Uptake of intermittent preventive treatment for malaria during pregnancy with sulphadoxine-pyrimethamine(IPTP-SP)among postpartum women in Zomba district,Malawi: a cross-sectionals study

Abstract

Malaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Despite the effectiveness of the intervention, Zomba district has below national average uptake of 43% of pregnant women who took at least two doses of SP. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district. The study used a cross-sectional survey with simple random sampling in selecting two public health facilities (HFs) from two strata (urban and rural). One HF was selected from each stratum. Study participants were selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire from the two HFs. Univariate and multiple binary logistic regression was employed in data analysis. Out of all the enrolled participants (n=463), 92% women had complete information for analysis. Of these, (n=426)women, 127 (29.8%, 95% CI: 25.6-34.3) received three (optimal) or more doses of SP, 299 (70.2%, 95% CI: 65.7-74.4) received two or less doses (poor uptake or suboptimal). Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR=0.31, 95% CI 0.13-0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR=0.29, 95% CI 0.18-0.48); not taking SP under direct observation therapy (DOT) (AOR=0.18, 95% CI (0.05-0.63). The prevalence of low birth was 6.5% (95% CI 4.0-10.3, n=248) and there was no evidence of an association between poor IPTp-SP uptake and low birth weight even after adjusting for other variables, (AOR=0.59, 95% CI 0.19-1.78). There is low utilisation of SP in this population and this seems to be associated with the number of ANC visits, use of DOTs and distance to health facility. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.