Abstract:
Routine administration of Sulphadoxine Pyrimethamine (SP) to pregnant women for intermittent preventive treatment (IPTp) of malaria during pregnancy leads to improved maternal health and pregnancy outcomes. This study explores determinants for IPTp-SP utilization among mothers of under-one children in rural Lilongwe, Malawi. Using multi-stage sampling method, this cross sectional study recruited 355 mothers of children under the age of one year from six health facilities. Respondents were aged 18-49 years and were interviewed using an interviewer-administered questionnaire. Bivariate analysis using Chi-Square and multivariate analysis (binary logistic regression) were performed. Overall, 84.0% of the mothers attended at least three antenatal care (ANC) visits, exposing them to the prospect of receiving optimal IPTp-SP. However, only 24.8% of the mothers received optimal (3+) doses of IPTp while 52.7% took partial (1-2) doses, and 22.5% did not utilize the intervention during pregnancy. Factors associated with IPTp utilization include knowledge (p = 0.005), attitudes (p < 0.001), timing of ANC visit (p < 0.001) and frequency of visits (p = 0.005), health education (p < 0.001), and perceived benefits of IPTp (p < 0.001). Women who were observed by a health worker while taking the SP were more likely to receive optimal IPTp (AOR 6.96; 95%CI 2.04-23.71). Women who expressed satisfaction with service delivery at ANC clinics also had higher likelihood of optimal IPTp-SP utilization (AOR 1.94; 95%CI 1.07-3.51). Despite a high ANC coverage, optimal IPTp-SP utilization in the study area is low. Apart from the influence of the identified client-level factors, this is low coverage can be attributable to health workers’ non-adherence to IPTp guidelines leading to missed opportunities. Program efforts should aim at addressing the identified knowledge gaps and reinforcing community trust in the intervention. Operational research is recommended to explore bottlenecks limiting effective coverage of the intervention.
