Knowledge of malaria influences the use of insecticide treated nets but not intermittent presumptive treatment by pregnant women in Tanzania.
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.
Nganda
Rhoida Y
RY
Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania. rhoidanganda@yahoo.com <rhoidanganda@yahoo.com>
Drakeley
Chris
C
Reyburn
Hugh
H
Marchant
Tanya
T
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
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine