Menu
Menu
Menu
Menu
Background: Malaria in pregnancy contributes greatly to maternal morbidity and mortality in Uganda. Thus it is urgent to identify possible barriers that limit access to existing interventions. The aim of this study was to assess perceptions and practices regarding malaria prevention during pregnancy in a peri-urban area and explore ways to scale-up malaria prevention interventions, since little is known about malaria in peri-urban settings. Methods: A survey was conducted in Kabale municipality south-western Uganda from April-June, 2015. Data was collected using a structured questionnaire targeting pregnant women, who delivered in the study area 1 year prior to the survey. Univariate analyses were performed at assess the level of knowledge and practices on malaria prevention during pregnancy. Results: A total of 800 women was interviewed. The majority of women, 96.1 % knew that malaria was a dangerous disease in pregnancy; 60.3 % knew that it caused anaemia, and 71.3 % associated malaria with general weakness. However, fewer women (44.9 %) knew that malaria in pregnancy caused abortions, while 14.9 % thought it caused stillbirths. Similarly, few women (19 %) attended the recommend four antenatal care visits; less than a half (48.8 %) accessed two doses of sulfadoxine-pyrimethamine (SP) for malaria prevention in pregnancy while 16.3 % received at least three doses of SP, as recommended by the current policy. The main reasons for poor antenatal care attendance were: women felt healthy and did not see a need to go for antenatal care, long distances and long waiting hours at clinics. The reasons given for not taking SP for malaria prevention were: women were not feeling sick; they were not aware of the benefits of SP in pregnancy, they were sleeping under insecticide-treated nets; fear of side effects of SP; and the antenatal care clinics were far. Conclusion: Despite a good knowledge that malaria is a dangerous disease in pregnancy, there was poor access to antenatal care and use of SP for malaria prevention in pregnancy. There is urgent to address existing health system constraints in order to increases access to malaria prevention in pregnancy in this setting.
A survey was conducted in Kabale municipality, south-west Uganda, from April to June, 2015. This area was selected because little is known about malaria in peri-urban areas. All the three divisions in Kabale municipality participated in the study. A division has a population of approximately 50,000 people and a ward 5000 people. Data collection targeted pregnant who delivered 1 year prior to the survey. The Local Council III offices provided data on divisions, wards and the number of households in each ward. In each ward, a list of households was obtained and all women aged 15–49 years, who had delivered 1 year preceding the survey and consented to participate in the study were interviewed. The study was conducted in Kabale District, in south-western Uganda. The district experiences low malaria transmission and occasionally gets malaria outbreaks with severe signs and symptoms of the disease. It is situated 560 km from the capital city, Kampala and has temperatures ranging from 11 to 24 °C; with a mean annual rainfall of 1000–1250 mm. There are two rainy seasons, the heavy one between March and May, and the lesser one between September and November. Kabale municipality has a total of 32 health facilities including eight government health centres and one referral hospital. All the health facilities offer antenatal care (ANC), distribution of insecticide-treated nets (ITNs), malaria treatment and information on prevention of malaria. Data was collected on the following variables: socio-demographic characteristics, access to ANC and delivery care, access to malaria prevention services, use of SP for IPTp, and knowledge on adverse effects of malaria and preventions practices. Five research scientists experienced in malaria research conducted the interviews. They underwent refresher training for 3 days on research techniques, and study procedures; and participated in the pretesting and revision of the questionnaire tools before actual field work. The questionnaire was pretested among 43 participants outside the study area. Some questions on perceptions of malaria in pregnancy that had not been framed well and therefore not understood by the participants were revised for clarity. The final questionnaire was administered in the local language (Rukiga). Said Ishak supervised all aspects of data collection. Sample size calculation aimed to detect a difference of 5 % in the proportion of women who completed antenatal care visits in the district estimated at 38 % [21]. In order to estimate the proportion with a ±5 % absolute precision, at a power of 80 and 5 % level of significance (two-sided), a minimum sample of 784 pregnant women with 10 % non-participation was targeted for the study. Data was entered and verified using Microsoft Access 2007 (Microsoft Inc., Redmond, Washington) and analysed using STATA version 11.0 (STATA Corporation, College Station, Texas). Univariate analyses were performed to calculate proportions on perceptions and preventing practices. Responses from open-ended questions were coded and manually analysed. Ethical approval for the research was granted by Makerere University, College of Health Sciences, School of Public health Higher Degrees, Research and Ethics Committee (HDREC). Permission was also granted by the District health office. During field work, an information sheet about the study was given out and written informed consent was sought prior to the interviews.
N/A
