Factors Associated with Adherence to Intermittent Preventive Treatment of Malaria in Pregnancy among Postnatal Mothers at Fort Portal Regional Referral Hospital in Kabarole District

Abstract

Background Malaria in pregnancy (MiP) causes maternal and newborn complications. Intermittent Preventive Treatment (IPTp) is effective in preventing MiP. It is recommended that pregnant women receive three or more doses of IPTp all by directly observed therapy (DOT). In 2016, the national uptake of IPTp3 was 17% and 21% in Tooro Sub-region which was much lower than the 2020 Ministry of Health target of 93%. It is also not clear whether all the IPTp3 reported was actually taken by DOT. This study aimed at establishing the level of adherence to IPTp3 by DOT and its associated factors. Methods This cross-sectional study was conducted at Fort Portal regional referral hospital (FPRRH) in Kabarole district in May 2019. It involved 385 consecutively selected postnatal mothers. Eight key informant interviews were also carried with Assistant District Health Officer in charge of Maternal Child Health (MCH) who was also the acting district malaria focal person (MFP), district biostatistician, Antenatal Care (ANC) in-charge, hospital data officer, two midwives and two mothers who were village health team members (VHT). The primary outcome was adherence to IPTp3 by DOT which was measured as a binary outcome of ‘adherence’ and ‘non-adherence’. Data was analyzed using Stata version 14 and the association with different factors was determined using Modified Poisson regression at 95% confidence level. The measure of association was prevalence ratio. Variables that achieved p-value ˂ 0.05 were considered significant. Qualitative data was analyzed manually using thematic analysis. Findings All the mothers attended at least one ANC visit while 74.0% (285/385) attended at least four visits. xii About 65.9% (245/372) [CI 60.9 - 70.5] took at least three doses of IPTp. However, 61.8% (230/372) [CI 56.7 - 66.6] took at least three doses by DOT (adhered). About 9.1% (34/372) received at least one dose of IPTp without observation and 11.8% (4/34) reported not to have swallowed the Fansidar when they reached home. Non-adherence was associated with attending less than four ANC visits [aPR 1.35, CI 1.07-1.71] and starting ANC late was the main reason for attending less than four ANC visits. Fansidar stock outs, inadequate number of midwives and inadequate health education were the main health system factors affecting adherence to IPTp. The HMIS tools for recording and reporting IPTp data were not updated, increasing the risk of under reporting. Conclusion and recommendations: The level of adherence to IPTp was lower than the ministry of health target, but higher than previously reported. Attending less than four ANC visits and Fansidar stock-outs were the main factors affecting adherence. Health education should emphasize starting ANC early and attending at least four ANC visits. The Ministry of health should also increase on the SP stocks supplied.