title: Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria.
abstract: BACKGROUND
  Intermittent preventive treatment of malaria for pregnant women (IPTp) is a very important strategy for the control of malaria in pregnancy in malaria-endemic tropical countries, where mosquito bites easily occur during evening outdoor activities. Issues related to provision, cost, and acceptability may affect the use of IPTp in some developing countries. The aim of the study was to assess the uptake and adherence to sulphadoxine-pyrimethamine-based intermittent preventive treatment of malaria during pregnancy and the relationship of IPTp use to pregnancy outcomes in two major obstetric centers in South East Nigeria.
  
  
  METHODS
  This was a prospective descriptive study involving women who received antenatal and delivery services. All recruited women were followed-up from booking until delivery, and statistical analysis was done with Epi Info version 7.
  
  
  RESULTS
  A total of 516 parturients were studied. The mean gestational age at booking was 21.8±6.9 weeks while the mean number of antenatal visits throughout the pregnancy was 5.5±3.1. The rate of uptake of at least one dose of prescribed IPTp was 72.1% (367/516). Of the 367 who took prescribed IPTp, adherence to second doses of IPTp was 59.7% (219/367), and only 4.9% (18/367) took a third dose. Clinical malaria occurred in 85% (127/149) of women who did not receive IPTp at all compared to 20.5% of those who received at least one dose of IPTp. All those who had clinical malaria despite IPTp had only one dose of IPTp despite booking in the second trimester. Malaria in pregnancy occurred significantly more in women who failed to adhere to subsequent doses of IPTp than in those who adhered (24.6% versus 14.3%, respectively; risk ratio =2.5; 95% confidence interval 2.1, 3.0; P<0.001). Similarly, neonatal malaria occurred significantly more in neonates whose mothers did not receive IPTp compared to those whose mothers received at least one dose of IPTp (7.4% versus 3.4%; risk ratio =1.4; 95% confidence interval 0.9, 2.1; P=0.003).
  
  
  CONCLUSIONS
  More than one half of parturients failed to adhere to prescribed intermittent preventive treatment for malaria in pregnancy in the major obstetric centers in Abakaliki, South East Nigeria. The very high prevalence of malaria among women who failed to adhere to IPTp and the associated adverse neonatal outcomes demands more pragmatic ways of improving access to, and acceptability of, malaria preventive measures in this area.
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Azubike Kanario
authors.initials: AK
authors.lastname: Onyebuchi
authors.affiliation: School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Nigeria.
authors.forename: Lucky Osaheni
authors.initials: LO
authors.lastname: Lawani
authors.affiliation: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Chukwuemeka Anthony
authors.initials: CA
authors.lastname: Iyoke
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Chukwudi Robinson
authors.initials: CR
authors.lastname: Onoh
authors.affiliation: Department of Obstetrics and Gynecology, Mile Four Catholic Hospital, Abakaliki, Nigeria.
authors.forename: Nwabunike Ekene
authors.initials: NE
authors.lastname: Okeke
keywords: malaria in pregnancy; pregnancy outcome; prevention
references.citation: BMC Pregnancy Childbirth. 2012 Mar 29;12:21
references.pmid: 22458645
references.citation: Afr J Reprod Health. 2008 Dec;12(3):49-58
references.pmid: 19435012
references.citation: Niger J Clin Pract. 2013 Jul-Sep;16(3):292-6
references.pmid: 23771448
references.citation: Bull World Health Organ. 2008 Feb;86(2):93-100
references.pmid: 18297163
references.citation: PLoS Med. 2010 Jan 26;7(1):e1000221
references.pmid: 20126256
references.citation: Malar J. 2005 Jul 18;4:29
references.pmid: 16026623
references.citation: Am J Epidemiol. 1997 Nov 15;146(10):826-31
references.pmid: 9384203
references.citation: Bull World Health Organ. 2007 Nov;85(11):873-9
references.pmid: 18038078
references.citation: Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2 Suppl):28-35
references.pmid: 11425175