Evaluation of the Intermittent Preventive Therapy in Pregnancy using Sulphadoxine/ Pyrimethamine (IPTp-SP) Program in Chiredzi District, Zimbabwe, 2021

Background Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulphadoxine/ Pyrimethamine (SP) is used for the prevention of malaria among pregnant women in Zimbabwe. The program is integrated into routine Antenatal care (ANC) where a minimum of three doses is recommended during each pregnancy. The third dose coverage for Chiredzi District has consistently been below the 80% target coverage. We evaluated IPTp implementation in Chiredzi to understand the reasons for underperformance. Methods An analytical cross-sectional study was conducted using a Process-Outcome evaluation with the Logical Framework Approach. We interviewed 50 women in postnatal care and determined ANC services accessed using their ANC booklets. Health workers were interviewed for knowledge of the program. Stock availability and drug delivery records were reviewed using checklists at five high-volume sites. Epi Info 7.2.4.0™ was used for data capturing and analysis. The software was used to calculate frequencies, medians, proportions, odds ratios and p-values at a 95% confidence interval. The outcome variable was receiving ≥3 doses of SP which was computed against the independent variables such as client-related characteristics to determine which factors were contributory using univariate and bivariate analysis. Results Only 12/50 (24%) women received ≥3 doses of SP during their pregnancy. Two (4%) women started their ANC visits in the first trimester. Thirty-three (66%) had missed at least one SP dose during their ANC visit because of medicine unavailability. Knowing the number of times SP is given (OR 11.9; 95% CI 2.54-55.8) and having attended at least 4 ANC visits (OR 13.6; 95% CI 1.59 -116.0) increased the likelihood of receiving adequate SP dosing. Conclusions The IPTp-SP program in Chiredzi District was underperforming, we attributed this largely to health system factors. Erratic supply and stock-outs of SP resulted in clients missing SP doses. Clients also missed SP doses because of late ANC booking and lack of knowledge on IPTp benefits. Improving stock management and raising community awareness on prevention of malaria among pregnant women was recommended.

1345Uptake of Intermittent Preventive Treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi

Background This study aimed to estimate the proportion of and identify factors associated with uptake of ≥ 3 doses of Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) among pregnant women in Malawi after adoption of the 2012 updated WHO IPTp-SP policy. Methods The 2015–16 Malawi Demographic and Health Survey dataset was re-analysed. Only 1069 women were included in the analysis from 1219 women who had live births, born after July 2015. Logistic regression was used in data analysis considering complex survey sample design. Results Of the 1069 women, 447 (42%) received ≥3 doses (optimal) of IPTp-SP, while 47% managed to attend ≥4 antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made ≥4 ANC visits. The number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC at most twice were less likely to receive optimal doses than those who managed to attend ANC ≥4 times during pregnancy (AOR = 0.71, 95% CI 0.49–1.02) and (AOR = 0.12, 95% CI 0.06–0.21) respectively. Conclusions There is low uptake of optimal SP doses in Malawi. This seems to be associated with the number of ANC visits. However, there is limited effectiveness of increased number of ANC visits on the uptake of optimal SP doses. Key messages Increased number of ANC visits is not enough to increase uptake of optimal doses of IPTp-SP. There is need for continued and varied efforts.

Determinants of the uptake of intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine in Sabatia Sub County, Western Kenya

Background Annually, 125.2 million pregnant women worldwide risk contracting malaria, including 30.3 million and 1.5 million in Sub-Saharan Africa and Kenya respectively. At least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) is recommended for optimal benefit. Kenya recorded low IPTp-SP optimal uptake in 2015. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya. Methods A cross-sectional study was conducted in Sabatia Sub County from April to October 2020. Using a validated semi-structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15–49 years with live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during pregnancy were excluded. Pearson Chi-square and Fisher’s Exact test were measures of association used. Binary logistic regression analysed predictors of optimal IPTp-SP uptake. Results Optimal IPTp-SP uptake was 79.6%, 95% CI 75.5%–83.7%. Predictors of IPTp-SP optimization were gestational age at first antenatal care (ANC) visit (P = 0.04), frequency of ANC visits (P < 0.001), maternal knowledge of IPTp-SP benefits (P < 0.001), maternal knowledge of optimal sulphadoxine pyrimethamine (SP) dose (P = 0.03) and SP administration at ANC clinic (P = 0.03). Late ANC initiators were less likely to receive optimal IPTp-SP (aOR = 0.4, 95% CI 0.2–0.9). Odds of optimizing IPTp-SP increased among women with ≥ 4 ANC visits (aOR = 16.7, 95% CI 7.9–35.3), good knowledge of IPTp-SP benefits (aOR = 2.4, 95% CI 1.3–4.5) and good knowledge of optimal SP dose (aOR = 1.9, 95% CI 1.1–3.4). Women who never missed being administered SP were highly likely to receive optimal IPTp-SP (aOR = 2.9, 95% CI 1.1–7.2) Conclusions This study has found high IPTp-SP optimal uptake in the study area. Efforts should be directed towards early and more frequent ANC visits. Intensive and targeted health education is required. It’s fundamental to adequately stock and consistently administer SP. Future studies considering larger samples and health workers’ perspectives of the health system delivery factors are recommended. Graphical abstract

Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana

IntroductionGhana adopted the revised WHO recommendation on intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in 2012. This study has assessed the effectiveness and safety of this policy in Ghana.MethodsA total of 1926 pregnant women enrolled at antenatal care (ANC) clinics were assessed for birth outcomes at delivery, and placental histology results for malaria infection were obtained from 1642 participants. Association of reduced placental or peripheral malaria, anaemia and low birth weight (LBW) in women who received ≥4 IPTp-SP doses compared with 3 or ≤2 doses was determined by logistic regression analysis.ResultsAmong the 1926 participants, 5.3% (103), 19.2% (369), 33.2% (640) and 42.3% (817) of women had received ≤1, 2, 3 or ≥4 doses, respectively. There was no difference in risk of active placental malaria (PM) infection in women who received 3 doses compared with ≥4 doses (adjusted OR (aOR) 1.00, 95% CI 0.47 to 2.14). The risk of overall PM infection was 1.63 (95% CI 1.07 to 2.48) in 2 dose group and 1.06 (95% CI 0.72 to 1.57) in 3 dose group compared with ≥4 dose group. The risk of LBW was 1.55 (95% CI 0.97 to 2.47) and 1.06 (95% CI 0.68 to 1.65) for 2 and 3 dose groups, respectively, compared with the ≥4 dose group. Jaundice in babies was present in 0.16%, and 0% for women who received ≥4 doses of SP.ConclusionThere was no difference in the risk of PM, LBW or maternal anaemia among women receiving 3 doses compared with ≥4 doses. Receiving ≥3 IPTp-SP doses during pregnancy was associated with a lower risk of overall PM infection compared with 2 doses. As there are no safety concerns, monthly administration of IPTp-SP offers a more practical opportunity for pregnant women to receive ≥3 doses during pregnancy.

Malaria intermittent preventive treatment in Nigeria: a qualitative study to explore barriers

Background While the use of sulphadoxine pyrimethamine (SP) is effective in preventing malaria infection during pregnancy, there are challenges limiting its uptake in Nigeria. This study aimed at exploring the barriers to IPTp usage among pregnant women in Kano state - Nigeria. Methods This is a qualitative study. The purposive sampling strategy was used for identification and selection of 14 key informants for interviews. In addition, six focus group discussions (FGDs) were conducted with pregnant women (3 FGDs) and married men (3 FGDs). The conventional content analysis method was used to interpret meaning from the content of the data. MAXQDA 10 software was used for data management and analysis. Results Poor policy implementation, poor antenatal care attendance, inadequate access to intermittent preventive treatment at the community levels, lack of sustainable funding, and poor community engagement emerged as major barriers to IPTp use in Nigeria. Conclusion While the political will to allocate sufficient financial resources could help improve service delivery and IPTp usage among pregnant women, community participation is critical to sustain the gains.

Simultaneous determination of Sulphadoxine and Pyrimethamine by taking Tolterodine as an internal standard in Pharmaceutical dosage form by RP-HPLC

A simple, rapid, economic, sensitive and precise HPLC method has been developed for the simultaneous determination of Sulphadoxine and Pyrimethamine in pharmaceutical dosage form by taking Tolterodine as an internal standard. The method was carried out using Phenomenex C18 (4.6ID × 250mm; 5µm) column and mobile phase comprised of methanol and Phosphate Buffer in proportion of ratio 60:40 v/v. The flow rate was 1.0mL/min and detection was carried out at 276nm. The retention time of Sulphadoxine, Pyrimethamine and Tolterodine were found to be 2.967, 4.058 and 6.908 respectively. Linearity of Sulphadoxine and Pyrimethamine in the range of 2 to 12μg/mL and 4 to 24μg/mL respectively. The % recoveries of Sulphadoxine and Pyrimethamine were found to be in between 99.93% to 99. 96 % respectively. The proposed method is suitable for the routine quality control analysis for simultaneous determination of Sulphadoxine and Pyrimethamine was in bulk and pharmaceutical dosage form.

Intermittent preventive treatment comparing two versus three doses of sulphadoxine pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: A cross-sectional study

In 2012 the World Health Organisation (WHO) revised the policy on Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine (IPTp-SP) to at least three doses for improved protection against malaria parasitaemia and its associated effects such as anaemia during pregnancy. We assessed the different SP dosage regimen available under the new policy to determine the dose at which women obtained optimal protection against anaemia during pregnancy. A cross-sectional study was conducted among pregnant women who attended antenatal clinic at four different health facilities in Ghana. The register at the facilities served as a sampling frame and simple random sampling was used to select all the study respondents; they were enrolled consecutively as they kept reporting to the facility to receive antenatal care to obtain the required sample size. The haemoglobin level was checked using the Cyanmethemoglobin method. Multivariable logistic regression was performed to generate odds ratios, confidence intervals and p-values. The overall prevalence of anaemia among the pregnant women was 62.6%. Pregnant women who had taken 3 or more doses of IPTp-SP had anaemia prevalence of 54.1% compared to 66.6% of those who had taken one or two doses IPTp-SP. In the multivariable logistic model, primary (aOR 0.61; p = 0.03) and tertiary education (aOR 0.40; p = <0.001) decreased the odds of anaemia in pregnancy. Further, pregnant women who were anaemic at the time of enrollment (aOR 3.32; p = <0.001) to the Antenatal Care clinic and had malaria infection at late gestation (aOR 2.36; p = <0.001) had higher odds of anaemia in pregnancy. Anaemia in pregnancy remains high in the Northern region of Ghana. More than half of the pregnant women were anaemic despite the use of IPTp-SP. Maternal formal education reduced the burden of anaemia in pregnancy. The high prevalence of anaemia in pregnancy amid IPTp-SP use in Northern Ghana needs urgent attention to avert negative maternal and neonatal health outcomes.

Determinants of the Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine Pyrimethamine in Sabatia Sub County, Western Kenya

Background: Malaria in pregnancy remains a major public health problem. Annually, 125.2 million pregnant women worldwide are at risk of malaria infection including 30.3 million and 1 million pregnant women in Sub-Saharan Africa and Kenya respectively. The World Health Organization recommends that pregnant women in malaria endemic areas receive at least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) for optimal benefit. However, IPTp-SP optimal uptake is undesirably low in Kenya. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya. Understanding the epidemiology of malaria in pregnancy is core for making decisions and setting priorities towards IPTp-SP optimization.Methods: This was a cross-sectional study conducted in Sabatia Sub County. Using a validated semi structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15 – 49 years who had a live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during their pregnancy were excluded. Association between IPTp-SP uptake and independent variables was analysed using Pearson Chi-square and Fisher’s Exact test. Bivariate and multiple binary logistic regression analysed predictors of optimal IPTp-SP uptake.Results: Overall, 99.46 % of the respondents received at least one IPTp-SP dose. The prevalence of optimal IPTp-SP uptake was 79.57% (95% CI 75.47%, 83.67%). After multivariate analysis; gestational age at first antenatal care (ANC) visit (p = 0.04), frequency of ANC visits (p < 0.001), maternal knowledge of IPTp-SP benefits (p < 0.001), maternal knowledge of optimal SP dose (p = 0.03) and administration of sulphadoxine pyrimethamine at ANC clinic (p = 0.03) significantly predicted the optimal uptake of IPTp-SP.Conclusions: Optimal uptake of IPTp-SP is high in the study area. Efforts towards early and more frequent ANC attendance should be enhanced and sustained. Structured and targeted health education should be adopted and health workers should always administer SP drugs or explain to some pregnant women their ineligibility for initial IPTp-SP receipt. Future studies considering large sample drawn from the whole country and health workers’ perspective of the health system delivery factors are recommended.

Effects of Intervention Schemes on Sulphadoxine-Pyrimethamine Compliance Among Pregnant Women in a Health Facility in Port Harcourt, Rivers State, Nigeria

Background: Malaria causes diverse adverse effects in the fetus due to the invasion of the placenta by Plasmodium. The use of intermittent preventive treatment (Sulphadoxinepyrimethamine- IPTp-SP) as a control measure for malaria in pregnancy has been recommended and shown to reduce unwanted birth outcomes. Objectives: This work aimed to evaluate the effects of intervention schemes on sulphadoxine-pyrimethamine (SP) compliance and utilization among pregnant women in a health facility in Port Harcourt, Nigeria. Methods: A hospital-based survey was carried out among pregnant women admitted to the Labor ward of Obio-Cottage hospital. The information of mothers was collected using a well-structured and pre-tested questionnaire and from their antenatal care (ANC) records. Results: Time of ANC registration indicated that 87%, 11.33%, and 1.66% of mothers were registered during their first, second, and third trimesters, respectively. Sulphadoxinepyrimethamine was the drug of choice for 93.66% of the women while 6.33% took other drugs. The survey revealed that 97.15% and 2.85% of the women started SP usage in their second and third trimesters, respectively. It was observed that the majority of the women (69.39%) took SP thrice while 24.19% and 6.40% consumed it twice and once, respectively. Regarding knowledge about SP, 89% of the women viewed SP as a preventive drug for malaria while 11% acknowledged it as a therapeutic drug. The birth outcomes of the neonates whose mothers took SP indicated that 1.42% had low birth weight (LBW) while 98.57% had acceptable birth weight. Meanwhile, 10.53% of the babies born to the mothers who did not use SP had LBW, and 89.47% of them had acceptable birth weights. Overall, 98.93% of the neonates of SP-compliant women and 89.48% of the babies of non-compliant women were alive. Non- compliant women had higher prevalence of preterm birth (5.76%) and fetal death (5.26%) than SP-compliant women (0.7% and 0.35%, respectively). Conclusions: Adequate knowledge and compliance with SP usage were high in the studied population, which was associated with favorable birth outcomes.