Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda.
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.
Kiwuwa
Mpungu S
MS
Clinical Epidemiology Unit, Faculty of Medicine, Makerere University, Uganda. skiwuwa@med.mak.ac.ug
Mufubenga
Patrobas
P
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
D000962:Antimalarials; D004338:Drug Combinations; D007306:Insecticides; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine