Determination of levels of utilization and adherence to intermittent presumptive treatment with sulphadoxine pyrimethamine among pregnant women in Ndola Urban District, Zambia
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Malaria in pregnancy is a major public health problem in Zambia and in many other developing countries. Adverse outcomes include low birth weight and fetal death as well as maternal mortality and morbidity. The Ministry of Health put in a policy in 2003 for routine prophylaxis against malaria in pregnancy using three doses of Intermittent Presumptive Treatment (IPT) using Sulfadoxine Pyrimethamine (SP), which was to be given one month apart by Directly Observed Therapy (DOT). The target set was to have 90 percent of adherence to IPT-SP by all pregnant women. In recent years, the region has experienced a dramatic resurgence of this disease and almost up to 450 million clinical cases of malaria recorded each year. Malaria is responsible for 30 - 40 percent of outpatient visits to health facilities, 10 - 20 percent of hospital admissions and 10-40 percent of severe cases in children under five years of age. Today malaria is the top killer disease in sub-Saharan Africa (MOH, 2000). Objectives: To determine levels of utilization and adherence to IPT with SP and the factors associated with utilization and adherence among pregnant women in Ndola Urban District. Methodology: A descriptive cross sectional study was used. The sample size comprised 350 client respondents aged 15-45 years from Ndola urban. Structured questionnaires, focus group discussions and checklists were used for data collection. The Pearsons' Chi square test was used to determine associations for contingency tables higher than 'two-by-two' tables. For 'two-by-two' tables with expected frequency greater than five, the Yates' corrected chi-square test was used to determine associations. When expected frequency was less than five in 'two-by-two' tables, Fishers Exact test was used. In order to determine independent factors associated with adherence, the forward logistic regression was used. The cut-off point for statistical significance was set at 5 percent. SPSS and EPI INFO soft wares were used for data processing and analysis. Study findings: Out of 350 respondents the majority (58.3 percent) of the clients were aged 20 - 29 years, and married. In spite of most clients attaining secondary education only 8.6 percent had formal employment. About half of the clients (54 percent) were not knowledgeable on malaria transmission. The utilization level of SP was very good (98.9 percent) while adherence was 77.4 percent. SP was available at most of the health facilities. About a third (38 percent) took SP from home unsupervised. The reasons for non-adherence to SP by clients were that the majority (49.4 percent) attended antenatal clinic twice or less; 27.8 percent were not given some of the doses of SP; and, 12.7 percent presented themselves to antenatal clinic late in the third trimester. More than half of the clients (52.3 percent) that received SP said that they experienced some side effects after taking SP such as: body weakness (30.4 percent); felt sick (24.2 percent); and, dizziness (19.3 percent). The study results have shown that there were myths associated with SP such as: felt sick (42 percent); abortions (15 percent); body weakness (13 percent); and, dizziness (12 percent). In spite of these effects and myths/taboos there were no significant associations with adherence. In multivariate analysis, respondents who could tell that a person has malaria were 7.59 times more likely to adhere to SP compared to clients who could not. Clients who started receiving SP at six months of pregnancy and below, were about five times more likely to adhere to SP than those who received SP after six months. Clients who perceived health care providers as being very good were 2.64 times more likely to adhere to IPT-SP than those that perceived them as being good. Recommendations: For the Ministry of Health to achieve the target set of 90 percent adherence (MOH, 2005) health providers should intensify health education during the antenatal clinics to clients on the need to take SP as DOT, and reemphasize early attendance and regular antenatal visits at the ANC.
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