UTILIZATION OF INTERMITTENT PREVENTIVE TREATMENT FOR MALARIA BY WOMEN ATTENDING ANTENATAL CLINICS IN PRIMARY HEALTH CARE CENTRES IN OGBOMOSO, OYO STATE NIGERIA

Abstract

Intermittent preventive treatment (IPT) is a key component of malaria control strategy in Nigeria and sulfadoxine-pyrimethamine (SP) is the drug of choice, IPT with SP has been shown to reduce the risk of maternal anemia, placental parasitaemia and low birth weight. The 2013 Nigeria Demographic and Health Survey revealed that 10.5% of pregnant women took at least two doses of SP in the southwestern zone, with the least proportion (3.0%) from Oyo State. Despite the evidence of the effectiveness of lPT strategy using SP in reducing the adverse effects of malaria during pregnancy the uptake and coverage in the southwestern zone of Nigeria is low. Thus this study assessed the utilization of IPT among pregnant women attending primary healthcare centres in Ogbomoso, Oyo State and identified factors influencing uptake. This was a cross-sectional survey conducted between March and April 2015 among 450 pregnant women selected from six primary health care centers using multistage sampling technique. Four hundred and thirty pregnant women were however interviewed using a pre-tested, semi-structured questionnaire to obtain data on socio-demographic characteristics, obstetric history, knowledge on IPT, attitude towards IPT use and utilization of IPT. Six focus group for the pregnant women (FGD), six key informant interviews (KII) for the healthcare workers and observation checklist were carried out. Data was summarized using frequencies, means and proportions. Chi square was used to compare proportions for categorical variables. Multivariate analysis using binary logistic regression was used to determine the predictors of IPT use and level of statistical significance was set at p value <0.05. Mean age of respondents was 27.2 years ±5.5SD. Mean gestational age was 29.5 weeks ±5.4SD. Three hundred and twenty (80.0%) took SP, out of which 122 (38.0%) took 2 doses and 111 (34.7%) took the drug under observation in the health facility. One hundred and twenty two (41.5%) with 2-4 antenatal care (ANC) visits had good utilization, 133 (45.7%) with good knowledge on IPT significantly had good IPT utilization and those with positive attitude 99 (42.1%) significantly had good IPT utilization. Also 62 (44.3%) skilled employees and 138 (50.0%) who took the first SP dose during the second trimester significantly had good utilization. Determinants of IPT utilization were; more than one ANC visit (aOR=5.64; CI: 1.19-26.63 ), knowledge on IPT (aOR=0.53; CI: 0.40-0.71), attitude towards IPT (aOR=2.11; CI: 1.52-2.93), occupation (aOR=1.37; CI: 1.08-1.73) and gestational age (aOR=11.57; CI: 5.66-23.67). The FGD revealed that IPT drugs were also taken at home. Utilization of IPT in the study was low due to late ANC booking despite good knowledge and positive attitude to intermittent preventive treatment. Also there was non-adherence to the practice of DOT scheme at most of the health facilities. Early registration for antenatal care and adherence to the practice of DOT scheme are recommended to improve utilization of intermittent preventive treatment during pregnancy.