Determinants of utilization of intermittent presumtive treatment of malaria using fansidar by pregnant women in the rural urban clinics of Lusaka province

Abstract

Objective: To assess the utilization and determinants of Intermittent Presumptive Treatment of malaria by pregnant women in the rural and urban clinics of Lusaka Province. Study Design: A comparative cross-sectional study design was carried out among pregnant women in the rural and urban clinics of Lusaka Province. Study Setting: The study was carried out in four rural clinics of Chongwe District and four urban clinics of Lusaka District. Subjects: The study focused on pregnant women who were in their third trimester and attending their usual ante-natal clinics at the selected rural and urban clinics. Sampling Technique: Four rural and four urban clinics in Chongwe and Lusaka were conveniently selected. A systematic sampling technique was then applied to select the respondents. Every second pregnant woman in the third trimester was requested to participate in the study. Totals of 370 pregnant women in Chongwe and 426 respondents in Lusaka were interviewed. Main outcome measures: In this study, full utilisation of Intermittent Presumptive Treatment of malaria using fansidar was used as the main outcome. The pregnant women who had received three or more doses of fansidar, or were receiving the third dose on the day of the interviews were considered to have fully utilised the service, while those who received less than three doses of fansidar were considered not to have fully utilised the service. Results: Full utilisation levels of IPT/SP were 27.3 percent in Chongwe and 31.0 percent in Lusaka (P=0.288). The study revealed that the following determinants were significantly associated with IPT/SP utilisation: gestation of the pregnancy at the time of the interview and gestation of the pregnancy at first dose of IPT/SP were significantly associated with utilisation of IPT/SP in both Chongwe (PO.001, P=0.008) and Lusaka (PO.001, P<0.001) respectively; respondents' perception of fansidar being beneficial or harmful to pregnant women and their unborn babies and behaviour of health workers towards clients were significantly associated with utilisation of IPT/SP in Chongwe only (P=0.008 and P=0.013 respectively). In Lusaka, knowledge of traditional medicine used for prevention of malaria in pregnancy, respondents taking fansidar in the presence of nurses, and availability of fansidar in the clinics were all associated with utilisation of IPT/SP, (PO.001, PO.001, and P=0.012). Conclusion: The study revealed that utilisation of IPT/SP service in rural Chongwe and urban Lusaka Districts were very low. It is therefore recommended that health workers need to strengthen health education on the importance of IPT/SP of malaria to all pregnant women and at the same time to be vigilant so as to ensure that all pregnant women who visit the ANC are given the fansidar whenever they are due to have it using the DOT strategy. -IV-