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.

Factors Affecting Adherence to National Malaria Treatment Guidelines in the Diagnosis, Treatment and Prevention of Malaria in Pregnancy among Healthcare Workers in Public Health Facilities in Jowhar District, Somalia

Introduction: Early diagnosis and effective treatment remain critical elements of a malaria control strategy in preventing mortality and reducing the incidence of severe malaria illness in Somalia. In Sub-Saharan African countries showed different levels of adherence to their national malaria guidelines for malaria treatment and prevention in pregnancy, while experiences from many countries indicated several challenges and constraints that may make the implementation of the guidelines difficult. Objective: The study aimed to assess factors affecting adherence to revised national malaria treatment guidelines in the diagnosis, treatment and prevention of malaria in pregnancy among health care workers in public health facilities in Jowhar District, Somalia. Methodology: A cross-sectional health facility-based study conducted in Jowhar district. A structured interview questionnaire was used for data collection from (n = 150). Healthcare workers selected from ten public health facilities using proportional to size sampling and an observational checklist was used to assess patient’s medical prescriptions to review their conformity to the guidelines and the availability of antimalarial drug, malaria diagnostic tests (mRDTs and microscopy) and job aids, such as the national malaria treatment guidelines, clinical algorithm (flow chart), malaria rapid diagnosis tests mRDTs’ use of wall charts, and drug dose wall charts at the facilities. Data was analyzed through the application of descriptive statistical analysis that includes frequency, and percentages by using Statistical Package for Social Sciences (SPSS) Version 25. Results: Healthcare workers interviewed were 89 (59.3%) aware of the existence of the revised national malaria treatment guidelines. However, 61 (40.7%) were not aware of the guidelines and only 46 (30.7%) had been trained for the national malaria guidelines in the treatment and prevention of malaria in pregnancy. Overall, 33 (22%) of the workers reported to adhere to guidelines, with 117 (78.0%) reported non-adherence. A significant difference was observed in the training status among different categories of health workers with (p-value of 0.022). Conclusion and Recommendation: In conclusion, the study showed that adherence to the national malaria guidelines for Malaria diagnosis, treatment and prevention in pregnancy among health care workers are associated with inadequate awareness of the revised national malaria guidelines among healthcare workers, inadequate supply of diagnostic tests (mRDTs and microscopy) at the health facilities and lack of access to revised national guidelines for malaria diagnosis and treatment, a lack of regular supervision and monitoring and lack of in-service training respectively. The national malaria control program should intensify efforts to strengthen the readiness of the public health facilities in the district to handle malaria in pregnancy cases, diagnosis, treatment and prevention, improve the availability of antimalarial drugs and malaria diagnostic tests (mRDTs and microscopy), job-aids at the health facilities and undertake regular monitoring and on job training to ensure the proper use of the guidelines at all levels of health care service delivery points across the country.

Effect of In-Service Training Program on the Practice of Healthcare Workers toward Malaria Prevention and Treatment Guidelines during Pregnancy in Health Facilities in Jowhar District, Somalia

Malaria is generally considered a major public health problem in Somalia. Providing early diagnosis and effective treatment is the key element of malaria control strategies in malaria-endemic countries, including Somalia. This required to advocate and ensure health worker’s adherence to the national malaria guidelines at all levels of health care service. A well-designed in-service training program may improve the level of health worker’s adherence to national malaria treatment guidelines, although results have been inconsistent. This is an interventional health facility-based pre and post comparative study aimed to assess the effect of an in-service training program on the practice of healthcare workers toward malaria prevention and treatment guidelines, during in pregnancy in health facilities in Jowhar district, Middle Shabelle region of Somalia. The study was implemented in three phases: pre-intervention phase, intervention phase and post-intervention phase. The sample size consisted of (n = 150) health workers who were selected from ten public health facilities using proportional to size sampling;the data collection adopted in this research is composed of a structured interview questionnaire and observational checklist. Data was analyzed through the application of descriptive statistical analysis that includes frequency and percentage and the Chi-square (x2) test was used to test the associations among variables using SPSS software version 25. The study showed that the level of health workers’ awareness of the national malaria guidelines in the treatment and prevention of malaria in pregnancy was found to be good before the intervention 89 (59.3%) and this proportion increased to 150 (100%) post-intervention of the training program. A significance difference has been observed between health workers’ awareness and their adherence to the malarial guidelines at pre-test and post-test with a p-value 0.000. The proportion of health workers who attended previous training on national malaria guidelines in the treatment and prevention of malaria in pregnancy increased from 46 (30.7%) at the pre-test to 150 (100%) after the post-test. A significant difference was observed in the training status among different categories of health worker and their adherence to the guidelines during the pre- and post-intervention of the training program, with a p-value of 0.000. The result showed that health workers were adhering to the guidelines at the pre-test 33 (22%), this increased after the post-test to 87 (58%). The knowledge of the need to adhere led to an increase in the adherence rate after the training program intervention. The study reveals that inadequate awareness was most reason for the non-adherence in the majority of the health workers as indicated by 89 (59.3%) at the pre-test and 56 (37.3%) in the post-test. However, difference was not significant between the availability of anti-malaria drugs in the facilities and the health workers’ adherence to the guidelines p-value 0.355 at the pretest and p-value 0.258 at post-test. The study concluded that the in-service training program significantly improved health workers’ knowledge and practice to the national malaria guidelines in the treatment, and prevention of malaria in pregnancy. The researcher recommends that the national malaria control programme (NMCP) of the Federal Ministry of Health should provide continuous regular in-service training to frontline healthcare workers at (facility and Community-based) to upgrade their skills and knowledge towards the malaria guidelines, disseminate job aids to the health facilities and undertake regular monitoring to ensure effective implementation of the national malaria treatment guidelines in the treatment and prevention of malaria in pregnancy in achieving desired proper case-management practices of malaria in pregnancy at all levels of health care service.

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.

Factors associated with risk of malaria infection among pregnant women in Lagos, Nigeria

Background:Pregnant women living in an area of stable malaria transmission such as Lagos,Nigeria,have been identified as being at an increased risk of the effects of malaria infection.In this area,most of the infections are asymptomatic which means they are overlooked and untreated much to the detriment of the mother and her foetus.The reality of scaled-up malaria interventions with long-lasting insecticide treated nets,vector control,artemisinin combination therapy(ACT)and intermittent preventive treatment of malaria pregnancy(IPTp)using sulphadoxine pyrimethamine(SP)is that it is also essential to determine the risk factors at play in these kinds of circumstances.This study was aimed at identifying the factors associated with risk of malaria infection in pregnant women in Lagos,Southwest Nigeria.Methods:Demographic information and malaria prevention practices of the pregnant women studied were captured using structured questionnaire.Microscopy was used to establish malaria infection,species identification and parasite density.Relative risk and multivariate logistic regression analysis were used to compare factors associated with malaria in pregnant women.Results:Malaria microscopy details,demographic information and malaria prevention practices of the pregnant women were obtained using a structured questionnaire.The prevalence of malaria using peripheral blood from 1,084 pregnant women that participated in the study was 7.7%.Plasmodium falciparum(P.falciparum)was seen in 95.2%of the cases as either mixed infection with P.malariae(3.6%)or as a mono infection(91.6%).Malaria preventive practices associated with a significant reduction(P<0.05)in the malaria infection was the use of insecticide sprays(RR=0.36,95 C.I.0.24-0.54),and the combined use of insecticide spray and insecticide-treated nets(ITN)(RR=6.53,95%C.I.0.92-46.33).Sleeping under ITN alone(RR=1.07,95%C.I.0.55-2.09)was not associated with significant reduction in malaria infection among the study participants with malaria parasitaemia.Young maternal age(<20years)(RR=2.86,95%C.I.1.48-5.50),but not primigravidity(RR=1.36,95%C.I.0.90-2.05),was associated with an increased risk of malaria infection during pregnancy.After a multivariate logistic regression,young maternal age(OR=2.61,95%C.I.1.13-6.03)and the use of insecticide spray(OR=0.38,95%C.I.0.24-0.63)were associated with an increase and a reduction in malaria infection,respectively.Conclusion:Malaria prevalence was low among the pregnant women studied.Young maternal age and non-usage of insecticidal spray were the main factors associated with an increased risk of malaria infection among pregnant women in Lagos,Nigeria.