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Factors affecting the uptake of optimal doses of intermittent preventive treatment of malaria in pregnancy using sulfadoxine pyrimethamine in Ghana: new evidence from the 2019 malaria indicator survey
Authors: Desmond Klu & Lily Owusu
Source: Journal of Public Health
Topic(s): Malaria
Maternal health
Country: Africa
Published: JUL 2023
Abstract: Background: Globally, a significant proportion of women in areas with a high malaria burden are susceptible to the risk of malaria during pregnancy. The Ghana Health Service adopted an antimalarial policy that states that intermittent preventive treatment of malaria in pregnancy using sulfadoxine/pyrimethamine (IPTp-SP) shall be administered as directly observed therapy (DOT) monthly during antenatal care (ANC) until delivery. This study, therefore, examined the effect of individual, household and health related factors on the uptake of optimal doses of IPTp-SP for malaria in pregnancy in Ghana. Methods: Data for this study were obtained from the 2019 Ghana Malaria Indicator Survey (GMIS) conducted between September 25 and November 24, 2019. The weighted sample comprised 353 pregnant women aged 15–49 years. Data were analysed with the Statistical Package for Social Sciences (SPSS) version 25 using both descriptive and multinomial logistic regression modelling. Results: The study found that 30.5% of pregnant women took optimal (= 3) doses of IPTp-SP to prevent malaria. Pregnant women aged 15–24 (aOR = 0.25, 95% CI = 0.09–0.71) were 75% less likely to take optimal doses of IPTp-SP at health facilities than those aged 35–39. Similarly, pregnant women at 16 weeks of gestation (aOR = 0.40,95% CI = 0.20–0.80) were 60% less likely to take 3 or more SP doses than those between the gestational period 24 to 40 weeks. Again, pregnant women who tested negative for malaria (aOR = 0.04, 95% CI = 0.09–0.32) had lower odds of taking up 1–2 SP doses and 3 or more SP doses (aOR = 0.01, 95% CI = 0.04–0.43) than those who tested positive for malaria. Pregnant women who are not anaemic were 87% and 92% less likely to take 1–2 and 3 or more SP doses, respectively, to prevent malaria during pregnancy relative to pregnant women who are anaemic. However, pregnant women residing in urban areas were more likely (aOR = 2.22, 95% CI = 1.01–4.90) to take optimal IPTp-SP doses than those dwelling in rural areas. Conclusions: Significant reduction of malaria in pregnancy is highly determined by socio-demographic and health factors that affect pregnant women and crucial to the success of Ghana’s antimalarial drug policy. It is therefore recommended that the Ministry of Health, National Malaria Elimination Programme and Ghana Health Service take cognizance of these factors in planning and rolling out programmes towards improving IPTp-SP drug uptake among pregnant women.