Determinants of use of intermittent preventive treatment of malaria in pregnancy: Jinja, Uganda.
BACKGROUND
Maternal malaria is associated with serious adverse pregnancy outcomes. One recommended means of preventing malaria during pregnancy is intermittent preventive therapy (IPTp) with sulfadoxine/pyrimethamine (SP). We sought to identify determinants of preventive use of SP during pregnancy among recently pregnant women in Uganda. Additionally, we characterized the timing of and indications for the administration of SP at antenatal care (ANC) visits and missed opportunities for SP administration.


RESULTS
Utilizing a population-based random sample, we interviewed 500 women living in Jinja, Uganda who had been pregnant in the past year. Thirty-eight percent (192/500) of women received SP for the treatment of malaria and were excluded from the analysis of IPTp-SP. Of the remaining women, 275 (89.3%) reported at least two ANC visits after the first trimester and had an opportunity to receive IPTp-SP according to the Ugandan guidelines, but only 86 (31.3%) of these women received a full two-dose course of IPTp. The remaining 189 (68.7%) women missed one or more doses of IPTp-SP. Among the 168 women that were offered IPTp, 164 (97.6%) of them took the dose of SP.


CONCLUSIONS
Use of IPTp in Uganda was found to be far below target levels. Our results suggest that women will take SP for IPTp if it is offered during an ANC visit. Missed opportunities to administer IPTp-SP during ANC were common in our study, suggesting provider-level improvements are needed.
Department of Global Health, University of Washington, Seattle, Washington, USA. lsangare@u.washington.edu
Laura R
LR
Sangaré
Andy
A
Stergachis
Paula E
PE
Brentlinger
Barbra A
BA
Richardson
Sarah G
SG
Staedke
Mpungu S
MS
Kiwuwa
Noel S
NS
Weiss
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004338:Drug Combinations; D005260:Female; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D014454:Uganda; D055815:Young Adult
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine