title: Validity of self-reported use of sulphadoxine-pyrimethamine intermittent presumptive treatment during pregnancy (IPTp): a cross-sectional study.
abstract: BACKGROUND
  Malaria in pregnancy is a major health problem that can cause maternal anaemia, stillbirth, spontaneous abortion, low birth weight and intra-uterine stunting. The WHO recommends use of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) in endemic areas. Towards monitoring and assessing IPTp coverage in the population, the Roll Back Malaria Partnership recommends the use of self-reported data. The aim of this study was to assess the validity of self-reported IPTp by testing for sulphadoxine in maternal blood at delivery.
  
  
  METHODS
  Two hundred and four pregnant women were consented and enrolled in a cross-sectional study in Mulago National Referral Hospital in Kampala Uganda. - Participants who reported a history of taking sulpha-containing drugs like co-trimoxazole , those who were not sure of dates relating to last menstrual period or who took IPTp within the first 20 weeks of gestation were excluded from the study. Data on demographic characteristics, obstetric history, and delivery outcome were collected. At birth, maternal venous blood was taken off aseptically and used to make thick blood smears for malaria parasites and plasma for determining sulphadoxine using high performance liquid chromatography (HPLC).
  
  
  RESULTS
  Of 120 participants who self reported to have used IPTp, 35 (29.2%) tested positive for sulphadoxine by HPLC, while 63 (75%) of 84 patients who reported not having used IPTp tested negative for sulphadoxine. Participants possessing post-primary education were more likely to have reported using IPTp. The low agreement (kappa coefficient = 0.037) between self-report and actual presence of the drug in the blood casts doubt on the validity of self-reported data in estimating IPTp coverage.
  
  
  CONCLUSIONS
  The results of this study question the accuracy of self-reported data in estimating IPTp coverage in the population. More studies on validity of self reported data are recommended. Since the validity of IPTp self reports is vital for guiding policy on malaria control in pregnancy, ways should be sought to improve accuracy of the information from such reports.
authors.affiliation: Department of Biochemistry, Makerere University, Kampala, Uganda.
authors.forename: Fatuma
authors.initials: F
authors.lastname: Namusoke
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ntale
authors.forename: Mats
authors.initials: M
authors.lastname: Wahlgren
authors.forename: Fred
authors.initials: F
authors.lastname: Kironde
authors.forename: Florence
authors.initials: F
authors.lastname: Mirembe
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000032:analysis; D001769:Blood / Q000469:parasitology; D018890:Chemoprevention / Q000379:methods; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D010949:Plasma / Q000737:chemistry; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000032:analysis; D012651:Self Medication / Q000379:methods*; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000032:analysis; D014454:Uganda; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine