Predictors of Optimum Uptake of Intermittent Presumptive Treatment of Malaria During Pregnancy Among Women at Navakholo Sub-County, Kakamega County - Kenya

Abstract

Introduction. Malaria in pregnancy is associated with high incidences of maternal and neonatal mortality in malaria endemic regions. World Health Organization recommends Intermittent Presumptive treatment of malaria in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). It is recommended that every pregnant woman receives at least three doses administered one month apart up to the time of delivery. Despite increased antenatal clinic attendance and concerted efforts to address known barriers to uptake of malaria preventive measures in Navakholo Sub-County, uptake of three or more IPTp-SP doses in the Sub-County has remained low.

Objective. This study aimed at determining predictors of optimum uptake of intermittent presumptive treatment of malaria in pregnancy among women in Navakholo Sub-County.

Methodology. This was a cross sectional study using mixed methods of data collection. The study was carried out in Navakholo Sub-County, Kakamega County, Kenya. Multistage cluster sampling method was employed to attain sample size (n = 608). Data was analyzed using descriptive statistics, bivariate and multivariate logistic regression while thematic analysis was used for qualitative data. Strength of association between independent variables and dependent variables was measured using odd ratio and p ≤ 0.05 used to reject null hypothesis of no association between independent variables and the main outcome which was the uptake of optimum doses of IPTp-SP.

Results. Out of the 587 participants, 294(50.1%) took optimum doses (three or more doses) of IPTp-SP, 248(42.2%) took IPTp-SP partially (one-two doses) and 45 (7.7%) did not take any dose.  The following variables were statistically significantly associated with uptake of optimum doses of IPTp-SP: having attained secondary level of education and above (OR = 0.6, 95% CI 0.4-0.98, p = 0.01); distance to health facility (OR = 0.2, 95% CI 0.06-0.8, p = 0.02); perception that SP drugs are not safe during pregnancy (OR = 7.3, 95% CI 1.5-35.7, p = < 0.01); opening of health facilities daily (OR = 161.8, 95% CI 29.5-885.7 p < 0.0001) and giving clients return dates (OR = 21.2, 95% CI 7.9-56.5, p = < 0 .0001).

Conclusion: Key factors that determine optimum uptake of IPTp-SP in the study area are: having attained at least secondary level of education; perceived safety of SP drugs; distance to health facility; opening of health facility daily and giving of return dates to clients.

Recommendation: - Community awareness through health education to increase awareness on the risks of malaria in pregnancy and safety of SPs in pregnancy.  The study further recommends that the daily opening of facilities within the study area, ensure return dates are given at every visit and introduction of mobile clinics to those who are staying far away from the nearest health facility.

Keywords; IPTp-SP, Malaria in Pregnancy, Optimum uptake of IPTp-SP doses, Navakholo Sub-County.

DOI: 10.7176/JHMN/60-08

Publication date:March 31^st 2019