Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria.
BACKGROUND
Malaria during pregnancy is dangerous to both mother and foetus. Intermittent preventive treatment of malaria in pregnancy (IPTp) is a strategy where pregnant women in malaria-endemic countries receive full doses of sulphadoxine-pyrimethamine (SP), whether or not they have malaria. The Nigerian government adopted IPTp as a national strategy in 2005; however, major gaps affecting perception, uptake, adherence, and scale-up remain.


METHODS
A cross-sectional study was conducted in peri-urban and rural communities in Nasarawa and Cross River States in Nigeria. Study instruments were based on the socio-ecological model and its multiple levels of influences, taking into account individual, community, societal, and environmental contexts of behaviour and social change. Women of reproductive age, their front-line care providers, and (in Nasarawa only) their spouses participated in focus group discussions and in-depth individual interviews. Facility sampling was purposive to include tertiary, secondary and primary health facilities.


RESULTS
The study found that systems-based challenges (stockouts; lack of provider knowledge of IPTp protocols) coupled with individual women's beliefs and lack of understanding of IPT contribute to low uptake and adherence. Many pregnant women are reluctant to seek care for an illness they do not have. Those with malaria often prefer to self-medicate through drug shops or herbs, though those who seek clinic-based treatment trust their providers and willingly accept medicine prescribed.


CONCLUSIONS
Failing to deliver complete IPTp to women attending antenatal care is a missed opportunity. While many obstacles are structural, programmes can target women, their communities and the health environment with specific interventions to increase IPTp uptake and adherence.
FHI360, C-Change Project, Global Health Population and Nutrition Division, 1825 Connecticut Avenue, Washington DC, NW 20009, USA. cdiala@fhi360.org.
Chamberlain C
CC
Diala
Thaddeus
T
Pennas
Celeste
C
Marin
Kassahun A
KA
Belay
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D009549:Nigeria; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage*; D012424:Rural Population; D013383:Suburban Population; D013413:Sulfadoxine / Q000008:administration & dosage*; D055815:Young Adult
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine