Factors affecting the intermittent preventive therapy of malaria in pregnancy programme in the ejisu-juabeng municipality

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Malaria in pregnancy is one of the major causes of maternal morbidity and adverse birth outcomes. In high transmission areas, its prevention has recently changed, moving from a weekly or bimonthly chemoprophylaxis to intermittent preventive treatment (IPTp). IPTp consists of the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy - regardless of whether the woman is infected or not. The drug is administered under supervision during antenatal care visits. Sulphadoxine-Pyrimethamine (SP) is the drug currently recommended by the WHO. While SP-IPTp seems an adequate strategy, there are many issues still to be explored to optimize it. In the Intermittent Preventive Therapy Programme for the prevention of Malaria in pregnancy in the Ejisu-Juaben Municipality, there is a wide variance between the results of pregnant women who have had at least two doses of Sulphadoxine Pyrimethamine (SP) (39.6%), and the WHO recommended outcome (60%). Therefore, a descriptive cross-sectional study involving 320 women who have recently delivered and ten health workers including the Municipal Health Director was undertaken .The objective of this study was to identify the service and client factors leading to this variance. The study was undertaken in three randomly selected sub municipalities out of the five, using interview guided questionnaires and checklist .The study established that, 58.4% of the pregnant women (n=320) attended ANC for the first time in their second trimester and 27.13%took IPT 1 within the recommended period of 16-18 weeks of pregnancy. None of the facilities had the IPT Guidelines. Average waiting time was three hours. There was no Focused ANC. Of the 320 women interviewed, 43.2% took SP at least twice. Though there was 100% availability of SP at the time of the survey there were reports from both staff and clients of intermittent shortages .Analysis of the extent of male involvement revealed that, 62% of the pregnant women were supported financially by their partners to attend ANC. The successful implementation of the IPTp-SP strategy in the Ejisu-Juaben Municipality depends on the proper planning of, and support to the training of health staff, the uninterrupted provision of logistics and sustained sensitization of pregnant women at health facility and community levels about the benefits of IPTp for the women and their unborn babies and the society as a whole.
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology, in partial fulfilment of the requirement for the degree of Master of Public Health in Health Education and Promotion.
Malaria in pregnancy, Intermittent preventive treatment