Assessment of Malaria Intermittent Preventive Treatment (Ipt) Uptake among Pregnant Women attending Antenatal Care at Kasanje Health Center III, Wakiso District

Preventive Treatment ◽

Malaria In Pregnancy ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Major Public Health Problem ◽

Background: Malaria in pregnancy is a major public health problem with substantial risks for both the mother and unborn child. Malaria is responsible for 10,000 maternal deaths globally, 20% of stillbirths, and 11% of newborn deaths in sub-Saharan Africa. The study intends to explore the extent of intermittent preventive treatment IPTp uptake among pregnant women attending ANC. Methodology A Cross-sectional survey was carried out among pregnant women attending antenatal care at Kasanje Health Center III to explore the extent of intermittent preventive treatment (IPTp) uptake among pregnant women attending ANC. Data on their socio-demographic characteristics and antenatal service utilization were collected using a questionnaire and review of antenatal care (ANC) cards. In-depth interviews were conducted and data on ANC service delivery collected and analyzed. Univariate, Bivariate and multiple logistic regression analyses were done to determine factors associated with uptake of IPTp. Results: A total of 75 pregnant women were interviewed, all in reproductive age 15-48 years, with an average age of 25.6years. All the respondents (100%) had attended antenatal care at least once. 58% of the participants wherein their third trimester. Many, 31% were on their second visit, 24% on their 3rd visit while only 10% were on their first visit. The majority of the participants (88%) had their ANC started in the first trimester. It was also noted that the number of IPTp varied significantly with the number of ANC visits (chi2=33.8, p<0.001). The majority (62.67) of the participants knew IPTp and the majority of the respondents (99%) knew how malaria is transmitted. Abortion was mentioned as the major outcome of malaria in pregnancy (95%) followed by Stillbirths (72%). Conclusion and recommendations: An increased number of ANC visits, providing IPTp information to pregnant women, and the gestational age of pregnancy resulted in increased uptake of IPTp.

The Association Between Early Antenatal Care and Intermittent Preventive Treatment of Malaria in Pregnancy in Sub-Saharan Africa: Effect Modification by Planned Pregnancy Status

Annals of Global Health ◽

10.5334/aogh.3550 ◽

2022 ◽

Vol 88 (1) ◽

pp. 4

Author(s):

Paschal Awingura Apanga ◽

Maxwell Tii Kumbeni ◽

Mary-Ann Wepiamo Chanase

Keyword(s):

Antenatal Care ◽

Preventive Treatment ◽

Effect Modification ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Planned Pregnancy ◽

Pregnancy Status ◽

Sub Saharan ◽

Impact of Insecticide Treated Nets and Intermittent Preventive Treatment in Reducing Malaria Morbidity among Pregnant Women in Gombe, Nigeria

Journal of Applied Sciences and Environmental Management ◽

10.4314/jasem.v24i7.22 ◽

2020 ◽

Vol 24 (7) ◽

pp. 1279-1282

Author(s):

R. Ali ◽

M.A. Qadeer ◽

B. Mohammed ◽

A. Sarki

Keyword(s):

Pregnant Women ◽

Malaria Parasite ◽

Public Health Problem ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Major Public Health Problem ◽

Insecticide Treated Nets ◽

The Difference ◽

Malaria in pregnancy is a major public health problem affecting women fetuses and new borns. Many studies highlight the critical importance of continuing the use of Insecticide Treated Nets (ITN) and Intermittent Preventive Treatment In Pregnancy (IPTp) among pregnant women to reduce the adverse consequences of malaria in pregnancy. This study was conducted in order to determine malaria prevalence in relation to the use ofITN and IPTp among the pregnant women in the study area. Five (5) ml of blood was obtained from each participant by the use of a sterile syringe and placed in a sterile EDTA container for laboratory analysis. The malaria parasite was detected by microscopic examination of Giemsa-stained thick blood films. Information on the use of ITN and IPTP was collected using administered questionnaire. A high prevalence of 78.4% was observed among the studied population. Although 74.4% of those that use ITN were positive for malaria parasite as against the 83.6% of those that reported not using the ITN, the difference was statistically not significant (p<0.05). 70.0% of those reported using IPTp were positive however, higher percentage was observed for those reported not using IPTp (83.7.0%). The difference was statistically significant in this case. This study has shown the influence of malaria prevention method during pregnancy on malaria infection and the need for targeted preventive starategies when designing and implementing policies aimed at improving uptake of these measures during pregnancy in Gombe. Keywords: malaria, pregnant women, ITN, Gombe, IPTp

Antenatal visits are positively associated with uptake of tetanus toxoid and intermittent preventive treatment in pregnancy in Ivory Coast

BMC Public Health ◽

10.1186/s12889-019-7847-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Sanni Yaya ◽

Komlan Kota ◽

Amos Buh ◽

Ghose Bishwajit

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Tetanus Toxoid ◽

Ivory Coast ◽

Multivariable Analysis ◽

Preventive Treatment ◽

Sub Saharan Africa ◽

Analysis Model ◽

Abstract Background Malaria and tetanus infections among pregnant women represent two major public health problems in sub-Saharan Africa. Optimum use of Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (IPTp-SP) and immunization against tetanus among pregnant women during antenatal care (ANC) visits are recommended strategies to prevent these issues. Despite these recommendations, many women in Africa remain deprived of these cost-effective and life-saving interventions. In this study, we aimed to examine the prevalence of women using these two services, and the association between women’s uptake of IPTp-SP and tetanus toxoid (TT) with antenatal care use in Ivory Coast. Methods This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Ivory Coast in 2016. Participants were 9583 women aged between 15 and 49 years. Outcomes were TT and Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). Data analysis was conducted using bivariate and multiple logistic regression. Results In this study, the prevalence of taking TT immunization and IPTp-SP drugs was 81.97 and 17.83% respectively. Of the participants who took these drugs at all, the prevalence of taking adequate doses of TT immunization was 78.75% and that of IPTp-SP was 35.46%. In the multivariable analysis model, higher age groups, 25–29 years (OR = 2.028, 95%CI = 1.120–3.669) were found to be positively associated with uptake of adequate doses of IPTp-SP drugs. Women who attended at least four ANC visits had higher odds of taking IPTp-SP drugs (OR = 1.656, 95%CI = 1.194–2.299) and TT immunization (OR = 2.347, 95%CI = 1.384–3.981), and also had higher odds of receiving adequate doses of IPTp-SP drugs (OR = 3.291, 95%CI = 2.157–5.020) and that of TT immunization (OR = 1.968, 95%CI = 1.398–2.771). The odds of taking IPTp-SP drugs were significantly higher among women with primary (OR = 2.504, 95%CI = 1.020–6.146) and secondary/higher education (OR = 3.298, 95%CI = 1.343–8.097) compared to those with no education. Also, women with higher parity had lower odds of taking TT immunization (OR = 0.218, 95%CI = 0.055–0.858) compared to those with lower parity. Findings from this study also revealed that the odds of taking adequate doses of IPTp-SP drugs were significantly lower among participants from Mandé du Nord ethnicity (OR = 0.378,95%CI = 0.145–0.983) compared to those from other ethnicities. Conclusion In this study, uptake of IPTp-SP drugs was much lower than TT immunization. High number of ANC visits were found to be significantly associated with taking IPTp-SP drugs and TT immunization and also with that of taking them in adequate doses. Vaccination promotion is necessary to protect pregnant women and reduce adverse health outcomes among the newborn in Ivory Coast.

Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys

International Journal of Epidemiology ◽

10.1093/ije/dyaa233 ◽

2020 ◽

Author(s):

Clara Pons-Duran ◽

Mireia Llach ◽

Charfudin Sacoor ◽

Sergi Sanz ◽

Eusebio Macete ◽

...

Keyword(s):

Antenatal Care ◽

Preventive Treatment ◽

Malaria Prevention ◽

Reproductive Age ◽

Cluster Sampling ◽

Household Surveys ◽

Cross Sectional ◽

Sub Saharan ◽

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, baseline information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.

A Socio-Ecological Approach To Understanding The Factors Influencing The Uptake Of Intermittent Preventive Treatment Of Malaria In Pregnancy (IPTp) In South Western Nigeria.

10.21203/rs.3.rs-40304/v1 ◽

2020 ◽

Author(s):

Gertrude Nsorma Nyaaba ◽

Atinuke O Olaleye ◽

Mary O Obiyan ◽

Oladapo Walker ◽

Dilly OC Anumba

Keyword(s):

Pregnant Women ◽

Healthcare Providers ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Bed Nets ◽

Public Healthcare ◽

Birth Attendants ◽

Faith Based ◽

Abstract Background: Malaria in pregnancy (MiP) remains a key cause of poor maternal and neonatal health outcomes. Two key strategies globally promoted to address MiP require pregnant women in malaria-endemic regions to sleep under insecticide-treated bed nets (ITNs) and take at least three doses of intermittent preventive treatment (IPTp) during pregnancy. Particularly in the African region where weak health systems grapple with prevailing socio-cultural and traditional practices, several multilevel factors influence the effective uptake of these strategies. This study explores the factors for the poor uptake of IPTp and use of ITNs in lower socio-economic communities in Nigeria. Methods: We conducted semi-structured interviews (SSI) and focus group discussions (FGD) with a total of 201 key stakeholders in 6 communities in Ogun State, South-western Nigeria. Twelve SSIs were conducted with traditional birth attendants (TBAs), faith-based birth attendants and healthcare providers operating in public health facilities. Community leaders (7), pregnant women (30) and 20 caregivers were also individually interviewed. Sixteen FGDs were conducted with multi- and first- time pregnant women grouped by location and pregnancy experiences. A thematic approach were used for data analysis. Results: At the individual and social levels, there is high general awareness of MiP, its consequences and ITNs but a low awareness of IPTp, with type of antenatal care (ANC) provider being a key factor influencing access to IPTp. Choice of type of ANC provider, which facilitates access to IPTp and ITNs, is influenced by experiences of relatives with ANC providers, attitudes of ANC providers and community perceptions of the type of ANC providers. Concurrent use of multiple ANC providers and ANC providers’ relationships further influence acceptability and coverage for IPTp and ITN use. At the health sector level, there is low awareness about preventive malarial strategies including IPTp among TBAs and faith-based birth attendants, in contrast to high IPTp awareness among public healthcare providers. Conclusion: The findings highlight several factors that influence the utilisation of IPTp services and call for greater synergy and sensitisation between the three groups of healthcare providers towards improving access to and acceptability of IPTp for improving maternal and child outcomes.

Factors Associated with Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy: A Cross-Sectional Study in Private Health Facilities in Tema Metropolis, Ghana

Journal of Tropical Medicine ◽

10.1155/2019/9278432 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Selina Amankwah ◽

Francis Anto

Keyword(s):

Antenatal Care ◽

Preventive Treatment ◽

Health Facilities ◽

Malaria In Pregnancy ◽

Second Trimester ◽

Cross Sectional ◽

Factors Associated ◽

Postnatal Women ◽

Introduction. Intermittent preventive treatment of malaria in pregnancy with sulfadoxine pyrimethamine (IPTp-SP) is effective in preventing the adverse consequences of malaria on birth outcomes. Methods. A cross-sectional survey was carried out among antenatal and postnatal women and midwives at private health facilities in Tema using the mixed method to investigate factors associated with uptake of IPTp-SP. Antenatal and postnatal women were consecutively enrolled and data on their sociodemographic characteristics and antenatal service utilization collected using a questionnaire and review of antenatal care (ANC) records. In-depth interviews involving attending midwives were conducted and data on ANC service delivery collected. The interviews were manually analyzed. Bivariate and multiple logistic regression analyses were done to determine factors associated with uptake of SP. Results. Of the 382 respondents, 178 (46.6%) took ≥ 3 doses of SP. Uptake was similar for those who had delivered and those yet to deliver (χ2 =2.94, p > 0.05). Ninety-seven of the 176 (55.1%) women who initiated antenatal visit during the first trimester received ≥ 3 doses of SP whilst 42.0% (76/181) of those who started during the second trimester received ≥ 3 doses (χ2 = 5.64, p = 0.02). Those who initiated ANC during the second trimester received more doses compared to those who started during the third trimester (χ2 = 4.43, p = 0.04). Respondents who attended ANC > 5 times increased their uptake by 83% compared to those who attended < 5 times (OR 0.2, 95% C.I 0.12-0.31). There was poor adherence to directly observed treatment and low knowledge of midwives on IPTp-SP protocol. Conclusion. Early initiation and regular visit to antenatal care centres promoted uptake of optimal doses of SP.

Population Pharmacokinetics of Mefloquine Intermittent Preventive Treatment for Malaria in Pregnancy in Gabon

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01113-18 ◽

2018 ◽

Vol 63 (2) ◽

pp. e01113-18 ◽

Cited By ~ 1

Author(s):

Michael Ramharter ◽

Matthias Schwab ◽

Ghyslain Mombo-Ngoma ◽

Rella Zoleko Manego ◽

Daisy Akerey-Diop ◽

...

Keyword(s):

Pregnant Women ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Pharmacokinetic Analysis ◽

Population Pharmacokinetic ◽

Blood Concentrations ◽

Split Dose ◽

Dosing Regimens ◽

ABSTRACT Mefloquine was evaluated as an alternative for intermittent preventive treatment of malaria in pregnancy (IPTp) due to increasing resistance against the first-line drug sulfadoxine-pyrimethamine (SP). This study determined the pharmacokinetic characteristics of the mefloquine stereoisomers and the metabolite carboxymefloquine (CMQ) when given as IPTp in pregnant women. Also, the relationship between plasma concentrations of the three analytes and cord samples was evaluated, and potential covariates influencing the pharmacokinetic properties were assessed. A population pharmacokinetic analysis was performed with 264 pregnant women from a randomized controlled trial evaluating a single and a split-dose regimen of two 15-mg/kg mefloquine doses at least 1 month apart versus SP-IPTp. Both enantiomers of mefloquine and its carboxy-metabolite (CMQ), measured in plasma and cord samples, were applied for pharmacokinetic modelling using NONMEM 7.3. Both enantiomers and CMQ were described simultaneously by two-compartment models. In the split-dose group, mefloquine bioavailability was significantly increased by 5%. CMQ induced its own metabolism significantly. Maternal and cord blood concentrations were significantly correlated (r2 = 0.84) at delivery. With the dosing regimens investigated, prophylactic levels are not constantly achieved. A modeling tool for simulation of the pharmacokinetics of alternative mefloquine regimens is presented. This first pharmacokinetic characterization of mefloquine IPTp indicates adequate exposure in both mefloquine regimens; however, concentrations at delivery were below previously suggested threshold levels. Our model can serve as a valuable tool for researchers and clinicians to develop and optimize alternative dosing regimens for IPTp in pregnant women.

Impact of Health Systems on the Implementation of Intermittent Preventive Treatment for Malaria in Pregnancy in Sub-Saharan Africa: A Narrative Synthesis

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5030134 ◽

2020 ◽

Vol 5 (3) ◽

pp. 134

Author(s):

Atinuke O. Olaleye ◽

Oladapo Walker

Keyword(s):

Health System ◽

Data Extraction ◽

Supply And Demand ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Narrative Synthesis ◽

Malaria in pregnancy is a public health challenge with serious negative maternal and newborn consequences. Intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine is recommended for the control of malaria during pregnancy within endemic areas, but coverage for the recommended ≥3 doses IPTp regimen has remained suboptimal. We searched PubMed, Cochrane library, and HINARI database from 1 January 2010 to 23 May 2020, for studies investigating the effect of the health system on IPTp implementation. Data extraction was independently performed by two investigators and evaluated for quality and content. Health system barriers and facilitators were explored using thematic analysis and narrative synthesis. Thirty-four out of 1032 screened articles were included. Key health system issues affecting the provision and uptake of IPTp were the ambiguity of policy and guidelines for IPTp administration, human resource shortages, drug stock-outs, conflicting policy implementation on free IPTp provision, hidden costs, unclear data recording and reporting guidelines, and poor quality of care. Factors affecting the supply and demand for IPTp services involve all pillars of the health system across different countries. The success of health programs such as IPTp will thus depend on how well the different pillars of the health system are articulated towards the success of each program.

Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya

Malaria Journal ◽

10.1186/s12936-020-03505-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Jenny Hill ◽

Peter Ouma ◽

Seth Oluoch ◽

Jane Bruce ◽

Simon Kariuki ◽

...

Keyword(s):

Preventive Treatment ◽

Standard Of Care ◽

Health Facilities ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Directly Observed Therapy ◽

Western Kenya ◽

Sub Saharan ◽

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. Methods A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. Results A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). Conclusions The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT.

A socio-ecological approach to understanding the factors influencing the uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in South-Western Nigeria

PLoS ONE ◽

10.1371/journal.pone.0248412 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248412

Author(s):

Gertrude N. Nyaaba ◽

Atinuke O. Olaleye ◽

Mary O. Obiyan ◽

Oladapo Walker ◽

Dilly O. C. Anumba

Keyword(s):

Pregnant Women ◽

Healthcare Providers ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Bed Nets ◽

Public Healthcare ◽

Birth Attendants ◽

Faith Based ◽

Malaria in pregnancy (MiP) remains a key cause of poor maternal and neonatal health outcomes, particularly in the African region. Two strategies globally promoted to address MiP require pregnant women in malaria-endemic regions to sleep under insecticide-treated bed nets (ITNs) and take at least three doses of intermittent preventive treatment (IPTp) during pregnancy. Yet, several multilevel factors influence the effective uptake of these strategies. This study explored the factors for the poor uptake of IPTp and use of ITNs in lower socio-economic communities in Nigeria. We conducted semi-structured interviews (SSI) and focus group discussions (FGD) with a total of 201 key stakeholders in six communities in Ogun State, South-Western Nigeria. Twelve SSIs were conducted with traditional birth attendants (TBAs), faith-based birth attendants and healthcare providers operating in public health facilities. Community leaders (7), pregnant women (30) and 20 caregivers were individually interviewed. Sixteen FGDs were conducted with multi- and first-time pregnant women grouped by location and pregnancy experiences. A thematic approach was used for data analysis. At the individual and social levels, there is a high general awareness of MiP, its consequences and ITNs but low awareness of IPTp, with type of antenatal care (ANC) provider being a key factor influencing access to IPTp. The choice of ANC provider, which facilitates access to IPTp and ITNs, is influenced by the experiences of women, relatives and friends, as well as the attitudes of ANC providers and community perceptions of the type of ANC providers. Concurrent use of multiple ANC providers and ANC providers’ relationships further influence acceptability and coverage for IPTp and ITN use. At the health sector level, there is low awareness about preventive malarial strategies including IPTp among TBAs and faith-based birth attendants, in contrast to high IPTp awareness among public healthcare providers. The findings highlight several factors that influence the utilisation of IPTp services and call for greater synergy and collaboration between the three groups of healthcare providers towards enhancing access to and acceptability of IPTp for improving maternal and child outcomes.