Uptake of Three or More Doses of Sulphadoxine Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy at Busia County Referral Hospital, Kenya

Abstract

Despite substantial efforts to control malaria globally, it has continued to be a health concern. Most malaria-related deaths are occurring in Sub-Saharan Africa, though it poses a threat to almost 50% of the world's population. Children and pregnant mothers are more susceptible to malaria infection and death, according to the Ministry of Health (MOH 2019) Kenya, hospitalized malaria cases among pregnant women can be as high as 60% in malaria endemic regions. It was projected to be 6.3% among women visiting their first antenatal care (ANC) visit. One evidence-based strategy for malaria control among pregnant mothers is taking of at least three IPTp-SP doses during the antenatal period. The uptake of up to three doses has however remained low. In 2021, globally, in 33 countries only 32% of all pregnant women received at least three doses of IPTp. In Kenya, only 49% in the Lake endemic region received up to three doses. There is a notable paucity of published evidence on determinants of uptake of three or more doses of IPTp-SP, especially in malaria endemic regions in Kenya. The study aimed to determine the prevalence and the individual and health system determinants of uptake of three or more doses of IPTp-SP at Busia County Referral Hospital, Kenya. This facility-based cross-sectional study targeted 384 mothers selected through consecutive sampling at the Maternity Unit during delivery for quantitative data. Additionally, 5 nurses from the Maternal and Child Health (MCH) Clinic were purposively selected to provide qualitative insights. Data were gathered using semi-structured questionnaires and key informant interviews. Quantitative data were analyzed using descriptive and inferential statistics, with findings presented through charts, graphs, and tables. The determinants were analyzed using both bivariate and multivariate logistic regression models, with results presented as odds ratios (ORs) and adjusted odds ratios (AORs). Statistical significance was determined at p < 0.05. Audio recordings from the qualitative interviews were transcribed verbatim and verified for accuracy. A deductive thematic analysis was then conducted to complement and enrich the quantitative findings. Majority of the mothers were aged between 20 – 25 years 33.6% (129/384), had secondary education as highest level 43.8% (168/384), married 79.9% (307/384), unemployed 52.9% (N = 87) and lived in the rural areas 92.2% (354/384). The prevalence of adherence to the recommended IPTP-SP dosage regimen was 43.0%. Individual factors that influenced uptake of IPTp3+ included starting the ANC visits in the first trimester (aOR = 2.1, 95% CI: 1.23 – 3.67, p = 0.046), making over 4 ANC visits (aOR = 3.1, 95% CI: 1.49 – 6.50, p = 0.002), a higher monthly income (aOR = 2.6, 95% CI: 1.24 – 5.36, p = 0.012), being aware of the IPTp-SP drugs benefits (aOR = 3.7, 95% CI: 1.40 – 9.74, p = 0.008), positive attitude on importance of ANC services even when not sick (aOR = 3.2, 95% CI: 1.61 – 6.31, p = 0.001). Health system factors that negatively influenced uptake were SP drug stock out (aOR = 0.24, 95% CI: 0.114 – 0.491, p < 0.001), longer distance to the ANC facility (aOR = 0.44, 95% CI: 0.206 – 0.649, p = 0.036), long waiting time in the facility and (aOR = 0.52, 95% CI: 0.305 – 0.877, p = 0.014). The prevalence of uptake of IPTp-SP in Busia County is still low with less than half of the pregnant mothers complying with WHO recommendations. The individual related factors that this study can report to have had an association with uptake of at least three doses of IPTp-SP drug were time when first ANC visit was made, number of ANC visits, level of income, mothers’ awareness about the IPTp-SP drug, and positive attitude on importance of antenatal clinics. Health system related factors that influenced IPTp-SP drug uptake were availability of the drug in the facility, long distance to the ANC facility, and long waiting time at the facility. There should be aggressive efforts to promote ANC attendance from an early stage and ensuring the drug is available at all times.