Factors associated with the uptake of intermittent preventive treatment of malaria in pregnancy in Nambale Sub-County Hospital, Kenya

Abstract

BACKGROUND: Malaria remains a significant public health problem globally, with highest morbidity and mortality reported in sub Saharan Africa. In 2022, 12.7 million (36%) Malaria in Pregnancy (MiP) cases in Sub Saharan Africa and 27% were reported from East Africa. In Kenya, 4,080,441 malaria cases and 5% MiP cases reported. Busia County, Kenya, reported 341,886 malaria cases and 22% MiP cases. WHO recommends administering intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) to prevent MIP in malaria-endemic zones. The objective of the study was to determine proportion of pregnant women utilizing IPTp-SP 3 and describe factors influencing utilization of IPTp-SP 3. METHODS: A cross-sectional study was employed, pregnant women of nine months, aged 14-49 years were interviewed, using questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with p value of ≤ 0.2, were subjected to multivariable logistic regression analysis to identify significant factors (variables with p value of ≤ 0.05) RESULTS: 384 pregnant women were interviewed, 90% resided in rural areas; 93% aware of IPTp use, 68% were married, 67% unemployed, 60% utilized IPTp-SP3 and 47% had secondary education. In the bivariate analysis, participant age 21-30 years {cOR = 2.34, 95% CI = 1.4-3.7}, belief in > 3 doses of IPTp preventing MiP {cOR = 3.09, 95% CI = 1.5-6.2}and having tertiary education {cOR = 2.71, 95% CI = 1.4-5.1} were associated with uptake of ≥3doses of IPTp. On multivariable logistics regression analysis, attendance of ANC at least 4 times {aOR = 8.42, 95% CI = 4.4-16.0} and uptake of IPTp-SP at 14-17 gestation weeks {aOR = 7.79, 95% CI = 3.2-18.7} independently associated with optimal utilization of IPTp (IPTp-SP3). CONCLUSION AND RECOMMENDATION: A sub-optimal IPTp-SP 3 utilization (60%) way below WHO target of 80%. ≥4ANC attendance and first IPTp-SP uptake at 14-17 gestation weeks were independently associated with optimal utilization of IPTp. Pregnant women attending ANC at the facility should ensure that they attend ANC at least four times and take at least three doses of IPTp for maximum protection against malaria in pregnancy. CLINICAL TRIAL NUMBER: Not applicable.