Abstract:
Background: Insecticides Treated Nets (ITNs) and Intermittent Preventive Therapy with two doses of Sulfadoxine-Pyrimethamine (SP IPTp) are the cornerstone for malaria control in pregnancy. Although the coverage of these interventions is high, it is not known whether they confer optimal protection time against malaria in pregnancy. Optimal protection time to the baby against placental malaria only occurs when these interventions are used for the entire period when the baby is at the greatest risk to placental malaria. Placental malaria is known to peak in the 2nd trimester; thus for ITNs to confer optimal protection an ITN must be obtained in the 1st antenatal clinic visit between the 12th to 18th weeks of pregnancy while two SP doses must be received in the 2nd visit between the 16th to 24th weeks and in the 3rd visit between the 28th & 34th weeks of gestation. This study investigated the timing of SP &ITNs uptake during pregnancy, the determinants of timely uptake and pregnancy time protected.
Methods: A facility based quantitative cross-sectional study was carried out in Bukoba urban district from 16th April to 29 May 2013. Pregnant women and post natal mothers attending in the Reproductive & Child Health (RCH) clinics of three health facilities were included in the study. Using questionnaire they were asked a series of closed questions about their socio-economic background, pregnancy history and attendance to RCH clinics in the antenatal period. They were also interviewed on the receipt of a voucher and acquisition of an ITN as well as receipt of SP for IPTp; their responses were validated from the records of antenatal cards.
Results: A total of 530 women were recruited into the study. The overall uptake of SP IPTp was 96%, uptake of two SP doses was 86%; only a small percentage (14%) received a single SP dose reasons being unavailability of SP and late antenatal booking. Out of 508 who received SP IPTp, 370 (72.8%) received 1st dose timely. Timely uptake of 1st dose was predicted by early antenatal booking, [OR.1.40 (1.23-1.69) P=0.001], and the availability of SP at the facility [OR.5.28 (2.78-10.008) P=0.000]. Uptake of 2nd dose was independent of any predictor factors. A total of 486 (91.6%) women received ITNs discount vouchers at different gestations; of these less than a quarter (21.4%) received the voucher timely.
Timely receipt of discount voucher was highly predicted by early antenatal booking [OR349 (116-512.86) P=0.000].
Conclusion: Although there is high coverage of SP IPTp & Discount vouchers for ITNs, timely uptake and therefore optimal protection time depended on early antenatal booking, the availability of (SP IPTp) and discount voucher at the facility.
