title: Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda.
abstract: BACKGROUND
  To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Uganda improved the antenatal care package by including a strong commitment to increase distribution of insecticide-treated nets (ITNs) and introduction of intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) as a national policy in 2000. This study assessed uptake of both ITNs and IPTp-SP by pregnant women as well as antenatal and maternity care use with the aim of optimizing their delivery.
  
  
  METHODS
  769 post-partum women were recruited from a rural area of central Uganda with perennial malaria transmission through a cross-sectional, community-based household survey in May 2005.
  
  
  RESULTS
  Of the 769 women interviewed, antenatal clinic (ANC) attendance was high (94.4%); 417 (57.7%) visiting initially during the 2nd trimester, 242 (33.5%) during the 3rd trimester and 266 (37.1%) reporting > or = 4 ANC visits. About 537 (71%) and 272 (35.8%) received one or > or = 2 IPTp-SP doses respectively. Only 85 (15.8%) received the first dose of IPTp-SP in the 3rd trimester. ITNs were used by 239 (31.3%) of women during pregnancy and 314 (40.8%) delivered their most recent pregnancy outside a health facility. Post-partum women who lacked post-primary education were more likely not to have attended four or more ANC visits (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2-9.3).
  
  
  CONCLUSIONS
  These findings illustrate the need to strengthen capacity of the district to further improve antenatal care and maternity services utilization and IPTp-SP uptake. More specific and effective community health strategies to improve effective ANC, maternity services utilization and IPTp-SP uptake in rural communities should be undertaken.
authors.affiliation: Clinical Epidemiology Unit, Faculty of Medicine, Makerere University, Uganda. skiwuwa@med.mak.ac.ug
authors.forename: Mpungu S
authors.initials: MS
authors.lastname: Kiwuwa
authors.forename: Patrobas
authors.initials: P
authors.lastname: Mufubenga
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D001512:Bedding and Linens; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004338:Drug Combinations; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007306:Insecticides; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D011739:Pyrimethamine / Q000627:therapeutic use; D012423:Rural Health; D013413:Sulfadoxine / Q000627:therapeutic use; D014454:Uganda
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D007306:Insecticides; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine