Factors influencing utilization of intermittent presumptive treatment of malaria (IPTP) services by pregnant women in Sesheke district of western province Zambia

Abstract

Background: Intermittent presumptive treatment of malaria in pregnancy (IPTp) is one of the recommended interventions by World Health Organization to mitigate the impact of malaria in pregnancy in malaria stable transmission zones such as Sub Saharan regions so as to ensure the best outcome for both the mother and her unborn child. In line with the Zambian policy in malarian control, Sesheke District started implementing IPTp in the year 2003 as one of the methods to combat malaria in pregnancy. This intervention augments the use of Insecticide treated mosquito nets (ITNs) to prevent malaria transmission and early case detection and effective case management of malaria. Despite the availability of IPTp services in all the health facilities in district, the uptake of IPTp is still very low especially for the second and third doses of IPTp (fansidar). The main purpose of the study was to identify the factors influencing utilization of IPTp services by pregnant women in Sesheke District.
Methodology: This study was a cross sectional, non intervention descriptive type. The study was conducted in Sesheke District in Western province of Zambia. Multistage sampling method was used to identify respondents to be included in the study. A purposeful method was used to select women to be included in the focus group discussions. Triangulation approach method was used to collect data which included one semi structured interview schedule which was administered to 403 eligible women who had delivered from January 2012 to March 2013 in communities of eight selected centers under study, one separate structured questionnaire which was administered to both the Health Center in- charge and to the community health workers providing IPTp services in that catchment area. Two focus group discussions were also conducted, one from a hard to reach Health Center (Mkusi) and another one from not so hard to reach Health Center (Mulimambango). Stock control cards were also checked in order to determine the availability of fansidar in the eight selected health centers during the year 2012. In order to ensure that the findings were valid, statistical significant was set at p<0.05.
Results: The study found that the uptake of IPTp among pregnant women in Sesheke for the third dose of IPTp (fansidar) was very low (30%). Factors influencing IPTp utilization identified in the study included; educational status of a woman, knowledge level of a woman about IPTp services, gestational age of the pregnancy at which a woman first starts antenatal care, number of times a woman attends antenatal care, and cultural misconceptions in the community. Lack of resources and transport in order for health providers to reach women in far and hard to reach areas was also identified as one of the most important challenges. The study also found that stock levels of fansidar in most of the health centers were good and that the majority of the women perceived use of fansidar during pregnancy as safe. The focus group discussions (FGD) also revealed that most of the women were willing to take fansidar despite the associated side effects. The commonest side effects were headache, dizziness, nausea and vomiting. 
Conclusion: This study demonstrates that effective IPTp service utilization in Sesheke District is very low. The study also identified factors and some challenges influencing IPTp service utilization. These factors and deficiencies urgently needed to be addressed if the district is to combat malaria in pregnancy. Address of these factors and deficiencies will not only contribute towards achievement of millennium development goals (MDGs) but also to overall improvement of maternal and child health.

Keywords: Malaria in pregnancy, intermittent presumptive treatment of malaria during pregnancy(IPTp), effective IPTp service utilization, and fansidar doses.