Barriers To Uptake Of Intermittent Preventive Treatment (Ipt) With Sulphadoxine-Pyrimethamine To Prevent Malaria In Pregnancy In The Kumasi Metropolis, 2010

ABSTRACT Background: Intermittent preventive treatment for prevention of malaria in pregnancy (IPTp) is a key component of malaria control strategy in Ghana and sulfadoxinepyrimethamine (SP) is the drug of choice. Despite the evidence of the effectiveness of IPTp strategy using SP in reducing the adverse effects of malaria during pregnancy the uptake and coverage in Kumasi metropolis of the Ashanti Region is low. Objective: This study set out to assess the use of IPTp among pregnant women and identify barriers to the uptake of IPT during pregnancy in the Kumasi Metropolis. Methods: A cross-sectional study was carried out between June and July 2010 among 300 mothers with children 0-11months selected by cluster random sampling from communities in Kumasi and 19 health service providers selected by convenience sampling. Information on utilization of IPTp, knowledge on IPTp, timing and number of ANC visits, and reasons for non utilization was obtained using an interviewer administered questionnaire. Key informant interviews were used to obtain information from the service providers. Descriptive statistics such as simple proportions, and medians were used. Logistic regression and Chi-square test were used to examine predictors of IPTp use. All analyses were performed at 5% level of significance. Results: One hundred and nineteen of the 300 (39.7%) mothers received IPTp1, whilst 101(33.7%) and 63 (21.0%) received IPTp2 and IPTp3 respectively. Only 3.7% (11/300) mothers had very good knowledge on IPTp with more than 50% (152/300) having no knowledge at all. The service providers demonstrated high level of knowledge on IPTp. More than two thirds of the mothers had their first ANC clinic within three months of pregnancy. Almost 90% of the mothers had had five or more ANC visits. The reason for more than 80% of mothers not receiving any IPTp was because they were not offered the medication. This was mainly attributable to shortage of the medicine in the health facilities. Overall, 64.3% (18/28) and 55.4% (41/74) did not receive IPTp2 and IPTp3 respectively for the same reason. All the service providers interviewed admitted periodic shortage of SP over a certain period of time. Irregular ANC visits as well as side effects were some of the reasons for some mothers not receiving IPTp2 and IPTp3. About 4.0% (4/103) of the mothers did not use IPTp because they were using traditional medicine. Treatment for malaria was the reason why 14 (13.9%) mothers did not get IPTp. Conclusion: Periodic shortage of SP could be the main reason for low IPTp coverage but mother‟s age, parity, knowledge about IPTp, number of ANC visits and use of a health centre were found to significantly affect the uptake of IPTp. Recommendation: A concerted effort should be made by the Ghana Health Service to avoid stock out of SP in the health facilities. Public education on IPTp should be stepped up to increase awareness of IPTp among the public especially among women of child bearing age since there was generally poor level of knowledge among mothers.