Evaluating the Implementation of Intermittent Preventive Treatment (IPTP) Programme Using Sulphadoxine Pyrimethamine for the Control of Malaria in Pregnancy in the Kwabre District of Ghana

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Malaria is one of the major public health problems worldwide especially in Sub-Saharan Africa. Its effect is severest amongst pregnant women and children. The introduction of a weekly antenatal chloroquine treatment for pregnant women and children, however, failed. In its place, the World Health Organization (WHO) recommended Intermittent Preventive Treatment in pregnancy (IPTp) using Sulphadoxine-Pyrimethamine (SP), which was introduced in Ghana in 2005. This study sought to evaluate the implementation of the IPTp programme and its effects on pregnant women in the Kwabre district to inform policy. The study is a descriptive cross-sectional study that was conducted from July to September 2007 in the Kwabre district of the Ashanti Region of Ghana. Three hundred and eight (308) pregnant women and nursing mothers who had recently delivered were sampled and interviewed using close-ended questionnaires. Twenty-five midwives and twenty-four heads of health facilities were purposively selected and interviewed using interview guides. Records were reviewed at both the facility and district levels. Key findings were that more than 90 percent of midwives on the IPTP programme had been adequately trained, though 78.8 percent had not had training in almost two years. Knowledge of the effects of malaria in pregnancy was high amongst midwives, nursing mothers and pregnant women, whilst record keeping in most of the health facilities was quite poor, because only 62.5 percent employed ledger/tally cards to keep records on the drugs and half of the facilities (50%) had run out of stock of SP for over a week in the last three months prior to the study. Majority of the nursing mothers received SP during pregnancy (65.4 percent), but most of them received it only once (40.2 percent). Adverse reactions of SP such as dizziness, nausea, itching, and palpitations were experienced by 27.3 percent of respondents but were not reported at the health facilities in the district. The proportion of pregnant women who had malaria decreased from 5.4 percent in 2004 to 4.3 percent in 2006 and so did the incidence of low birth weight rate. ANC attendance was also very high (98.7%) in the District. The implementation of the IPTp programme in the Kwabre district has been successful in terms of the awareness and knowledge of both the midwives and pregnant women of the effects of malaria in pregnancy. However, some major challenges exist which constrain the effective running of the programme. These include improper records keeping, adverse drug effect monitoring, regular shortages of SP, low second and third dose of IPTp coverage, and irregular training of midwives. These challenges pose a threat to the IPT programme and must be addressed. The study recommends that implementation lapses in training, drug supply, pharmacovigilance, record keeping and communication must be should be addressed to achieve targets readily.
A Dissertation Submitted to the School of Graduate Studies in Partial Fulfillment of the Requirements for the Award of Master of Public Health Degree (Population and Reproductive Health), 2008.