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Background: Intermittent preventive treatment during pregnancy (IPTp) with optimal doses (two+) of sulphadoxine-pyrimethamine (SP) protects pregnant women from malaria-related adverse outcomes. This study assesses the extent and predictors of uptake of optimal doses of IPTp-SP in six districts of Tanzania. Methods. The data come from a cross-sectional survey of random households conducted in six districts in Tanzania in 2012. A total of 1,267 women, with children aged less than two years and who had sought antenatal care (ANC) at least once during pregnancy, were selected for the current analysis. Data analysis involved the use of Chi-Square (χ§ssup§2§esup§) for associations and multivariate analysis was performed using multinomial logistic regression. Results: Overall, 43.6% and 28.5% of the women received optimal (two+) and partial (one) doses of IPTp-SP respectively during pregnancy. Having had been counseled on the dangers of malaria during pregnancy was the most pervasive determinant of both optimal (RRR = 6.47, 95% CI 4.66-8.97) and partial (RRR = 4.24, 95% CI 3.00-6.00) uptake of IPTp-SP doses. Early ANC initiation was associated with a higher likelihood of uptake of optimal doses of IPTp-SP (RRR = 2.05, 95% CI 1.18-3.57). Also, women with secondary or higher education were almost twice as likely as those who had never been to school to have received optimal SP doses during pregnancy (RRR = 1.93, 95% CI 1.04-3.56). Being married was associated with a 60% decline in the partial uptake of IPTp-SP (RRR = 0.40, 95% CI 0.17-0.96). Inter-district variations in the uptake of both optimal and partial IPTp-SP doses existed (P < 0.05). Conclusion: Counseling to pregnant women on the dangers of malaria in pregnancy and formal education beyond primary school is important to enhance uptake of optimal doses of SP for malaria control in pregnancy in Tanzania. ANC initiation in the first trimester should be promoted to enhance coverage of optimal doses of IPTp-SP. Programmes should aim to curb geographical barriers due to place of residence to enhance optimal coverage of IPTp-SP in Tanzania. © 2014 Exavery et al.; licensee BioMed Central Ltd.
The data for this study were collected in 2012 in six Tanzanian rural districts namely Geita, Kahama, Kondoa, Mbozi, Singida and Sumbawanga. The geographical locations of the districts, which are all malaria endemic, represent three of eight health zones as described by the Tanzania Ministry of Health and Social Welfare. The data were collected as part of a large cross-sectional household survey to serve baseline purposes for the Empower II Project implemented by the Ifakara Health Institute, in Tanzania. The project seeks to improve maternal, newborn and child health (MNCH) services for women of reproductive age and children aged less than five years in the stud area. It implements MNCH proven interventions to demonstrate how best such interventions can be scaled up across the country. Under the maternal component it helps to build capacity of district health managers to effectively deliver maternal health services in the continuum of care including malaria during pregnancy. Data collection tools were quantitative and there were field interviewers to interview each of the respondents sampled. Sampling for the survey was random and was implemented using probability proportionate to size (PPS). This method is used when sampling units (e.g. districts, villages, etc.) are of different sizes in order to ensure that the resulting sample is representative of each unit. Data entry was done in Microsoft Office Access and latter transferred in STATA statistical software for cleaning and analysis. Women who had children below the age of two years at the time of the survey and had sought ANC at least once during pregnancy were selected from the main database for the current analysis. Having sought ANC at least once was considered an important criterion because questions pertaining to MiP and IPTp were administered to women who did so. The dependent or outcome variable for this study was uptake of IPTp-SP. This was defined as the extent of SP utilization for malaria control during pregnancy and was derived from the question “During pregnancy of (NAME OF CHILD), did you use drugs (SP) to prevent malaria?” If yes, “how many times?” Responses were grouped in three categories such that: Independent variables included maternal age, marital status, maternal education, maternal occupation and district of residence. Others were whether a woman was counseled on the dangers of malaria during pregnancy, number of ANC visits made, timing of ANC initiation, and pregnancy intentions. The data were analysed both descriptively and analytically using standard methods of applied statistics in public health. Frequency distribution (one-way tabulations) of participants across background characteristics was performed first, then bivariate analysis was conducted, in which the outcome variable, IPTp-SP uptake, was cross-tabulated against each of the independent variables. The degree of association between each pair of variables was tested using Pearson’s Chi-Square (χ2) because all variables were categorical. In this process, the degree of IPTp-SP uptake was compared across categories of each of the independent variables. Where the test of association between the outcome and each of the independent variables showed a P-value of 5% or less, the null hypothesis of no association between the variables was rejected and consequently concluded that they were significantly associated, otherwise no association was deduced. The data were finally subjected to regression analysis using multinomial logistic regresion in a multivariable way. This was to ensure that variables were adjusted for one another to obtain independent predictors of the IPTp-SP uptake. The category ‘none’ of the outcome variable was made a baseline/pivot outcome thus assessing what predicts partial, and complete receipt of IPTp-SP doses. Selection of independent variables for the multivariate models relied on each one’s ability to improve the overall model. This was achieved through the use of log-likelihood ratio test. From the model outputs, relative risk ratios (RRR), their corresponding 95% confidence intervals (CI) and P-values were all presented. Significance level was set at 5%. The whole process of data analysis was conducted using STATA (version 11) statistical software. The primary study was approved by the Medical Research Coordinating Committee (MRCC) of the National Institute for Medical Research (NIMR) in Tanzania. During data collection, participation was voluntary, with potential respondents having to sign an informed consent form first. The interviewer read, and explained the content of the consent form to the potential respondent. The respondent was also free to read the consent form by herself and ask for clarifications concerning any aspect of the content. Then an interview followed only if the respondent agreed and signed the consent form to take part in the survey. The data were managed carefully and remained anonymous throughout.
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