title: Knowledge of malaria influences the use of insecticide treated nets but not intermittent presumptive treatment by pregnant women in Tanzania.
abstract: BACKGROUND
  To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Tanzania has recently adopted a policy of intermittent presumptive treatment for pregnant women using sulphadoxine-pyrimethamine (IPTp-SP). In addition, there is strong national commitment to increase distribution of insecticide treated nets (ITNs) among pregnant women. This study explores the determinants of uptake for both ITNs and IPTp-SP by pregnant women and the role that individual knowledge and socio-economic status has to play for each.
  
  
  METHODS
  293 women were recruited post-partum at Kibaha District Hospital on the East African coast. The haemoglobin level of each woman was measured and a questionnaire administered.
  
  
  RESULTS
  Use of both interventions was associated with a reduced risk of severe anaemia (Hb<8 g/dL) compared to women who had used neither intervention (OR 0.31, 95% CI 0.14-0.67). In a logistic regression model it was found that attendance at MCH health education sessions was the only factor that predicted IPTp-SP use (OR 1.8, 95% CI 1.1-2.9) while high knowledge of malaria predicted use of ITNs (OR 2.3, 95% CI 1.1-4.9).
  
  
  CONCLUSIONS
  Individual knowledge of malaria was an important factor for ITN uptake, but not for IPTp-SP use, which was reliant on delivery of information by MCH systems. When both these interventions were used, severe anaemia postpartum was reduced by 69% compared to use of neither, thus providing evidence of effectiveness of these interventions when used in combination.
authors.affiliation: Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania. rhoidanganda@yahoo.com <rhoidanganda@yahoo.com>
authors.forename: Rhoida Y
authors.initials: RY
authors.lastname: Nganda
authors.forename: Chris
authors.initials: C
authors.lastname: Drakeley
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: Tanya
authors.initials: T
authors.lastname: Marchant
mesh_terms: D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D000962:Antimalarials / Q000627:therapeutic use*; D001512:Bedding and Linens / Q000145:classification / Q000706:statistics & numerical data; D004338:Drug Combinations; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D009032:Mosquito Control / Q000379:methods; D016017:Odds Ratio; D010353:Patient Education as Topic; D049590:Postpartum Period; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013413:Sulfadoxine / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine