Evaluation of the use of intermittent presumptive treatment (IPT) for Malaria in pregnancy in Kilifi District, Kenya

Abstract

Malaria endemic countries have guidelines for malaria preventive measures in pregnancy (chemo prophylaxis or intermittent presumptive treatment (lPT)) and this is part of the antenatal care (ANC) package provided within the context of primary health care 1,2. The estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitaemia are a 5-12% reduction of low birth weight, an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g. infectious disease or poor nutrition during gestation) and 3-5 % reduction in infant mortality 3. Failure to gain this maximum benefit may result from operational constraints to delivering this intervention. A descriptive cross-sectional study was used to determine the factors that influence the delivery of IPT in Kilifi district, at the Kenyan coast. The study was carried out at sampled health facilities that included, Kilifi District Hospital, Vipingo health center, Ganze dispensary and Matsangoni dispensary all within Kilifi district. A total of 386 ANC client interviews, 337 maternity client interviews, 12 staff interviews and 20 different sets of observations of ANC client counseling sessions were done. A focus group discussion with the nurses at Kilifi District Hospital was also held. Despite IPT coverage being 1641333, 49.2% (proportion of clients receiving two or more doses of SP), only 47.7% (721151) of those who received two doses received the intervention as planned. 12.6% (191151) receiving both doses in the second trimester, 39.7% (601151) receiving both doses in the third trimester. It was also noted that 17.9% (271151) received both doses within less than four weeks interval. There was no association between the number of doses of SP and mean birth weight (p=0.426). IPT coverage was significantly associated with age of the mother (p<O.OOI), Number of ANC visits (p<O.OO1). and Parity (p=O.OO1). It was also influenced by staff attitude towards IPT. staff training on IPT guidelines and workload at the ANC clinic. The study suggests several strategies that could be used to increase the number of women who receive IPT appropriately. Strategies such as community-based approaches should be explored to complement facility based services. Women should be made aware of the importance of early and regular ANC clinic attendance. Refresher courses and retraining of health workers on IPT should be done to improve implementation.