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

Intermittent preventive treatment using SP (IPTp-SP) is still a superior interventional approach to control malaria during pregnancy. However its rate of use has gone down tremendously in malaria endemic areas. This study forms part of a larger study aimed at monitoring the compliance of IPTp-SP policy in malaria endemic areas of Tanzania. Two cross-sectional studies were conducted in Dar es Salaam and Njombe Regions of Tanzania. Overall, 540 pregnant women and 21 healthcare workers were interviewed using structured questionnaires. This study revealed that 63% of women were not willing to take SP during pregnancy while 91% would only take it if they tested positive for malaria during antennal visits. 63% of the interviewed women did not know the recommended dose of SP required during pregnancy, despite the fact that 82% of the women were aware of the adverse effect of malaria during pregnancy. It was found out that 54% of pregnant women (30–40 weeks) took single dose, 34% took two doses, and 16% did not take SP at the time of interview. It was also found that SP was not administered under direct observed therapy in 86% of women. There was no significant relationship between number of doses received by pregnant women and antenatal clinic (ANC) start date (r2 = 0.0033, 95% CI (−0.016 to 0.034)). However positive correlation between drug uptake and drug availability was revealed (p=0.0001). Knowledge on adverse effects of placental malaria among pregnant women was significantly associated with drug uptake (OR 11.81, 95% CI (5.755–24.23), p=0.0001). We conclude that unavailability of drugs in ANC is the major reason hindering the implementation of IPTp-SP.

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Effectiveness of Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment of Malaria and Adverse Birth Outcomes in Pregnant Women

Pathogens ◽

10.3390/pathogens9030207 ◽

2020 ◽

Vol 9 (3) ◽

pp. 207 ◽

Cited By ~ 2

Author(s):

Eulambius M. Mlugu ◽

Omary Minzi ◽

Muhammad Asghar ◽

Anna Färnert ◽

Appolinary A.R. Kamuhabwa ◽

...

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Birth Outcomes ◽

Birth Outcome ◽

Placental Malaria ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Adverse Birth Outcomes ◽

Malaria During Pregnancy ◽

To Receive

Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) for prevention of malaria and adverse birth outcomes can be compromised by parasites-resistance to sulfadoxine–pyrimethamine. This study prospectively evaluated the effectiveness of IPTp-SP in Southeast Tanzania. From January 2017 to May 2019, HIV-negative and malaria-negative (mRDT) pregnant women attending their first antenatal-care visit in the second or third trimester (n = 500) were enrolled to receive monthly IPTp-SP and followed the protocol till delivery. The primary outcome was the prevalence of histopathological placental malaria. Secondary outcomes were anemia, malaria parasites detected during pregnancy and at delivery, adverse birth outcomes (low-birth-weight [LBW], premature birth, fetal anemia, still birth, and spontaneous abortion). Rates of histopathological placental malaria, any parasitemia at delivery (placental, cord or maternal), and any adverse birth outcome were 9.4%, 20.9%, and 26.5%, respectively. Rates of symptomatic malaria and parasitemia during pregnancy were 2.8% and 16%, respectively. Histopathological placental malaria significantly increased the odds of any adverse birth outcomes, particularly LBW. IPTp-SP with more than or equal to three doses significantly improved birth weight and reduced the risk of LBW by 56% compared to <3 SP doses (p = 0.009). IPTp-SP with more than or equal to three doses is still effective in improving birth weight. However, the detection of histopathological placental-malaria in one-tenth and parasitemia in one-fifth of pregnant women reflects the need to optimize the prevention of malaria during pregnancy.

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Factors Associated with Under Utilization of Intermittent Preventive Treatment Using Sulfadoxine - Pyrimethamine among Pregnant Women Attending Antenatal Clinic in Gusau District of Gusau Local Government Area, Zamfara State of Nigeria

Acta Scientific Nutritional Health ◽

10.31080/asnh.2019.03.0485 ◽

2019 ◽

Vol 3 (11) ◽

pp. 36-52

Author(s):

Bello Liman

Keyword(s):

Local Government ◽

Pregnant Women ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Antenatal Clinic ◽

Local Government Area ◽

Factors Associated

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Malaria Preventive Practices among Pregnant Women in Akwa Ibom State, Southern Nigeria

Archives of Current Research International ◽

10.9734/acri/2019/v19i330158 ◽

2020 ◽

pp. 1-8

Author(s):

T. Kasso ◽

I. L. Oboro ◽

O. Maduka ◽

A. T. O. Awopeju ◽

N. I. Paul ◽

...

Keyword(s):

Pregnant Women ◽

Intermittent Preventive Treatment ◽

Open Data ◽

Public Health Problem ◽

Preventive Treatment ◽

Health Facilities ◽

Bed Nets ◽

P Value ◽

Cross Sectional ◽

Preventive Practices

Background: Malaria is a serious public health problem in developing countries with Africa bearing most of its burden. Pregnant women are more susceptible to malaria and it is one of the leading causes of maternal and perinatal mortality/morbidity. Use of effective malaria preventive measures during pregnancy reduces its burden and complications. Aim: This was to determine malaria preventive practices used by pregnant women in Akwa Ibom state, Nigeria. Materials and Methods: It was a cross sectional study of pregnant women attending public and private health facilities in Akwa Ibom state. An informed written consent was obtained from the participants. Stratified sampling method was used in selecting the health facilities and the study participants. Information was obtained with pretested questionnaires by trained personnel with the aid of Open Data Kit (ODK) on android phones. Data was managed with SPSS 22.0 and P-value of <0.05 was considered statistically significant. Results: There were 935 participants in the study. Their mean age was 28.52 ± 5.09 years with 879 (94.0%) being married. Most had secondary and tertiary degrees: 451(48.2%) and 440(47.1%). Majority of them were traders/business women and self-employed (58.2%) while 7% were unemployed. Malaria preventive practices were use of window net, bed net and insecticides accounting for 659(71%), 447(48.2%) and 207(22.3%) respectively. There were 612 (65.5%) participants that received malaria drugs for prevention with 452(73.9%) receiving Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP). Only 296 (31.7%) of them slept under bed nets the night before the interview. Conclusion: Common preventive practices employed by pregnant women were IPTp with SP, window nets, ITNs and modified IRS. Majority of the women utilized widow nets, though not as effective as ITNs. Efforts should be intensified concerning awareness creation about the benefits of ITN use during pregnancy.

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Effect of Sulfadoxine-Pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania

10.21203/rs.2.19381/v2 ◽

2020 ◽

Author(s):

Wigilya Padili Mikomangwa ◽

Omary Minzi ◽

Ritah Mutagonda ◽

Vito Baraka ◽

Eulambius M. Mlugu ◽

...

Keyword(s):

Pregnant Women ◽

Malaria Transmission ◽

Geometric Mean ◽

Placental Malaria ◽

Intermittent Preventive Treatment ◽

Premature Delivery ◽

Maternal Anaemia ◽

Malaria During Pregnancy ◽

Placental Blood ◽

Low Malaria Transmission

Abstract Background Malaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings. Methods A cross-sectional study that involved consecutively selected 1,161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR). Results In total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤2) while 764(65.8%) used optimal doses (≥3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI, 1.10-30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76± 2.51μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36 fold compared to ≥3 doses (aOR, 1.36; 95%CI, 1.04-1.79; p = 0.02). Conclusion The use of <2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥3doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.

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Quality of Sulfadoxine-Pyrimethamine Given as Antimalarial Prophylaxis in Pregnant Women in Selected Health Facilities in Central Region of Ghana

Journal of Parasitology Research ◽

10.1155/2016/9231946 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Danny F. Yeboah ◽

Richmond Afoakwah ◽

Ekene K. Nwaefuna ◽

Orish Verner ◽

Johnson N. Boampong

Keyword(s):

Pregnant Women ◽

Central Region ◽

Malaria Infection ◽

High Performance ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Health Facilities ◽

African Countries ◽

Malaria During Pregnancy

The use of sulfadoxine-pyrimethamine (SP) as an intermittent preventive treatment (IPT) against malaria during pregnancy has become a policy in most sub-Sahara African countries and crucially depends on the efficacy of SP. This study sets out to evaluate the effectiveness of the SP given to the pregnant women in some selected health facilities in the Central Region of Ghana to prevent maternal malaria in pregnant women. A total of 543 pregnant women recruited from 7 selected health centres in Central Region of Ghana participated in the study. Parasite density ofPlasmodium falciparumwas determined from peripheral blood of the pregnant women using microscopy. High performance liquid chromatography (HPLC) and dissolution tester were used to determine the quality of the SP. Malaria infection was recorded in 11.2% of pregnant women who had a history of SP consumption. SP failed the dissolution test. Pregnant women who did not receive IPT-SP were 44%. Low haemoglobin level was recorded in 73.5% of the pregnant women. The results indicated that SP was substandard. IPT-SP is ineffective in preventing malaria infection.

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Factors Associated with Anemia in Pregnancy in Cascades Region in Burkina Faso

European Journal of Nutrition & Food Safety ◽

10.9734/ejnfs/2015/21018 ◽

2015 ◽

pp. 663-664

Author(s):

Ilboudo Bernard ◽

Savadogo G. Léon Blaise ◽

Kinda Maurice ◽

Guiguemde T. Robert ◽

Dramaix-wilmet Michèle ◽

...

Keyword(s):

Burkina Faso ◽

Pregnant Women ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Anemia In Pregnancy ◽

Prevalence Of Anemia ◽

In Pregnancy

Objectives: To analyze the factors associated with anemia in pregnancy in the Cascades region in Burkina Faso. Methods: A cross-sectional study was carried out in antenatal clinics of the Cascades region in Burkina Faso during one month from May to June 2012. We collected data on socio-demographics and health characteristics of pregnant women attending these clinics. Hemoglobin was measured to assess anemia. Factors associated with anemia were identified through a multivariate analysis. Results: A total of 1763 pregnant women, irrespectively of pregnancy stage, were enrolled. The mean (SD) hemoglobin level was 10.6 (1.4) g/dl. The prevalence of anemia in pregnancy was 58.9%, 3.2% of them being severe. Factors associated with anemia were the absence of intermittent preventive treatment of malaria with sulfadoxin-pyrimetamin (OR = 1.3, 95% CI: 1.0-1.7), number of pregnancies >6 (OR = 1.4, 95% CI: 1.1-1.9). Moderate consumption of local alcohol extracted from Palmyra was associated with a lower prevalence of anemia (OR = 0.7, 95% CI: 0.5-0.9). Surprisingly, anemia was not associated with supplementation with folic acid + iron (p = 0.60). Conclusions: Interventions which aim to reduce the prevalence of anemia in pregnancy in Burkina Faso should improve the coverage of the intermittent preventive treatment of malaria and support the limitation of births.

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Prevalence of Anaemia among Pregnant Women in the First Antenatal Care (ANC) Clinic Visit in St. Mary's Hospital Okpoga, Okpokwu Local Government Area, Benue State, Nigeria

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2021/v42i1330509 ◽

2021 ◽

pp. 30-37

Author(s):

P. N. Atser ◽

E. B. Iorliam ◽

M. Ochogwu ◽

J. Ondoma ◽

S. Wuam

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Formal Education ◽

Medical Condition ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Educational Status ◽

Antenatal Clinic ◽

Clinic Visit ◽

Pregnant Mothers

Aims: The study was carried out to determine the prevalence of anaemia among pregnant women attending St. Mary's Hospital Okpoga, Benue State, Nigeria, with respect to demographic factors, socio-economic and underlying medical determinants among pregnant women. Methodology: A retrospective study design was used for the study. The study of 858 pregnant women who booked for antenatal care (ANC) between March 2019 to March 2020 was done. Their records were retrieved from the Records Department and the ANC unit using a standard proforma. Results: The findings revealed that prevalence of anaemia among pregnant women at booking was (55.2%). The highest prevalence of anaemia by age range 15-20 years was (62.2%), by educational status, highest prevalence was among those with no formal education (84.3%), by occupation highest prevalence was among house wives (59.9%). By underlying medical condition – severe form of parasitaemia (78.5%), by degree of severity, mild form of anaemia 74.1%, was most prevalent. By parity, it was highest among multiparous women (66.9%), by habitants it was highest among rural habitants (73.9%) while prevalence by gestational age it was highest among pregnant mothers who were in their 3rd trimester (60%) in the first antenatal care (ANC) visit. Conclusion: Pregnant mothers need to book early for antenatal clinic to access services such as intermittent preventive treatment, uptake of iron supplements and anthelmintics. They should also be empowered economically to access ANC in order to reduce the problem of anaemia in pregnancy.

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Regular Antenatal Attendance and Education Influence the Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy: A Cross-Sectional Study at the University Hospital, Kumasi, Ghana

Journal of Tropical Medicine ◽

10.1155/2018/5019215 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Otchere Addai-Mensah ◽

Max Efui Annani-Akollor ◽

Linda Ahenkorah Fondjo ◽

Kwadwo Sarbeng ◽

Enoch Odame Anto ◽

...

Keyword(s):

Pregnant Women ◽

Tertiary Education ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Cross Sectional Study ◽

World Health ◽

Bed Nets ◽

Sectional Study ◽

Formal Sector ◽

Cross Sectional

Background. The World Health Organization (WHO) recommends the use of Insecticide Treated Bed-Nets and Intermittent Preventive Treatment (IPT) with Sulphadoxine-Pyrimethamine (SP) as interventions in curbing malaria during pregnancy. However, increasing evidence shows a gap in coverage where not all pregnant women receive the recommended SP dose. This study evaluated the factors influencing uptake of IPTp-SP among pregnant women in Kumasi, Ghana. Methodology. This cross-sectional study was conducted among 280 pregnant women attending the Kwame Nkrumah University of Science and Technology Hospital in Kumasi, Ghana. Validated structured questionnaires were administered to obtain sociodemographic, medical/reproductive information, and IPTp-SP uptake among participants. Statistical analyses were performed using IBM SPSS 25.0 statistics. Results. The mean age of respondents was 29.7±4.9 years. Of the 280 women interviewed, 74.6% attended the antenatal care (ANC) clinic at least four times with only 31.8% completing the recommended doses. Tertiary education [aOR=3.15, 95% CI (0.94 -10.97), and p=0.042] and ≥ 4 ANC visits [aOR=24.6, 95% CI (5.87-103.07), p<0.0001] had statistically significant higher odds of completing the recommended IPTp-SP dose. However, participants employed by the formal sector [aOR=0.28, 95% CI (0.09 - 0.79), p=0.016] and participants with more than four children [aOR=0.14, 95% CI (0.03 - 0.63), and p=0.011] had statistically significant lower odds of completing the recommended IPT dose. Conclusion. ANC attendance is critical in IPTp uptake. The results emphasize the need for the Health Policy Makers in Kumasi to encourage pregnant women, especially women working in the formal sector and women having more than four children to patronize ANC attendance to ensure high coverage of the recommended IPTp dose.

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