Knowledge and Perceived Barriers towards Intermittent Prevention of Malaria in Pregnancy: A Cross-Sectional Study

Background: Intermittent prevention of malaria is a key strategy adopted globally to ensure the wellbeing of pregnant women. By extension, these strategies enhance the healthy development of the fetus. This study assesses the knowledge and practices of pregnant women towards intermittent malaria prevention strategies in the Juaben Government Hospital of Ghana. Methods: A cross-sectional, quantitative, descriptive survey was conducted among 120 pregnant women at the antenatal clinic of the Juaben Government hospital in the Ashanti region of Ghana using a simple random sampling technique in selecting the study participants. The participant response rate was 94.5%. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Majority (54.2%) of respondents were between 20 - 29 years of age. Majority of study respondents attended Antenatal visits in their first trimester of pregnancy. Majority (69.2%) have knowledge of malaria preventive strategies in pregnancy, with about 70% of respondents stating these strategies were designed only for pregnant women. Only 37.5% of study respondents could rightly identify the chemoprophylaxis indicated for malaria prevention in pregnancy. Whereas majority (93.3%) of respondents owned insecticide-treated mosquito nets, only 63.3% utilized these nets for their purpose. Barriers to utilization of insecticide-treated nets include difficulty in setting up the nets (26.7%), using mosquito coils (10.8%), and feeling uncomfortable sleeping in the nets (36.7%). Barriers to taking malaria prophylaxis include distance to health facilities (28.3%), thoughts of not being sick with malaria (55.8%), using herbs (10.0%), and not being aware of the essence of prophylaxis (7.5%). Conclusion: Knowledge of malaria preventive strategies in pregnancy is high. However, utilization of these strategies is low due to perceived human and institutional barriers. A comprehensive community-wide approach is required to improve the utilization of these services among pregnant women.

Prevalence and Individual-Level Determinants of Uptake of Three or More Doses of Sulphadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Busia County, Kenya

Background: Malaria in pregnancy causes maternal anemia, low birth weight, intrauterine growth retardation, and preterm deliveries. In malaria-endemic regions in Kenya, percentage of pregnant women hospitalized with malaria reach up to 60%. WHO recommends at least three doses of sulphadoxine pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) antenatally. This study sought to ascertain the prevalence and individual-level factors influencing the uptake of IPTp-SP3+. Methods: A facility-based cross-sectional study at Busia County Referral Hospital. 384 mothers were consecutively sampled at the maternity unit during delivery. Semi-structured questionnaires were used to collect data. Odds ratio (OR) and adjusted OR were used to determine statistical significance of individual factors influencing uptake of three or more IPTp-SP. Results: 43.0% of participants took IPTp-SP3+. Individual factors that affected the uptake of IPTp-SP3+ included starting ANC visits in the first trimester (adjusted odds ratio (aOR) = 2.1, 95% CI: 1.23 – 3.67, p = 0.046), having more than four ANC visits (aOR = 3.1, 95% CI: 1.49 – 6.50, p = 0.002), having a higher monthly income (aOR = 2.6, 95% CI: 1.24 – 5.36, p = 0.012), being aware of the advantages of IPTp-SP medications (aOR = 3.7, 95% CI: 1.40 – 9.74, p = 0.008), and having a positive attitude toward ANC services (aOR = 3.2, 95% CI: 1.61 – 6.31, p = 0.001). Conclusion: Less than half of the pregnant mothers are complyingIPTp-SP3+. There should be aggressive efforts by the County and National Ministries of Health promoting initiation of ANC attendance early and attendance of all the recommended eight visits together with ensuring availability of the drugs.

Low Birth Weight and Intermittent Preventive Treatment of Malaria in Pregnant Women in Lomé (Togo) in 2021: A Cross-Sectional Study

Background: Since 2012, the World Health Organization has recommended intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) to prevent malaria-related complications in pregnant women. Ten years following these recommendations, we conducted this study to estimate the coverage for three doses of IPT-SP (IPT3) as well as the prevalence of low birth weight (LBW), and its associated factors in Lomé (Togo) in 2021. Methods: A cross-sectional study was conducted between January and March 2021. An exhaustive recruitment of women and their newborns was carried out in the maternity wards of the Sylvanus Olympio University Hospital Center. Data from antenatal consultations and clinical data of the newborns were collected. Multivariate logistic regression was carried out to determine factors associated with LBW. Results: A total of 252 mother-child pairs were included in this study. Median age of the mothers was 27 years, IQR [24-31]. More than a third (35.3%) of the mothers were primigravida. IPT3 coverage was 66.7% and 14.7% of newborns had a LBW. The prevalence of LBW was 33.3% [23.3-43.4] in women who had received fewer than 3 doses of IPT-SP and 5.4% [2.0-8.8] in those who had received at least 3 doses of IPT-SP (p Conclusion: Ten years following recommendations of the WHO on IPT-SP, malaria prevention based on IPT-SP is not optimal among pregnant women in Lomé, and the proportion of LBW children remains high. Actions to strengthen the three-dose IPT-SP policy are needed to prevent malaria and its consequences among newborns in Togo.

Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia(2006–2012):Potential determinants and highlight of lessons learnt

Objective:To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment(IPTp), given to pregnant women as early as possible during the second trimester in Zambia.Methods: Data from four national malaria surveys(2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics(ANCs) who received two or more doses of sulfadoxine–pyrimethamine(IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake.Results: The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9% in 2006; and to 72% by 2012(P < 0.001), and overall the uptake was 1.41 times higher in 2012 compared to 2006. From 2006 to 2012,IPTp2 uptake among women with no formal education increased from 51% to 68%(P < 0.1). Likewise, uptake among pregnant women with the lowest wealth index increased from 58.2% to 61.2%. By 2012, IPTp uptake among pregnant women within the lowest wealth index increased to a similar level as the women with high wealth index(P = 0.05). Incidence of malaria cases, hospital admissions and mortality during pregnancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas(OR = 1.56, 95% CI: 1.39–1.74), having college(OR = 1.83,95% CI: 1.25–2.75) or secondary education(OR = 1.68, 95% CI: 1.44–1.96) or of being of higher wealth status(OR = 1.86, 95% CI: 1.60–2.17).Conclusions: Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities.

Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine: An in silico pharmacological model

Objective:To explore the efficacy of intermittent preventive treatment in pregnancy(IPTp)with sulfadoxine and pyrimethamine(SP)against sensitive parasites.Methods:A pharmacological model was used to investigate the effectiveness of the previous recommended at least two-dose regimen,currently recommended three-dose regimen and 4,6,8-weekly regimens with specific focus on the impact of various nonadherence patterns in multiple transmission settings.Results:The effectiveness of the recommended three-dose regimen is high in all the transmission intensities,i.e.>99%,98%and 92%in low,moderate and high transmission intensities respectively.The simulated 4 and 6 weekly IPTp-SP regimens were able to prevent new infections with sensitive parasites in almost all women(>99%)regardless of transmission intensity.However,8 weekly interval dose schedules were found to have 71%and 86%protective efficacies in high and moderate transmission areas,respectively.It highlights that patients are particularly vulnerable to acquiring new infections if IPTp-SP doses are missed.Conclusions:The pharmacological model predicts that full adherence to the currently recommended three-dose regimen should provide almost complete protection from malaria infection in moderate and high transmission regions.However,it also highlights that patients are particularly vulnerable to acquiring new infections if IPTp doses are spaced too widely or if doses are missed.Adherence to the recommended IPTp-SP schedules is recommended.

Comprehension of Risk Factors of Malaria during Pregnancy among Pregnant Women Attending Antenatal Care in Malawi

A study was conducted to determine the comprehension of pregnant women on malaria risk factors during pregnancy. Comprehension of Malaria risks is important to ensure compliance to prevention methods and treatment by the pregnant women and hence optimizes the pregnancy outcomes. The study was conducted in 2012 at three health facilities, Queen Elizabeth Central Hospital, Ndirande health Centre and St. Joseph Mission Hospital in Malawi. The study design was descriptive and utilized quantitative data collection and analysis methods on a random sample of 316 antenatal mothers. The study targeted antenatal mothers who were aged between 15 and 49 years, in the gestation period of 28 to 36 weeks and able to converse in English or vernacular language. A structured questionnaire was used to collect data which were analyzed using SPSS version 16.0. Most of the participants (79.4%, n = 251) knew the risk factors of malaria during pregnancy but very few (18.4%, n = 58) knew about intermittent prevention treatment despite taking SP as prescribed. The motivation factors for taking SP were husband support and the desire to protect their babies and themselves from Malaria. Although the comprehension of the intermittent prevention treatment among the women was low, the women were motivated to adhere to the treatment when instructed by the healthcare workers due to the desire for good health for themselves and their unborn babies. Husbands were the most significant other that motivated the pregnant women to adhere to treatment. Results show that there is a need for healthcare workers to facilitate comprehension of intermittent prevention treatment among pregnant mothers.

Knowledge and Practices of Pregnant Women on Malaria Prevention in Brazzaville

Introduction: Since the deployment of preventive measures against malaria in pregnant women in Congo, the coverage rates in Intermittent Preventive Treatment for malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) and Long Lasting Insecticidal Nets (LLINs) remain low compared to the objectives set by WHO. This study aimed to analyze the knowledge and practices of pregnant women in the prevention of malaria in Brazzaville. Population and Method: This is an analytical cross-sectional study, conducted from September 15th to October 30th, 2021. The sample consisted of pregnant women who performed at least three antenatal care consultations one month apart each;obtained from a two-stage random sample. Data were collected from a self-administered questionnaire and analyzed with Epi-Info version 7.2.6 software. The odds-ratios and their 95% confidence intervals were calculated to assess the associations between the variables. Results: A total of 331 pregnant women were selected. The mean age was 27 years (22;31). Most women were single (82.8%), multiparous (63.4%) and 74.9% had secondary level education. The level of knowledge was insufficient in 53.8% of respondents;nearly 64.7% had good preventive practices. Pregnant women with no education are 8 times more likely to have insufficient knowledge of malaria prevention (OR = 8.33 [2.02 - 34.17];p = 0.0036). Also, those whose gestational age is between 22 - 27 weeks are 2.54 times more likely to have insufficient knowledge than those with gestational age of 36 weeks and above (OR = 2.54 [1.33 - 4.46], p = 0.0071). Conclusion: It is important to strengthen the awareness in order to bring pregnant women to improve their knowledge of malaria prevention and change their behavior.

Intermittent Preventive Treatment in Pregnancy with Sulphadoxine-Pyrimethamine Does Not Have Effect on Maternal Hemoglobin at Delivery and Birth Weight in Kisangani, Democratic Republic of Congo

Background: The consequences of malaria during pregnancy are different regarding local conditions of malaria transmission. In stable malaria areas, the main complications are maternal anaemia and fetal growth restriction. This study aims to determine if pregnancy-associated malaria is associated with the risk of the above-mentioned complications and to determine if IPTp-sp reduces them in Kisangani. Methods: It is a cross-sectional analytical study conducted in parturients, in 6 medical facilities of Kisangani, from January 1st to September 30th, 2017. At delivery we measured their hemoglobin, we performed the thick blood smear of their peripheral blood and placental apposition;and we weighed their newborns at birth. Results: Risk of anaemia at delivery increased with malaria access during pregnancy (p = 0.0056;OR: 1.4221, 95% CI: 1.0851 - 1.8638) and peripheral parasitaemia at delivery (p = 0.0000;OR: 6.3855, 95% CI: 4.5552 - 8.9512). LBW increased with peripheral parasitaemia at delivery (p = 0.0000;OR: 3.5299, 95% CI: 2.4424 - 5.1015) and placental parasitaemia (p = 0.0000;OR: 18.3247, 95% CI: 12.5141 - 26.8332). IPTp-sp did not have effect on maternal hemoglobin at delivery (p = 0.1546;OR: 0.7553, IC à 95%: 0.4414 - 1.2923) and the birth weight (p = 0.1225;OR: 0.6638, IC à 95%: 0.3375 - 1.3056). Conclusion: In Kisangani, pregnancy-associated malaria is associated with maternal anaemia at delivery and LBW. IPTp-sp does not reduce the risk of these complications. Therefore, studies evaluating IPTp alternatives are required in malaria endemic areas.

Prescription of intermittent preventive therapy (IPTp) among doctors practicing in an army hospital in Lagos, Nigeria

Background: Malaria infestation in pregnancy is a major public health concern and ranks amongst the commonest complications of pregnancy in Nigeria. Approximately 50,000 Nigerian women die each year from largely preventable pregnancy related complications. Intermittent preventive therapy for malaria in pregnancy (IPTp) is a key recommendation in the National guideline for malaria treatment in Nigeria. This study assessed the prescription pattern of intermittent preventive therapy with Sulphadoxine-Pyrimethamine for pregnant women among doctors practicing in 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. Methods: This was a retrospective study using case notes of pregnant women seen at antenatal clinic of 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria from January, 2008 to December, 2008. A total of 336 case notes were reviewed. The findings were precoded, data entry and analysis was done using EPI INFO 2002. Results: A good proportion of the women (82.9%) booked for antenatal clinic within the first and second trimesters of pregnancy. Most commonly prescribed by doctors was the weekly pyrimethamine (daraprim) for malaria prophylaxis in pregnancy (100.0%). Very few doctors prescribed intermittent preventive therapy with sulfadoxine-pyrimethamine, and the few who did prescribed just one dose. Conclusion: The study showed a very low level of prescription of IPTp among doctors practicing at 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. There is a great need for training of these doctors and other health professionals on the recommendations of the current National Antimalarial Treatment Guidelines.

Household Environment and Malaria in Pregnancy in Ibadan, Nigeria

Introduction: Malaria in pregnancy, which enormously creates substantial risks for the mother and her fetus, is a public health problem in Nigeria. Design and Methods: Through questionnaire administration, this cross-sectional survey investigates the influence of the household environment on malaria preventive and treatment behaviors among 300 pregnant women in two selected areas of Oyo State, Nigeria. In addition, four focus group discussions and four in-depth interviews were conducted, all between October 2015 and March, 2016. Results: Findings from the study indicate a positive relationship between income level (P = 0.000), educational level (P = 0.000) and preventive behavior and perception of malaria. There, however, is a negative relationship (P = 0.122) between place of residence and number of malaria episodes of the respondents. A high awareness on the cause of Malaria was recorded in this study, while a low awareness on the consequences of malaria infection in Pregnancy was visible. Conclusion and Recommendation: The household environment of pregnant women was found a key predictor in the prevention and treatment of malaria in both rural and urban areas of Oyo State Nigeria. Nationwide programme aimed at reducing malaria especially among pregnant women is needed in Nigeria.

Missed Opportunities for Intermittent Preventive Treatment among Pregnant Women, in a Secondary Health Facility, Cross River State, Nigeria

The study determined the magnitude and contributory factors for missed opportunities for the administration of IPTp （intermittent preventive treatment for malaria prevention）, during pregnancy among pregnant women attending a secondary health facility in Calabar. This study was a descriptive survey. Exit interviews were carried out on all pregnant and post natal women who attended the antenatal clinic of a secondary health facility for two weeks in November 2008. Data were analyzed using descriptive and inferential statistics. The mean age of respondents was 27.0 ± 5.4, mean parity was 2.4 ± 1.5, mean clinic attendance 4.9 ± 4.0 while mean gestational age at booking was 18.6± 7.7. The prevalence of missed opportunity among the pregnant women was 59.1% for IPTpl ＆ 56.0% for IPTp2; among pregnant PLWHA （people living with HIV/AIDS）, it was 100% for IPTp3, 70% for IPTp2 ＆ 80.0% for IPTpl. Factors accountable for missed opportunity include non-availability of SP （sulfadoxine-pyrimethamine）, lack of supervision, failure to prescribe medication, late booking and lack of knowledge. More women significantly received IPTp2 compared to IPTpl （P = 0.001）. Discussion： The findings establish the need for making SP available in the ANC （antenatal clinic）, educating health workers about current schedule and procedures for administration and early mobilization of pregnant mothers for ANC.

妊娠期疟疾的症状、防治及产科处理

维和任务区疟疾发病率很高,孕妇是疟疾主要的成年高危人群,孕妇感染疟疾(包括感染和临床疾病)的风险比非妊娠妇女高,症状更严重,危及她们自身及其胎儿的健康,妊娠期疟疾的防治非常重要,可以说妊娠期疟疾(malaria in pregnancy,MIP)是击退疟疾战略的一个优先领域。笔者就其对母体和胎儿的影响,症状表现和防治及其产科处理等作详细介绍。