UPTAKE OF INTERMITTENT PREVENTIVE THERAPY IN MALARIA AMONG PREGNANT WOMEN IN NIGERIA
In Africa, malaria is highly endemic and is the leading cause of morbidity and mortality. It contributes 4–19% to low birth weight, 3–15% to maternal anemia, and 3–8% to infant deaths, while maternal anemia contributes 7–18% to low birth weight.Chukwu (2020) The impact of malaria prevention in pregnancy using chemoprophylaxis with routine anti-malarial drugs and intermittent preventive treatment (IPT) with sulfadoxine–pyrimethamine (SP) is well documented.R.W. Steketee, B.L. Nahlen, M.E. Parise, C. Menendez (2019)IPT with SP has been shown to reduce malaria episodes, maternal parasitemia, anemia, and the incidence of low birth weight.R.W. Steketee, B.L. Nahlen, M.E. Parise, C. Menendez(2019) The beneficial effects of IPT are more pronounced among primigravidae and secundigravidae as compared to multigravidae women.13, 16, 17 In Kenya, it was demonstrated that IPT with SP could reduce severe anemia among primigravidae by 39%.7 As a result of these studies, the World Health Organization (WHO) recommends that all pregnant women living in malaria endemic areas be given malaria chemoprophylaxis or IPT with SP.18
Despite implementation of IPT, poor accessibility and use are reported. In Malawi, although 90% of the pregnant women knew that SP was recommended during pregnancy, only 36% received the recommended two-dose regimen.19 Similarly, in Kenya, despite 96% of the providers being aware of IPT with SP, only 5% of the pregnant women received SP and constraints in commodity supply and high costs of accessing services were cited.Elsewhere, low use and adherence to IPT has also been attributed to late antenatal care attendance.
Data on community-based approaches with IPT are limited. In Kenya and The Gambia, village health volunteers and traditional birth attendants (TBAs) provided malaria chemoprophylaxis to pregnant women and were successful in reducing malaria episodes and parasitemia, and increasing birth weight of babies and maternal hemoglobin levels. However, these studies were randomized and did not assess how these resource persons could provide chemoprophylaxis under a normal health-seeking behavior pattern. We designed a study to assess a community-based delivery of IPT for malaria prevention in pregnancy through TBAs, drug shop vendors (DSVs), adolescent peer mobilizers (APMs) and community reproductive health workers (CRHWs). The main objective of the study was to assess the effect of this novel delivery system on access and use of IPT, and its effect on maternal parasitemia, anemia and low birth weight.