The predictors of uptake of optimal doses of sulphadoxine pyrimethamine for intermittent preventive therapy of malaria during pregnancy among postpartum women in Tandahimba district, Tanzania

Abstract

Background Intermittent Preventive Treatment (IPT) using Sulphadoxine-Pyrimethamine (SP) has been shown to avert the adverse effects of malaria in pregnancy to both the mother and foetus. Although the new guidelines of optimal (≥3) doses of SP-IPTp have been implemented in Tanzania for the last 5 years, coverage of IPTp3+ has consistently remained low by 26%, conceivably due to a number of factors from the facility and client perspectives. The timing of first ANC visits and number of visits as well as other obstetric characteristics and socio demographic factors as predictors of optimal uptake of SP-IPTp have not fully been investigated. Other factors such as availability of SP, water and adequate cups for DOT as well as distance to the facility and knowledge of effects of malaria to the mother and unborn baby potentially affects uptake of optimal doses of SP-IPTp. This study appraised the predictors of uptake of optimal doses of SP- IPTp in Tandahimba district. Methodology: A quantitative facility based cross sectional study was conducted among 330 postpartum women in six randomly selected public health facilities from Tandahimba district in Tanzania from July to August 2019. Probability proportional to size was used to obtain representative samples from each facility. Data were analysed using SPSS version 22 and summarized by descriptive statistics, while bivariate logistic regression analysis was carried out to assess the association between independent with dependent variables. All independent variables with a P-value < 0.2 were subjected to multivariate logistic regression analysis while controlling for confounders by calculating the AOR. The level of significance was set at 5% (0.05) two-tailed at 95% CI. Results: A total of 330 postpartum women within 42 days were studied. The study revealed that 79.7% of respondents received optimal (≥3) doses of SP. Having married or living with partner (AOR 7.55, 95% CI3.79-15.05. attending ANC clinic four or more visits (AOR 4.97, 95%CI 2.46-10.03) and walking < 30 minutes from home (AOR 2.52, 95%CI 1.24-5.12) were found to be more likely associated with the uptake of optimal doses of sulphadoxine pyrimethamine. Conclusion and recommendation: This study has demonstrated that having married or living with partner, attending ANC clinic four or more visits and short distance from home to facility with ANC can significantly influence the uptake of optimal doses of sulphadoxine xii pyrimethamine. Hence, advocacy and sensitization for ANC visits for pregnant women, construction of health facility near community residence and importance of swallowed SP infront of health care providers should be strengthened through all stakeholders (MoHCDGEC, CHMT, community and USAID Boresha Afya) worked in Tandahimba district for improving higher uptake of optimal SP-IPTp. However since this study focused on the clients perspectives further studies are needed to examine the facility and providers factors that might contribute to promotion of uptake of ≥ 3 IPTp-SP.