The factors associated with the uptake of intermittent preventive treatment of Malaria in pregnancy in Nambale Sub-County Hospital, Kenya

Abstract

Background: Malaria remains a significant public health problem globally, with highest morbidity and mortality reported in sub Saharan Africa. In 2022, there were 12.7 million (36%) cases of Malaria in Pregnancy (MiP) in Sub Saharan Africa and 27% were reported from East Africa. In Kenya, there were a total of 4,080,441 malaria cases and 5% MiP cases. Busia County in Western Kenya reported 341,886 malaria cases and 22% MiP cases. WHO recommends administering intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) as preventive treatment for malaria in pregnancy (MIP) in malaria-endemic zones to prevent MiP. Objectives: To determine proportion of pregnant women of nine months’ pregnancy utilizing IPTp-SP 3 and to describe sociodemographic, health facility and individual factors influencing utilization of IPTp-SP 3 among pregnant women of nine months’ pregnancy attending antenatal care at Nambale Sub-County Hospital in Busia County. Methods: This was a cross-sectional study that employed consecutive sampling whereby, pregnant women of nine months, aged between 14-49 years were interviewed, using the interviewer- administered questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. A Descriptive of factors was done, Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with p value of ≤0.2, were subjected to multivariable logistic regression analysis to identify variables with p value of ≤0.05 associated with utilization of IPTp-SP among pregnant women. Results: A total of 384 pregnant women were interviewed. Their median age was 25 years (range of 14 – 49 years), 68% (262/384) were married and 90% (348/384) of all the participants resided in rural areas. More than half of the participants, 60% (232/384) utilized IPTp SP3. Awareness of use and the benefits of IPTp was reported by 93% (256/384) of participants. Majority of the respondents, 67% (258/384) were unemployed, and 47% (182/384) had secondary education as their highest level of education. In the bivariate analysis, participant age 21-30 years {cOR=2.34, 95% CI=1.4–3.7}, belief that >3 doses of IPTp prevented MiP {cOR=3.09, 95% CI=1.5–6.2}and participant having attained tertiary education {cOR=2.71, 95% CI=1.4–5.1} were associated with uptake of three or more doses of IPTp by the participants. On multivariable logistics regression analysis, attendance of ANC at least 4 times {aOR=8.42, 95% CI=4.4–16.0} and participants taking IPTp-SP for the first time at 14-17 gestation weeks {aOR=7.79, 95% CI=3.2 18.7} were factors independently associated with optimal utilization of IPTp (IPTp-SP3). Conclusion: A sub-optimal IPTp-SP 3 utilization (60%) way below WHO target recommendation of 80%. More than four ANC attendance with the first IPTp-SP uptake beginning 14-17 gestation weeks were independently associated with optimal utilization of IPTp (IPTp-SP3). Recommendation: Pregnant women attending ANC at the facility should ensure that they attend ANC at least four times and take at least three doses of IPTp for maximum protection against malaria in pregnancy. Enhanced risk communication and community engagement by the community health volunteers on IPTp-SP awareness and importance. Key Words: FELTP, IPTp-SP, Kenya, Malaria, Pregnancy, WHO