Implementation of intermittent preventive treatment with sulphadoxine-pyrimethamine for control of malaria in pregnancy in Kisumu, western Kenya.
OBJECTIVE
In 1998, the Kenyan Ministry of Health introduced intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), one treatment dose in the second trimester (16-27 weeks) and one treatment dose between 28 and 34 weeks of gestational age, for the control of malaria in pregnancy. We evaluated the coverage and determinants of receipt of IPT after its introduction in the Provincial Hospital in Kisumu, western Kenya.


METHODS
Information on the use of IPT in pregnancy was collected from women who attended the antenatal clinic (ANC) and delivered in the same hospital. In exit interviews, we assessed patterns of IPT use in the ANC.


RESULTS
Of 1498 women who delivered between June 1999 and June 2000, 23.7%, 43.4% and 32.9% received > or =2, 1 or no dose of SP, respectively. Late first ANC attendance was the most important factor contributing to incomplete IPT; 45% of the women started attending ANC in the third trimester. More women received at least one tetanus toxoid immunization than at least one dose of IPT (94%vs. 67%, P < 0.05). In exit interviews, 74% correctly associated IPT with treatment of malaria; however, knowledge on the need for the second dose was poor. Three per cent of the administrations were given despite contraindications. The agreement between gestational age by date of last menstrual period and by palpation was low (kappa = 0.1).


CONCLUSIONS
Education of pregnant women and ANC staff to increase earlier attendance for ANC has the potential to substantially increase the proportion of women receiving two doses of IPT with SP.
van Eijk
Anna M
AM
Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya. avaneijk@kisian.mimcom.net
Ayisi
John G
JG
ter Kuile
Feiko O
FO
Slutsker
L
L
Otieno
Juliana A
JA
Misore
Ambrose O
AO
Odondi
J O
JO
Rosen
Daniel H
DH
Kager
Piet A
PA
Steketee
Rick W
RW
Nahlen
Bernard L
BL
D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D001294:Attitude to Health; D001364:Awareness; D004338:Drug Combinations; D005260:Female; D005865:Gestational Age; D006801:Humans; D016778:Malaria, Falciparum / Q000517:prevention & control* / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control* / Q000523:psychology; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D011739:Pyrimethamine / Q000008:administration & dosage*; D013413:Sulfadoxine / Q000008:administration & dosage*
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine