INTERMITTENT PREVENTIVE TREATMENT FOR MALARIA AND PREGNANCY OUTCOME AMONG PARTURIENT WOMEN AT ADEOYO MATERNITY TEACHING HOSPITAL, IBADAN, NIGERIA

Abstract

Malaria control programmes rely on the Antenatal Clinic (ANC) for the delivery of Intermittent Preventive Treatment in pregnancy (IPTp). The IPTp with Sulfadoxine-Pyrimethamine (IPTp-SP) is an effective strategy to reduce the level of parasitism and adverse outcome of pregnancy such as low birth weight, anaemia and pre-term delivery. However, in Nigeria the proportion of women who comply with the recommended doses during pregnancy are low. In this study, the relationship between ANC visits, IPT compliance and pregnancy outcome among women delivering at Adeoyo Maternity Teaching Hospital, Ibadan were investigated. A cross-sectional survey of 339 consenting parturient women presenting at the lying-in ward of the Adeoyo Maternity Teaching Hospital and their neonates was carried out over a period of three months. An interviewer-administered questionnaire was used to obtain information on demographic characteristics, knowledge of IPTp, history or index pregnancy (ANC attendance, IPTp use, malaria episode, gestational age at parturition), birth weight of neonates and compliance with IPTp-SP. Compliance with IPTp-SP is the use of two or more doses of IPTp. Blood was collected by maternal finger prick and neonatal heel prick to detect malaria parasite and to determine Packed Cell Volume (PCV). Data were analysed using descriptive statistics, Chi-square test and logistic regression at p= 0.05. Mean age of respondents was 28.1 ± 0.3 years. Twenty five were aware of the use of IPTp but 60.0% of these relayed its use correctly. About 27.0% had their first ANC after months into the pregnancy and 62.2% had four or more ANC visits. Only 19.3% complied with the recommended doses of IPTp. The prevalence of malaria parasite was 13.3% in parturient women and 3.2% in neonates. Anaemia was found in 39.5% parturient women and in 1.5% neonates. Low Birth Weight (LBW) was recorded in 8.8% newborns and was significantly associated with being primigravidae (OR=2.5, CI=1.1- 5.5), female sex (OR-3.4. Cl=4.1- 7.9) and less than four ANC visit (OR=2.9, Cl=1.3 - 6.7). Term babies with LBW were more likely to be from mothers who had less thin four ANC visits when compared with term babies with normal birth weight (OR=3.113, CI=1.267 - 7.646). Compliance with IPTp-SP had no significant relationship with number of ANC visits, birth weight, gestational age at delivery and PCV. There was no significant relationship between the awareness of IPTp and compliance with IPTp-SP. Mothers who had patent parasitaemia were more likely to have anaemia (OR= 1.9, CI=1.0-3.6) and neonates with parasitaemia (OR=6.0, Cl=1.8- 20.6). Awareness and compliance with intermittent protective treatment among women was very low. Antenatal Clinic attendance did not translate to women's compliance. Education should be intensified among pregnant women on malaria prevention in pregnancy and benefits. Interventions aimed at improving IPTp uptake should be targeted at care providers and pregnant women.