Uptake of intermittent preventive treatment for malaria in pregnancy in Arapai sub county, Soroti district following a change in the drug administration policy.
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Introduction: The global burden of malaria in pregnancy is shouldered by low income countries in sub-Saharan Africa. The World Health Organization (WHO) recommends administration of at least three doses of Sulfadoxine-Pyrimethamine (SP) to pregnant women at routine antenatal care (ANC) visits to prevent malaria in pregnancy. Uganda adopted this strategy in October, 2012 and recently aligned her policy to the updated WHO policy. However, uptake of Intermitted Preventive Treatment of Malaria in Pregnancy (IPTp) is low, estimated at only 17% nationally and 13.8% in Teso region. This study aimed to determine the uptake of IPTp and associated factors among postpartum women in Arapai Sub County, Soroti district. Methods: A mixed methods - community based cross sectional study was conducted among 405 post-partum women who delivered in the previous six months. A multi – stage sampling approach was used to select women for the quantitative interview. Data was collected using a structured interviewer-administered questionnaire adapted from 2014 Uganda Malaria Indicator Survey (MIS) and 2016 Uganda Demographic and Health Survey (UDHS). Factors associated with IPTp uptake were established using prevalence ratios estimated by modified Poisson regression, with robust standard errors. The data were analyzed using Stata 14.0. Focus Group Discussions (FGDs) were conducted among six groups comprising of post-partum women to explore their knowledge, attitudes and perceptions towards IPTp. Eight Key informant interviews with health facility staff and members of the District Health Teams were held to solicit information on health system factors that affect uptake of IPTp. The primary outcome was uptake of IPTp defined as the proportion of women who took at least three doses of IPTp during their last pregnancy. Results: A total of 263 (64.9%) post-partum women with a mean age of 25.2 years (SD 6.16) took at least three doses of SP for IPTp. Uptake of IPTp was less likely among respondents who perceived SP as a threat (APR = 0.84, 95% CI: 0.73-0.96) and among those who attended their first ANC after the sixth month of pregnancy (APR = 0.56, 95% CI: 0.41-0.78). Uptake of IPTp was more likely among respondents who had support from their peers to take SP for IPTp (APR = 1.93, 95% CI: 1.07-3.49), and those knowledgeable about malaria in pregnancy (APR = 1.96, 95% CI: 1.25-3.05). xi Based on the focus group discussions and key informant interviews, moderate levels of IPTp uptake were the result of individual, interpersonal, institutional and community factors. The individual and interpersonal factors included not showing signs of malaria when pregnant, not knowing one is pregnant, perceiving oneself as an expert in pregnancy, fear of side effects of SP and lack of partner support. The institutional included frequent drug stock outs, scarcity of drinking water, inadequate human resource, and health workers not having adequate knowledge about the new administrative policy for IPTp and community factors included pregnant women seeking care from traditional birth attendants. Conclusion: The findings suggest that the uptake of IPTp is moderate. Designing interventions for increasing early ANC attendance, knowledge on malaria in pregnancy and partner support and mitigating the perceived threat and frequent stock outs of SP should be made a priority.