattern of IPTp utilization in a rural town in Western Nigeria and identify factors that influence its use.

Study Highlights:

– The study recruited 255 pregnant women in Sagamu, Nigeria.
– The prevalence of Malaria attack in the last 3 months was 47.8%.
– Only 40.4% of the women practiced IPTp for malaria prevention during their current pregnancy, with only 14.6% taking the recommended second dose.
– The most frequently used medication for the treatment of Malaria in Pregnancy was Chloroquine.
– Factors such as early booking age, adverse last pregnancy outcome, and parity were not statistically associated with IPTp utilization.
– The only predictor of IPTp use was the knowledge of prophylaxis for malaria prevention.

Recommendations for Lay Reader and Policy Maker:

– Health education for pregnant women is crucial in increasing IPTp uptake, especially in rural areas with regular drug stockouts.
– Efforts should be made to improve the availability and accessibility of IPTp medications in primary health care centers.
– Policy makers should prioritize the training of health care providers on the importance of IPTp and its proper administration.
– Further research is needed to explore other potential determinants of IPTp utilization and develop targeted interventions to improve uptake.

Key Role Players:

– Health care providers: They play a crucial role in educating pregnant women about the importance of IPTp and providing the necessary medications.
– Community health workers: They can assist in disseminating information about IPTp and ensuring pregnant women have access to antenatal care services.
– Policy makers: They are responsible for implementing policies and allocating resources to improve IPTp utilization.
– Researchers: They can conduct further studies to explore additional factors influencing IPTp utilization and evaluate the effectiveness of interventions.

Cost Items for Planning Recommendations:

– Training programs for health care providers on IPTp: This would include the cost of organizing workshops, materials, and facilitators.
– Procurement and distribution of IPTp medications: This would involve the cost of purchasing the medications and ensuring their availability in primary health care centers.
– Health education campaigns: This would include the cost of developing educational materials, conducting community outreach programs, and hiring health educators.
– Monitoring and evaluation: This would involve the cost of data collection, analysis, and reporting to assess the impact of interventions on IPTp utilization.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is an analytical cross-sectional study, which provides valuable information about the prevalence and determinants of IPTp utilization in a specific population. The sample size of 255 pregnant women is relatively large, increasing the generalizability of the findings. However, the study could be improved by providing more information about the data collection methods, such as how the semi-structured questionnaire was administered and how the data were analyzed. Additionally, the abstract does not mention any limitations of the study, which would be helpful for interpreting the results. To improve the evidence, future studies could consider using a longitudinal design to assess IPTp utilization over time and explore other potential determinants that were not examined in this study, such as access to healthcare facilities and socio-economic factors.

Abstract

This was a analytical cross-sectional study that sought to determine the pattern of IPTp utilization by pregnant women in Sagamu, Nigeria. All consenting pregnant women who attended antenatal clinic at least twice and were due for delivery were eligible to participate in the study. The study was carried out in Sagamu, the biggest town in Sagamu Local Government Area (LGA) located about midway between Lagos the commercial nerve center of Nigeria and Ibadan, the largest city in West Africa. It has an estimated land area of 20.05 km2. It is bounded on the West by Obafemi |Owode Local Government Area, on the east by Ikenne Local Government and by Ogijo town on the South. Sagamu has a population of 135,000 inhabitants projected from the 1991 census figure and consists mainly of Remo-speaking people of Ogun State. An estimated 40,000 of the women are of child bearing age. There are 15 political wards in the Local Government. Eleven of these are within Sagamu metropolis. Health facilities in the town include a Teaching Hospital, 42 private hospitals majority of which provide ante natal care services, 12 maternity homes and 30 registered birth attendants. Although the Local Government contains seven centres for primary health care services, only three within the metropolis were providing ANC activities at the time of the study. The others were not providing ANC due to organizational and logistic problems. The minimum sample size required for the study was estimated to be 246 using the formula N = P (1 − P)(Zα/D)2 where n is the sample size, Zα is the standard normal deviate, set at 1.96 (for 95% confidence level), d is the desired degree of accuracy (taken as 0.05) p, is the estimate of the proportion of pregnant women who practice IPTp = 6.5% [15]. A total of 47 women was calculated. All women [a total of 255 women] who have had at least two antenatal visits and were due for delivery at the three designated primary health care centres over the period of study were eligible for the study were recruited into the study within a 2 months period. Women who consented to partake in the survey were interviewed using a structured questionnaire, which was administered by four trained interviewers between February and March 2008. The interviewers were all female and had assisted in similar studies in the past. The data were collected on antenatal clinic days by the interviewers at the respective health care facilities. Completed questionnaires were scrutinized on the spot and at the end of daily field sessions for immediate correction of erroneous entry. The questionnaire was pretested among 20 women receiving antenatal care at similar health care facilities in Abeokuta. Appropriate adjustments were then made to the questionnaire to improve its internal validity. The instrument was a structured questionnaire which contained 39 items and was divided into 6 sections, namely socio-demographic; Knowledge of malaria prophylaxis was determined by assessing the correct answer given to a set of 4 simple questions about the cause, transmission, consequences’ and the need for prophylaxis to prevent Malaria in pregnancy such as What is the cause of Malaria? Can Malaria be transmitted to unborn child during pregnancy? What are the consequencies of Malaria in pregnancy [with options]? Can sulphadoxine-pyrimethamine [fansidar] be used to prevent Malaria in pregnancy? 100% was taken as having a good knowledge of Malaria prophylaxis in pregnancy. IPTp use was defined as those that used SP for at least once in pregnancy for prevention of Malaria. Information and counseling on malaria during pregnancy, use of malaria prevention treatment, experience of malaria disease during pregnancy and use of insecticide treated nets were also assessed. The socio-demographic section included information on socio-demographic data such as age, marital status, parity, number of living children, occupation of the woman and her husband, educational level completed. Others were duration of pregnancy at the time of interview, duration of pregnancy at the first antenatal visit. The other sections explored women’s knowledge and access to information on malaria. · Have had at least one antenatal clinic visit before the interview. This was used as proof that they have been registered in that facility. · Only pregnant women that were due for delivery were interviewed. · Registering for the first time in the health facility. · Disabilities that disallowed responses to questionnaire. · Refusal to partake in study. Ethical clearance was obtained from the Olabisi Onabanjo Teaching Hospital Ethics Board. Confidentiality on candidate’s information was maintained. Permission of the State Ministry of Health was obtained before the commencement of the study. At each of the selected study site, the matron and medical officer in-charge were informed for consent and antenatal clinic day(s) before the commencement of the study. The purpose, general content and nature of the study were explained to each respondent to obtain verbal and written consent before inclusion into the study. The data were coded and entered into a computer database using EPI INFO 2002 statistical software (CDC and WHO 2002). Percentages or means and standard deviations were computed for baseline characteristics of women interviewed. Cross tabulations that identify important relationships between variables were done. The relationship between socio-demographic characteristics of the women and their use or non-use of intermittent preventive treatment of malaria during pregnancy was examined through bivariate analysis, by computing odds ratio at 95% confidence level. A p-value < 0.05 was considered as statistical significance.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile health (mHealth) interventions: Develop mobile applications or text messaging services to provide pregnant women with information and reminders about the importance of IPTp utilization and other maternal health practices.

2. Community health workers: Train and deploy community health workers to educate pregnant women in rural areas about the benefits of IPTp and provide them with the necessary medication and support.

3. Telemedicine: Establish telemedicine services to connect pregnant women in rural areas with healthcare providers who can provide guidance and support for IPTp utilization.

4. Supply chain management: Improve the supply chain management system to ensure consistent availability of IPTp medication in rural health facilities, reducing stockouts and increasing access for pregnant women.

5. Health education campaigns: Conduct targeted health education campaigns in rural communities to raise awareness about the importance of IPTp and dispel any misconceptions or myths surrounding its use.

6. Integration of services: Integrate IPTp services with other maternal health services, such as antenatal care and family planning, to ensure comprehensive care for pregnant women and increase the likelihood of IPTp utilization.

7. Financial incentives: Explore the use of financial incentives, such as conditional cash transfers or vouchers, to encourage pregnant women to attend antenatal care visits and utilize IPTp services.

8. Partnerships and collaborations: Foster partnerships and collaborations between government agencies, non-governmental organizations, and private sector entities to pool resources and expertise in improving access to maternal health services, including IPTp utilization.

AI Innovations Description

Based on the information provided, the recommendation to improve access to maternal health in the context of this study is to prioritize health education for pregnant women regarding the importance of Intermittent Preventive Treatment of Malaria (IPTp) for malaria prevention during pregnancy. The study found that the knowledge of prophylaxis for malaria prevention was the only predictor of IPTp use among the study population. Therefore, by providing comprehensive and accurate information about the benefits and importance of IPTp, pregnant women can make informed decisions and increase their uptake of this preventive treatment. This recommendation highlights the significance of health education in increasing IPTp utilization, especially in rural areas with limited resources.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase health education: Implement comprehensive health education programs that specifically target pregnant women in rural areas. This should focus on raising awareness about the importance of intermittent preventive treatment of malaria (IPTp) and its benefits in preventing maternal and child deaths.

2. Strengthen antenatal care services: Improve the quality and availability of antenatal care services in rural areas. This includes ensuring that all primary health care centers provide ANC activities and have adequate resources and trained staff to deliver IPTp to pregnant women.

3. Address drug stockouts: Take measures to address the regular drug stockouts at the facility level in rural areas. This could involve improving supply chain management, strengthening procurement processes, and ensuring a consistent supply of IPTp medications.

4. Community engagement: Engage the local community, including traditional birth attendants and community leaders, to promote the importance of IPTp and encourage pregnant women to seek ANC services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Collect data on the current utilization of IPTp and other relevant factors such as knowledge, availability of ANC services, and drug stockouts.

2. Define indicators: Identify specific indicators to measure the impact of the recommendations, such as the percentage increase in IPTp utilization, the reduction in malaria infection rates among pregnant women, or the improvement in knowledge about IPTp.

3. Intervention implementation: Implement the recommended interventions, such as health education programs, strengthening ANC services, addressing drug stockouts, and community engagement.

4. Data collection post-intervention: Collect data after the implementation of the interventions to assess the changes in the identified indicators.

5. Data analysis: Analyze the collected data to determine the impact of the interventions on improving access to maternal health. This could involve comparing the pre- and post-intervention data and conducting statistical analyses to assess the significance of the changes observed.

6. Evaluation and reporting: Evaluate the effectiveness of the interventions and prepare a report summarizing the findings. This report can be used to inform future decision-making and guide further improvements in access to maternal health services.

It is important to note that the specific methodology for simulating the impact may vary depending on the available resources, time constraints, and the scope of the study.

Author

Dima Health

Statistics:

Citations: 31

Identifiers:

DOI: 10.1186/1742-4755-9-12

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Multi-Countries, Nigeria

Study Design:

Case-Control Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female