Factors associated with coverage of intermittent preventive treatment for Malaria in pregnancy in Bungoma County, Kenya.

Abstract

Background: The burden of malaria cases stands at 229 million, according to latest world malaria report, with about 94% of all cases and death reported in Africa. Globally, approximately 54.7 million pregnant women reside in areas with stable transmission of Plasmodium falciparum malaria. The IPT with sulfadoxine- pyrimethamine (IPTp-SP) is part of antenatal care services interventions for the prevention of malaria during pregnancy. Bungoma County recorded (43%) the least coverage in Lake Region malaria endemic counties. Objectives: The study determined coverage of IPTp of pregnant women with sulfadoxine-pyrimethamine and described socio-demographic, pregnancy related, health facility related, and cultural factors among women of 36 weeks gestation or more attending Antenatal care (ANC) services in Bungoma County, Kenya. Method: Both qualitative and quantitative studies were conducted using cross- sectional study design. A total of 362 pregnant women of 36 weeks and above gestation attending eight selected health facilities providing ANC services across the Bungoma County were interviewed. Data was collected using pretested structured questionnaire. Thirteen Key Informants (KII) were recruited across the selected sub- counties and interviews conducted using semi-structured interview guide and checklist to record observation. Descriptive analyses were done using measures of central tendency and dispersion for continuous variables and frequency for categorical variables. Multivariate analysis was performed to determine factors associated with IPTp-SP coverage. Adjusted odds ratios (AOR) were calculated, and 95% confidence intervals (CI) recorded with p values < 0.05 considered statistically significant. The qualitative data for KII was transcribed and the transcript analysed thematically. Result: The coverage of the recommended three or more doses of IPTp-SP among study participants was 47.3%. About 305(84.3%) respondents started their clinic late or missed the visits. Being catholic or protestant compared to being a Muslim and making three or more visits to the antenatal clinic increased doses of IPTp-SP. Shortage of health care workers at ANC, resulting in high workload, and stock out of IPTp-SP were recorded by Key Informants as reason for low coverage of IPTp-SP in Bungoma County. Conclusion: The use of IPTp-SP is sub-optimal. Pregnant women’s late timing of ANC attendance, missing ANC visits, shortage of healthcare workers and frequent IPTp-SP stock outs were the major barriers to IPTp-SP access. Three times or more antenatal care clinic visits increased IPTp-SP dosing. Recommendation: Continuous sensitization of pregnant women on the benefit of early ANC visits. Employment of more healthcare workers to reduce workload and the County to enhance uninterrupted supply of IPTp-SP in all health facilities providing ANC services.