Accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania

BMC Health Services Research

Leonard EG Mboera⁴  Tabitha Mlacha⁴  Grades Stanley⁴  Benjamin K Mayala⁴  Robert C Malima⁴  Elizabeth H Shayo⁴  Malongo RS Mlozi³  Veneranda M Bwana⁴  Dorothy Wei²  Carolyn A Fahey²  Maria M Zinga¹  Susan F Rumisha⁴ 

[1] Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania;Georgetown University, Washington, DC, USA;Sokoine University of Agriculture, Chuo Kikuu, Morogoro, Tanzania;National Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania

关键词: Tanzania;    Preventive treatment;    Mosquito nets;    Interventions;    Pregnancy;    Malaria;   

Others  :  1126022
DOI  :  10.1186/1472-6963-14-452

 received in 2013-11-07, accepted in 2014-09-15,  发布年份 2014

【 摘 要 】

Background

Universal access to and utilization of malaria prevention measures is defined as every person at malaria risk sleeping under a quality insecticide-treated mosquito net (ITN) and every pregnant woman at risk receiving at least two doses of sulfadoxine-pyrimethamine (SP). This study aimed to determine factors affecting accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania.

Methods

Women of reproductive age with children <5 years old or those who had been pregnant during the past 5 years were included in the study. A structured questionnaire was used to seek information on malaria knowledge, accessibility and utilization of malaria interventions during pregnancy.

Results

A total of 297 women (mean age=29±6.8 years) were involved. Seventy percent of the women had attained primary school education. About a quarter of women had two children of <5 years while over 58% had ≥3 children. Most (71.4%) women had medium general knowledge on malaria while only eight percent of them had good knowledge on malaria in pregnancy. A significant proportion of women were not aware of the reasons for taking SP during pregnancy (35%), timing for SP (18%), and the effect of malaria on pregnancy (45.8%). Timing for first dose of SP for intermittent preventive treatment in pregnancy (IPTp) was 1-3 months (28.4%) and 4-6 months (36.8%). Some 78.1% were provided with SP under supervision of the health provider. Knowledge on malaria in pregnancy had a significant association with levels of education (p=0.024). Ninety-eight percent had an ITN, mostly (87.1%) received free from the government. All women attended the ANC during their last pregnancy. The coverage of IPT1 was 53.5% and IPTp2 was 41.1%. The proportion of women making more ANC visits decreased with increasing parity.

Conclusion

This study showed that the knowledge of the pregnant women on malaria in pregnancy and IPTp was average and is likely to have an impact on the low IPTp coverage. Campaigns that provide educational massages on the risk of malaria during pregnancy and the usefulness of IPTp need to be emphasised.

【 授权许可】

   
2014 Rumisha et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]De Beaudrap P, Turyakira E, White LJ, Nabasumba C, Tumwebaze B, Muehlenbaachs A, Guérin PJ, Boum Y, McGready R, Piola P: Impact of malaria during pregnancy on pregnancy outcomes in a Ugandan prospective cohort with intensive malaria screening and prompt treatment. Malaria J 2013, 12:139. BioMed Central Full Text
• [2]Teplin SW, Burchinal M, Johnson-Martin N, Humphry RA, Kraybill EN: Neurodevelopmental, health, and growth status at age 6 years of children with birth weights less than 1001 grams. J Pediat 1991, 1991(118):768-777.
• [3]Steketee RW, Wirima JJ, Hightower AW, Slutsker L, Heymann DL, Breman JG: The effect of malaria and malaria prevention in pregnancy and on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi. Am J Trop Medicine Hyg 1996, 55(1 Suppl):33-41.
• [4]Steketee RW, Nahlen BL, Parise ME, Menendez C: The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg 2001, 64(Suppl 1–2 l):28-35.
• [5]Taylor HG, Klein N, Minich NM, Hack M: Middle-school-age outcomes in children with very low birth-weight. Child Develop 2000, 71:1495-1511.
• [6]Guyatt HL, Snow RW: Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa. Trans Royal Soc Trop Med Hyg 2001, 95:569-576.
• [7]Guyatt HL, Snow RW: Impact of malaria during pregnancy on low birth weight in Sub-Saharan Africa. Clin Microb Rev 2004, 17:760-769.
• [8]Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B: Developmental potential in the first 5 years for children in developing countries. Lancet 2007, 369:60-70.
• [9]WHO: World Malaria Report. Geneva: World Health Organization; 2012:195.
• [10]TDHS: Tanzania Demographic and Health Survey, 2004–2005. Dar es Salaam, Tanzania, ORC Macro, Calverton, Maryland, USA: National Bureau of Statistics; 2005.
• [11]TDHS: Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania, ICF Macro Calverton, Maryland, USA: National Bureau of Statistics; 2011.
• [12]THMIS: Tanzania HIV/AIDS and Malaria Indicator Survey 2011–12. Maryland, USA: TACAIDS, ZAC, NBS, OCGS and ICF International: ICF Macro Calverton; 2013.
• [13]MoHSW/IHI/NIMR/WHO: Midterm Analytical Review of the Performance of the Health Sector Strategic Plan III 2009-2015. Dar es Salaam, Tanzania: Ministry of Health and Social Welfare, Ifakara Health Institute, National Institute for Medical Research and World Health Organization; 2013.
• [14]THMIS: Tanzania HIV/AIDS and Malaria Indicator Survey 2007-08. Dar es Salaam, Tanzania: National Bureau of Statistics; 2008.
• [15]Mutagonda R, Kamuhabwa AAR, Massawe S, Mpembeni R: Intermittent Preventive Therapy and Treatment of Malaria during Pregnancy: A Study of Knowledge among Pregnant Women in Rufiji District, Southern Tanzania. Trop J Pharm Res 2012, 11:835-845.
• [16]Mubyazi GM, Magnussen P, Goodman C, Bygbjerg IC, Kitua AY, Olsen OE, Byskov J, Hansen KS, Bloch P: Implementing intermittent preventive treatment for malaria in pregnancy: review of prospects, achievements, challenges and agenda for research. Open Trop Med J 2008, 1:92-100.
• [17]Uddenfeldt Wort U, Hastings I, Mutabingwa TK, Brabin BJ: The impact of endemic and epidemic malaria on the risk of stillbirth in two areas of Tanzania with different malaria transmission patterns. Malaria J 2006, 5:59. BioMed Central Full Text
• [18]Lwanga SK, Lemeshow S: Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991.
• [19]WHO: Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-pyrimethamine (IPTp-SP). Updated WHO Policy Recommendation (October 2012); http://www.who.int/malaria/iptp_sp_updated_policy_recommendation_en_102012.pdf webcite
• [20]Mubyazi G, Bloch P, Kamugisha M, Kitua A, Ijumba J: Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe District, North-Eastern Tanzania. Malaria J 2005, 4:31. BioMed Central Full Text
• [21]Tarimo DS: Appraisal on the prevalence of malaria and anaemia in pregnancy and factors influencing uptake of intermittent preventive therapy with sulfadoxine-pyrimethamine in Kibaha District, Tanzania. E Afr J Pub Hlth 2007, 4:80-83.
• [22]Anders K, Marchant T, Chambo P, Mapunda P, Reyburn H: Timing of intermittent preventive treatment for malaria during pregnancy and the implications of current policy on early uptake in north-east Tanzania. Malaria J 2008, 7:79. BioMed Central Full Text
• [23]Steketee RW, Sipilanyambe N, Chimumbwa J, Banda JJ, Mohamed A, Miller J, Basu S, Miti SK, Campbell CC: National Malaria Control and Scaling Up for Impact: The Zambia Experience through 2006. Am J Trop Med Hyg 2008, 79:45-52.
• [24]WHO: Malaria in Pregnancy. Guidelines for Measuring Key Monitoring and Evaluation Indicators. Geneva: World Health Organization; 2007.
• [25]Hill J, Hoyt J, van Eijk AM, D’Mello-Guyett L, ter Kuile FO, Steketee R, Smith H, Webster J: Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 2013, 10(7):e1001488.
• [26]Marchant T, Nathan R, Jones C, Mponda H, Bruce J, Sedekia Y, Schellenberg J, Mshinda H, Hanson K: Individual, facility, and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania. Malaria J 2008, 7:260. BioMed Central Full Text
• [27]Onyeneho NG, Orji BC, Okeinbunor JC, Brieger WR: Characteristics of Nigerian women taking sulfadoxine/pyrimethamine twice during pregnancy for the prevention of malaria. Int J Gyn Obst 2013, 123:101-104.
• [28]Mbonye AK, Neema S, Magnussen P: Preventing malaria in pregnancy: a study of perceptions and policy implications in Mukono District, Uganda. Hlth Policy Plan 2006, 21:17.
• [29]van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA: Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Hlth 2006, 3:2.
• [30]Ndyomugyenyi R, Katamanywa J: Intermittent preventive treatment of malaria in pregnancy (IPTp): do frequent antenatal care visits ensure access and compliance to IPTp in Uganda rural communities? Trans Roy Soc Trop Med Hyg 2010, 104:536-540.
• [31]Hill J, Kazembe R: Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges. Trop Med Int Health 2006, 11:409-418.
• [32]Ouma PO, van Eijk AM, Hamel MJ, Sikuku E, Odhiambo F, Munguti K, Ayisi JG, Kager PA, Slutsker L: The effect of health care worker training on the use of intermittent preventive treatment for malaria in pregnancy in rural western Kenya. Trop Med Int Hlth 2007, 12:953-961.
• [33]Manongi RN, Marchant TC, Bygbjerg IC: Improving motivation among primary health care workers in Tanzania: a health worker perspective. Hum Res Hlth 2006, 4:6. BioMed Central Full Text
• [34]Ahmed AM, Desta A, Tekle K, Mweta EA: Pursuing better health care delivery at district level. World Health Forum 1993, 14:360-366.
• [35]Ben Salem B, Beattie KJ: Facilitate supervision: a vital link in quality of reproductive health service delivery. In Engender Health Working Paper No. 10. New York: AVSC International; 1996.