Determinants of the Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine Pyrimethamine in Sabatia Sub County, Western Kenya
Abstract Background: Malaria in pregnancy remains a major public health problem. Annually, 125.2 million pregnant women worldwide are at risk of malaria infection including 30.3 million and 1 million pregnant women in Sub-Saharan Africa and Kenya respectively. The World Health Organization recommends that pregnant women in malaria endemic areas receive at least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) for optimal benefit. However, IPTp-SP optimal uptake is undesirably low in Kenya. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya. Understanding the epidemiology of malaria in pregnancy is core for making decisions and setting priorities towards IPTp-SP optimization.Methods: This was a cross-sectional study conducted in Sabatia Sub County. Using a validated semi structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15 – 49 years who had a live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during their pregnancy were excluded. Association between IPTp-SP uptake and independent variables was analysed using Pearson Chi-square and Fisher’s Exact test. Bivariate and multiple binary logistic regression analysed predictors of optimal IPTp-SP uptake.Results: Overall, 99.46 % of the respondents received at least one IPTp-SP dose. The prevalence of optimal IPTp-SP uptake was 79.57% (95% CI 75.47%, 83.67%). After multivariate analysis; gestational age at first antenatal care (ANC) visit (p = 0.04), frequency of ANC visits (p < 0.001), maternal knowledge of IPTp-SP benefits (p < 0.001), maternal knowledge of optimal SP dose (p = 0.03) and administration of sulphadoxine pyrimethamine at ANC clinic (p = 0.03) significantly predicted the optimal uptake of IPTp-SP.Conclusions: Optimal uptake of IPTp-SP is high in the study area. Efforts towards early and more frequent ANC attendance should be enhanced and sustained. Structured and targeted health education should be adopted and health workers should always administer SP drugs or explain to some pregnant women their ineligibility for initial IPTp-SP receipt. Future studies considering large sample drawn from the whole country and health workers’ perspective of the health system delivery factors are recommended.