USE OF INTERMITTENT PREVENTIVE TREATMENT OF MALARIA AMONG WOMEN ATTENDING FEE PAYING AND FREE ANTENATAL CLINICS IN SELECTED LOCAL GOVERNMENT AREAS IN PARTS OF OYO STATE

Abstract

Malaria in pregnancy is a public health concern. Studies show that use of Intermittent Preventive Treatment(IPT) of Malaria in pregnancy using Sulphadoxine-Pyrimethamine (S.P) and Insecticide Treated Bednets (ITNs)as Roll Back Malaria(RBM)interventions can substantially reduce malaria related morbidity. RBM policy of providing every pregnant woman attending government Ante Natal Clinics (ABCs) free S-P and those with first pregnancies, free ITN as incentives exclude those attending private ANCs. Few studies have considered the malaria knowledge and benefits of chemoprophylaxis in pregnancy, constraints to IPT access and how these factors influence willingness to adopt the intervention. This study assessed the factors that influence the adoption of IPT by pregnant women attending ANCs in Akinyele, Ibadan South-East and Ibadan North Local Government Areas in Oyo State. The study was a cross-sectional survey. Three hundred and five women, who received both S-P and ITN and delivered at the fee paying and free ANCs were selected using stratified sampling technique. The study sample consists of respondents who attend fee paying 202(66%)and free ANCs 103(34%). Data collection was by means of a pre-tested, semi-structured questionnaire administered at the respondents' homes. Issues explored in the questionnaire included respondents' socio-demographic characteristics, malaria knowledge and perception, vulnerability, cost and willingness to adopt IPT, Data were analysed using SPSS 10.0 for windows.

The mean age of the respondents in Fee Paying ANC and Free ANC were 28.7 years (SD 4.77) and 27.8 years (SD 4.94) respectively. Overall, 287(94%) of them were married and 242(79%) had post primary education. The mean score based on a 5-point malaria knowledge scale was 2.75 (SD 0.80). The FP-ANC group had a higher mean knowledge score of 2.67 (SD 0.89). The mean knowledge scores based on an 8 point scale relating to the benefits of chemoprophylaxis among the FP-ANC and F-ANC respondents were 2.11 (SD 0.48) and 2.18 (SD 0.46) respectively (p 0.01). Furthermore, 24 (11.9%)of the respondents from TP-ANC and three from F-ANC consistently slept under nets. 188(93%) of the respondents from FP-ANC and 16(15.5%)from F-ANC were willing to pay for S-P and ITNs during future pregnancies. Barriers to ITN use among FP-ANC respondents included lack of skill on net use 52(26%), use of other preventive measures 58(29%)and perception that ITN use is only for the sick 61(30%). The barriers among F-ANC respondents were the use of alternative preventive measures 15(15%), cost (37%)and non-availability of ITN 27(26%). Respondents' willingness to use S-P and ITN in the future was significantly related to knowledge of malaria (p 0.00), knowledge of chemoprophylaxis (p 0.04, parity (p=0.00) and occupation (p 0.00). The study shows that the respondents had a fair knowledge of malaria causation,prevention and benefits of chemoprophylaxis. Malaria programme managers should promote compliance with RBM policy regarding malaria prevention in pregnancy. They should also promote health education programmes aimed at upgrading expecting mothers' knowledge and skills relating to malaria prevention in pregnancy.