Contextual factors influencing intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) uptake (original) (raw)
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2012
Background Malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her fetus and the neonate. The World Health Organization (WHO) currently recommends a package of interventions for controlling malaria during pregnancy in areas with stable transmission of Plasmodium falciparum, which includes the use of insecticide treated nets (ITNs), the administration during pregnancy of at least 2 doses of intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) after quickening and effective case management of malaria 1. Preliminary data from recent observational studies have suggested reduced effectiveness of SP for IPTp in Malawi, the first country where IPTp-SP was implemented in 1993 2. In addition, there is growing concern over the decreasing effectiveness of the 2-dose regimen of SP for IPTp in other countries with a high level of resistance to SP, especially in Eastern and Southern Africa, regions that also carry the...
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.4\_April2018/IJHSR\_Abstract.030.html, 2018
Malaria in pregnancy is associated with a number of adverse pregnancy outcomes. As a result, Intermittent Preventive Treatment has been recommended as one of the means for reducing the burden of infection and adverse consequences associated with it. This paper aims to evaluate the effectiveness of 2-dose Intermittent Preventive Treatment with Sulphadoxine-Pyrimethamine (IPT-SP) in reducing the risk of these adverse events. A comprehensive literature search of experimental studies was conducted, restricted to papers published from the year 2000 onwards. Thirteen studies were included, each comparing a 2-dose IPT-SP with another regimen and /or placebo. The Cochrane risk of bias assessment tool was used to assess the quality of included studies and a qualitative synthesis was done. Two-dose IPT-SP showed a consistent superiority over Chloroquine. It also demonstrated non-inferiority to other anti-malarial drugs like mefloquine and proguanil which were considered as ‘gold-standards’. Only higher doses of SP and Dihydroartemisinin-piperaquine, showed clear superiority over 2-dose SP. This study shows that the 2-dose IPT-SP is effective in reducing the incidence of malaria in pregnancy and its adverse pregnancy outcomes. This effectiveness is complimented by its relative safety and ease of administration.
Maternal and child health journal, 2011
Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTpSP) is one of the major strategies of malaria control in most African countries where malaria is endemic. The use of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy was adopted when proof of its superiority to weekly prophylactic dosing with either chloroquine or pyrimethamine became evident from studies in different malaria endemic countries. The administration of 2 and 3 treatment doses of SP for HIV-negative and HIV-positive pregnant women respectively, given after quickening and at an interval not less than 4 weeks was recommended. The prospects of this control strategy lies on the efficacy of SP, convenient treatment dose and high compliance rate. However, the implementation of this strategy and the efficacy of SP are faced with challenges such as: timing of SP administration, rising levels of parasite resistance to SP in the general population, effect of folate supplementation, adequacy of the recommended doses with regards to malaria endemicity and HIV status, interactions between SP and antiretroviral drugs and low coverage in the bid to scale-up its use. This review highlights the prospects and challenges of scaling up IPTp-SP.
Academia Medicine, 2024
Malaria continues to pose a significant threat to pregnant women in sub-Saharan Africa, including Ghana, where the uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) remains below optimal levels. This study explored factors influencing IPTp-SP uptake among 300 postpartum mothers in Asunafo North Municipal using a descriptive cross-sectional design. Data were gathered through pretested questionnaires, and statistical analyses included descriptive, bivariate, and multivariate methods, with logistic regression used to assess relationships at a significance level of α = 0.05. A significant proportion (43.7%) of participants received three or more doses of IPTp-SP, while 56.3% received two or fewer doses. Key barriers to uptake included being unmarried (AOR = 0.36, [95% CI 0.145–0.881], p = 0.025) and unemployed (COR = 0.61, [95% CI 0.38–0.98], p = 0.042). Fewer antenatal care (ANC) visits (≤3 times) were strongly associated with lower odds of receiving three or more doses (AOR = 0.03, [95% CI 0.01–0.83], p < 0.001). Higher IPTp-SP uptake was positively linked to the perceived severity of malaria in pregnancy (AOR = 0.19, [95% CI 1.02–4.20], p = 0.045) and the perceived benefits of IPTp-SP (AOR = 0.39, [95% CI 0.19–0.78], p = 0.008). Perceived susceptibility to malaria did not significantly affect uptake. Sociodemographic factors such as age, education, and parity showed no significant associations. Major barriers included time and financial constraints related to ANC attendance. The study underscores the need for better alignment between ANC attendance and IPTp-SP administration, and suggests that future research should evaluate ANC interventions to enhance IPTp-SP uptake and reduce malaria-related complications.
Research Square (Research Square), 2021
Background Ghana malaria control programme recommends the uptake of ve doses of SP during pregnancy following the review of the WHO recommendations in 2012. The uptake of higher doses of SP since the implementation of the new policy in 2016, has been low across the country. The current study determined factors that can be improved to increase uptake of IPTp-SP in malaria endemic regions. Methods A descriptive cross-sectional study was carried out among women who had just delivered in selected health facilities in the Sekondi-Takoradi Metropolis of Ghana. Participants were enrolled from the lying-in wards of the study facilities after delivery. Data including time of initiating ANC, number of visits, time of rst dose of SP and number of doses were collected. ANC books were also reviewed. Logistic and multinomial logistic regression analyses were done to determine respondent factors associated with uptake of IPTp-SP using Stata 15. Results Out of the 496 mothers who participated in the study, 370 (74.60%) initiated ANC during the rst trimester, 123 (24.80%) during the second, with only three (0.60%) starting during the third trimester. Majority (463/496, 93.35%) made > 4 visits. Uptake of at least one dose of SP was 98.79% (490/496), ≥ 2 doses was 92.75 (460/496), ≥ 3 doses was 80.65% (400/496) and ≥ 4 doses was 40.32% (200/496). Uptake of IPTp 5 was very low (6.65%, 33/490). A unit increase of one ANC visit was associated with 20% higher odds of receiving 3-4 doses of SP with respect to receiving 1-2 doses (p<0.001). The probability of receiving 5 or more doses of SP with respect to 1-2 doses was 26% higher with a unit increase of one ANC visit. Conclusion Uptake of 3-4 doses and ≥ 5 doses of SP were associated with making more ANC visits. Encouraging and motivating expectant mothers to make more ANC visits can improve uptake of ≥ 5 doses of SP.
Clinical Infectious Diseases, 2011
Malaria in pregnancy (MIP) remains a major public health concern, inspite of the adoption of WHO recommended intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) for its control in Nigeria. Using interviewer administered questionnaires, information on knowledge of the burden, consequences and the use of SP for malaria control in pregnancy was obtained from 800 mothers within 24 h after delivery at two health centres in Ibadan. Women who attended antenatal care (ANC) at the secondary facility were less likely to demonstrate poor knowledge of causes (OR = 0.18, 95% CI = 0.08, 0.38), consequences (OR = 0.37, 95% CI = 0.24, 0.55) and control strategies (OR = 0.32, 95% = 0.18, 0.59) compared with tertiary facility. Only 56.4% of all the mothers were aware of IPTp SP as government policy for prevention of MIP out of which 16.9% used IPTp SP in index pregnancy. Overall, only 18.4% of all mothers used IPTp SP. Being unaware of the existing government policy and educational attainment of 9 years independently predicted non-usage of IPTp SP. This study revealed that the uptake of IPTp SP in pregnancy is poor in spite of good knowledge of burden of malaria in pregnancy and underscores the need to scale up awareness campaign and monitor implementation at all levels of health care.
International Journal of TROPICAL DISEASE & Health, 2018
Malaria in pregnancy is a major international public health concern in tropical and subtropical regions because pregnancy is a unique period vulnerable to malaria infection. In the Sub Saharan Africa region, the subclinical infection usually occurs during pregnancy and leads to the maternal anaemia, intrauterine growth retardation of the foetus, low birth weight and infantile deaths. The WHO recommended the use of sulfadoxine and pyrimethamine (SP) as intermittent preventive treatment (IPTp) for pregnant women living in moderate to high malaria transmission regions. The increasing number of SP-resistant parasites is a threatening matter for public health prophylaxis intervention. Therefore, in the context of threatening SP resistance, there is a need to consider the
Infectious Diseases of Poverty, 2021
Background: Annually, 125.2 million pregnant women worldwide risk contracting malaria, including 30.3 million and 1.5 million in Sub-Saharan Africa and Kenya respectively. At least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) is recommended for optimal benefit. Kenya recorded low IPTp-SP optimal uptake in 2015. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya. Methods: A cross-sectional study was conducted in Sabatia Sub County from April to October 2020. Using a validated semi-structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15-49 years with live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during pregnancy were excluded. Pearson Chi-square and Fisher's Exact test were measures of association used. Binary logistic regression analysed predictors of optimal IPTp-SP uptake. Results: Optimal IPTp-SP uptake was 79.6%, 95% CI 75.5%-83.7%. Predictors of IPTp-SP optimization were 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 sulphadoxine pyrimethamine (SP) dose (P = 0.03) and SP administration at ANC clinic (P = 0.03). Late ANC initiators were less likely to receive optimal IPTp-SP (aOR = 0.4, 95% CI 0.2-0.9). Odds of optimizing IPTp-SP increased among women with ≥ 4 ANC visits (aOR = 16.7, 95% CI 7.9-35.3), good knowledge of IPTp-SP benefits (aOR = 2.4, 95% CI 1.3-4.5) and good knowledge of optimal SP dose (aOR = 1.9, 95% CI 1.1-3.4). Women who never missed being administered SP were highly likely to receive optimal IPTp-SP (aOR = 2.9, 95% CI 1.1-7.2) Conclusions: This study has found high IPTp-SP optimal uptake in the study area. Efforts should be directed towards early and more frequent ANC visits. Intensive and targeted health education is required. It's fundamental to adequately stock and consistently administer SP. Future studies considering larger samples and health workers' perspectives of the health system delivery factors are recommended.