title: Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study.
abstract: BACKGROUND
  Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women's compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria.
  
  
  METHODS
  A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Binary logistic regression was used to determine the factors associated with the use of SP-IPTp in the study population.
  
  
  RESULTS
  Use of SP-IPTp was self-reported by 41% of the total respondents. Lack of autonomy in the households to receive sulfadoxine-pyrimethamine (SP) during ANC was the main barrier to use of IPTp (83%). Other barriers were stock-outs of free SP (33%) and poor supervision of SP ingestion by directly observed treatment among those who obtained SP from ANC clinics (36/110 = 33%). In the multivariate logistic regression, the odds of using SP-IPTp was increased by the knowledge of the use of insecticide treated nets (ITNs) (OR = 2.13, 95% CI: 1.70-3.73) and SP (OR = 22.13, 95% CI: 8.10-43.20) for the prevention of MIP. Use of ITNs also increased the odds of using SP-IPTp (OR = 2.38, 95% CI: 1.24-12.31).
  
  
  CONCLUSIONS
  Use of SP-IPTp was low and was associated with knowledge of the use of ITNs and SP as well as the use of ITNs for the prevention of MIP. There is a need to strengthen PHC systems and address barriers to the usage of SP-IPTp in order to reduce the burden of MIP.
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria. sote_ameh@yahoo.com.|Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. sote_ameh@yahoo.com.
authors.forename: Soter
authors.initials: S
authors.lastname: Ameh
authors.affiliation: Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
authors.forename: Eme
authors.initials: E
authors.lastname: Owoaje
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
authors.forename: Angela
authors.initials: A
authors.lastname: Oyo-Ita
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Caroline W
authors.initials: CW
authors.lastname: Kabiru
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
authors.forename: Obaji E O
authors.initials: OEO
authors.lastname: Akpet
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
authors.forename: Aniekan
authors.initials: A
authors.lastname: Etokidem
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
authors.forename: Okokon
authors.initials: O
authors.lastname: Enembe
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
authors.forename: Nnette
authors.initials: N
authors.lastname: Ekpenyong
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D016015:Logistic Models; D008288:Malaria / Q000517:prevention & control*; D008875:Middle Aged; D009549:Nigeria; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
keywords: Barriers; Cross River State; Determinants; Intermittent preventive treatment of malaria in pregnancy; Nigeria; Sulfadoxine-pyrimethamine; Use