DETERMINANTS OF USE OF INTERMITTENT PREVENTIVE TREATMENT AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE AT THREE LEVELS OF CARE IN OYO STATE

Abstract

The World Health Organization recommends consistent use of insecticide treated net (ITN) and intermittent preventive treatment using Sulphadoxine-pyrimethamine (IPTp-SP) as the two important preventive measures against malaria in pregnancy for use in highly endemic regions. Despite the effectiveness and safety of IPTp- SP, and the adoption of a national IPTp policy the uptake of lPTp-SP has been consistently low in Nigeria, many pregnant women are still at risk of malaria in pregnancy (MIP) and its related negative pregnancy outcomes. The NDHS 2013 revealed that Oyo State has the poorest compliance in the south west region with a compliance rate of 3%. This study therefore aims at identifying and comparing the determinants of preventive use of SP among pregnant women attending antenatal clinics at the three levels of health care facilities in Oyo State, Nigeria. This study is a cross sectional comparative survey among pregnant women attending antenatal care in tertiary, secondary as well as primary health care facilities in Oyo State. Four-hundred and seventy-four pregnant women attending antenatal clinics were interviewed; this comprises one hundred and fifty eight respondents at each of the three different facilities surveyed.Respondents were selected consecutively as they come in for antenatal care till the required number needed was reached. Data was collected using interviewer-administered questionnaire, three focus group discussions were held among eight pregnant women in each facility surveyed, the discussion was audio recorded. Information on socio-demographic characteristics, knowledge and perception on IPTp-Sp as well as use of IPTp-SP were obtained from the respondents. Descriptive statistics, Chi-square, Logistic regression were used to analyse quantitative data at 5% level of significance while content analysis was used for the qualitative data. Mean age and mean gestational age of the pregnant women was 28.2±5.6 years (range- 18.0 and 45.0years) and 31.1±3.1 weeks (range- 28.0 and 41.0 weeks), respectively. Three hundred and ninety-one (82.5%) of the respondents used IPTp while 17.5% did not use IPTp. Reasons given for non- use include, the drug not being offered or prescribed 34.9%, late/poor attendance to ANC 15. 7%, "just don't want to use" 18.1%,"being afraid of complications" 9.6%, " non- availability of the drug at the ANC" 9.6%, forgetfulness 9.6% and ''the drug could cause weakness 2.4%. Non-use otlPTp was highest among the THC attendees with a percentage of 21.5% followed by the PHC attendees with 18.4%. About half 241 (50.8%) had a poor perception on JPTp-SP and 42.6% had good knowledge on malaria and IPTp-SP. Poor knowledge about IPTp-SP(OR= 0.2, 95%CI=0.09-0.49)and regular keeping of ANC attendance ( OR= 3.8, 95%CI=1.92-7.64) were found to be statistically significantly associated with IPTp-SP use. The prevalence of non-use of IPTp-SP is lower than that reported in >IDHS.2013; the use of JPTp-SP among many pregnant women in this study is encouraging. However, for Oyo state to achieve the Roll Back Malaria target of 0% non-use, the providers practices must change positively and access as well as acceptability should be improved.