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The use of intermittent preventive treatment in pregnancy and insecticide-treated bed nets for malaria prevention by women of child-bearing age in eight districts in Malawi.

Mwandama D, Gutman J, Wolkon A, Luka M, Jafali J, Ali D, Mathanga DP, Skarbinski J - Malar. J. (2015)

Bottom Line: Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39-0.69) and aOR 0.67 (95 % CI 0.47-0.95), respectively].In addition, age [aOR 0.61 (95 % CI 0.45-0.83) for women 15-19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2-2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1-2.8)] were associated with ITN use.Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use.

View Article: PubMed Central - PubMed

Affiliation: Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi. dmwandama@mac.medcol.mw.

ABSTRACT

Background: Intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) can reduce the morbidity and mortality associated with malaria in pregnancy. Although the coverage for both IPTp and ITN use have been described in Malawi, the analysis of factors associated with IPTp receipt and ITN use is lacking. This analysis was conducted to assess IPTp and ITN use and predictors of use by women of child-bearing age (WOCBA).

Methods: A two-stage cluster-sample cross-sectional survey was conducted April 16-30, 2009 in eight districts across Malawi. Information on receipt of two or more doses of IPTp, ITN ownership, and ITN use the night before the survey was collected. Multivariate logistic regression was used to assess predictors of IPTp and ITN use.

Results: Data were collected from 7407 households containing 6985 WOCBA and 3213 recently pregnant women (women who reported a completed pregnancy in the 2 years before the survey). Most recently pregnant women (96 %) had at least one antenatal care (ANC) clinic visit; 91 % reported receiving at least one dose of IPTp, and 72 % reported receiving two or more doses of IPTp. Women in Phalombe, Rumphi, and Lilongwe were more likely to receive two doses of IPTp than those in Blantyre [adjusted odds ratio (aOR) 2.5 (95 % CI 1.5-4.5), 2.5 (95 % CI 1.5-4.3), and 2.0 (95 % CI 1.2-3.1), respectively]. Educated women were more likely to have received IPTp compared to women with no education [aOR 1.6 (95 % CI 1.0-2.6) for those who completed primary school, aOR1.9 (95 % CI 1.1-3.3) for some secondary school, and aOR 4.1 (95 % CI 1.9-8.7) for completed secondary school or above], and women in the poorest socioeconomic status quintile were less likely to receive IPTp than those in the least poor quintile [aOR 0.68 (95 % CI 0.48-0.97)]. In all, 53 % of WOCBA used an ITN the previous night. Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39-0.69) and aOR 0.67 (95 % CI 0.47-0.95), respectively]. In addition, age [aOR 0.61 (95 % CI 0.45-0.83) for women 15-19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2-2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1-2.8)] were associated with ITN use.

Conclusion: In Malawi in 2009, IPTp and ITN use in WOCBA fell short of national and international goals. Adoption of new guidelines encouraging administration of IPTp at every scheduled ANC visit might increase IPTp use. Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use.

No MeSH data available.


Related in: MedlinePlus

Map of Malawi showing eight survey districts
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Fig1: Map of Malawi showing eight survey districts

Mentions: The household survey has been described in detail elsewhere [8]. Briefly, we conducted a two-stage cluster-sample cross-sectional household survey April 16–30, 2009 at the end of the long rains, in the middle of the high malaria transmission season. The study was conducted in both urban and rural communities in eight of the 28 districts in Malawi (Lilongwe, Blantyre, Mwanza, Chiradzulu, Phalombe, Rumphi, Nkhotakota, and Karonga), which were selected in collaboration with the Ministry of Health to serve as sentinel districts to monitor malaria burden and coverage of malaria control interventions—but did not constitute a nationally representative probability sample. These districts contain approximately 33 % of the entire population of Malawi and are dispersed in the north, central, and south regions (Fig. 1). A two-stage cluster sampling design was used. The first stage was composed of selecting enumeration areas (EAs). Altogether, 30 EAs per district were chosen using systematic random sampling with selection probability proportional to estimated size using the 1998 census. In the second stage, the EAs were divided into segments of roughly 30–60 households and a segment was randomly selected using a personal digital assistant (PDA; Dell Axim X50s, Dell Inc., Austin, TX, USA) with a specially-designed programme for random segment selection developed by the Centers for Disease Control and Prevention, USA. All households or a randomly selected subset of households in a selected segment were invited to participate in the survey. Informed consent was obtained from the head of household or other adult household resident. All the minors between 7 and 17 years were asked to provide an assent to participate in the study. All household members were asked to participate. A household listing was created which included all people who usually live in the household as well as guests of the household who stayed in the household the previous night. Information on the number, and visual inspection on the integrity of the bed nets in the household was collected by creating a bed net roster, which included information on whether nets were ITNs or conventional nets. Using the bed net roster and household listing, we recorded which household member slept under which bed net, allowing us to collect detailed, linked information on household members and bed nets in order to explore useful information on the ITN ownership and use. Women of child-bearing age (WOCBA) were defined as all women aged 15–49 years. The use of IPTp was defined as the uptake of at least two doses of sulfadoxine–pyrimethamine (SP) with at least one received at an ANC visit under direct observed therapy.Fig. 1


The use of intermittent preventive treatment in pregnancy and insecticide-treated bed nets for malaria prevention by women of child-bearing age in eight districts in Malawi.

Mwandama D, Gutman J, Wolkon A, Luka M, Jafali J, Ali D, Mathanga DP, Skarbinski J - Malar. J. (2015)

Map of Malawi showing eight survey districts
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536790&req=5

Fig1: Map of Malawi showing eight survey districts
Mentions: The household survey has been described in detail elsewhere [8]. Briefly, we conducted a two-stage cluster-sample cross-sectional household survey April 16–30, 2009 at the end of the long rains, in the middle of the high malaria transmission season. The study was conducted in both urban and rural communities in eight of the 28 districts in Malawi (Lilongwe, Blantyre, Mwanza, Chiradzulu, Phalombe, Rumphi, Nkhotakota, and Karonga), which were selected in collaboration with the Ministry of Health to serve as sentinel districts to monitor malaria burden and coverage of malaria control interventions—but did not constitute a nationally representative probability sample. These districts contain approximately 33 % of the entire population of Malawi and are dispersed in the north, central, and south regions (Fig. 1). A two-stage cluster sampling design was used. The first stage was composed of selecting enumeration areas (EAs). Altogether, 30 EAs per district were chosen using systematic random sampling with selection probability proportional to estimated size using the 1998 census. In the second stage, the EAs were divided into segments of roughly 30–60 households and a segment was randomly selected using a personal digital assistant (PDA; Dell Axim X50s, Dell Inc., Austin, TX, USA) with a specially-designed programme for random segment selection developed by the Centers for Disease Control and Prevention, USA. All households or a randomly selected subset of households in a selected segment were invited to participate in the survey. Informed consent was obtained from the head of household or other adult household resident. All the minors between 7 and 17 years were asked to provide an assent to participate in the study. All household members were asked to participate. A household listing was created which included all people who usually live in the household as well as guests of the household who stayed in the household the previous night. Information on the number, and visual inspection on the integrity of the bed nets in the household was collected by creating a bed net roster, which included information on whether nets were ITNs or conventional nets. Using the bed net roster and household listing, we recorded which household member slept under which bed net, allowing us to collect detailed, linked information on household members and bed nets in order to explore useful information on the ITN ownership and use. Women of child-bearing age (WOCBA) were defined as all women aged 15–49 years. The use of IPTp was defined as the uptake of at least two doses of sulfadoxine–pyrimethamine (SP) with at least one received at an ANC visit under direct observed therapy.Fig. 1

Bottom Line: Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39-0.69) and aOR 0.67 (95 % CI 0.47-0.95), respectively].In addition, age [aOR 0.61 (95 % CI 0.45-0.83) for women 15-19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2-2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1-2.8)] were associated with ITN use.Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use.

View Article: PubMed Central - PubMed

Affiliation: Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi. dmwandama@mac.medcol.mw.

ABSTRACT

Background: Intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) can reduce the morbidity and mortality associated with malaria in pregnancy. Although the coverage for both IPTp and ITN use have been described in Malawi, the analysis of factors associated with IPTp receipt and ITN use is lacking. This analysis was conducted to assess IPTp and ITN use and predictors of use by women of child-bearing age (WOCBA).

Methods: A two-stage cluster-sample cross-sectional survey was conducted April 16-30, 2009 in eight districts across Malawi. Information on receipt of two or more doses of IPTp, ITN ownership, and ITN use the night before the survey was collected. Multivariate logistic regression was used to assess predictors of IPTp and ITN use.

Results: Data were collected from 7407 households containing 6985 WOCBA and 3213 recently pregnant women (women who reported a completed pregnancy in the 2 years before the survey). Most recently pregnant women (96 %) had at least one antenatal care (ANC) clinic visit; 91 % reported receiving at least one dose of IPTp, and 72 % reported receiving two or more doses of IPTp. Women in Phalombe, Rumphi, and Lilongwe were more likely to receive two doses of IPTp than those in Blantyre [adjusted odds ratio (aOR) 2.5 (95 % CI 1.5-4.5), 2.5 (95 % CI 1.5-4.3), and 2.0 (95 % CI 1.2-3.1), respectively]. Educated women were more likely to have received IPTp compared to women with no education [aOR 1.6 (95 % CI 1.0-2.6) for those who completed primary school, aOR1.9 (95 % CI 1.1-3.3) for some secondary school, and aOR 4.1 (95 % CI 1.9-8.7) for completed secondary school or above], and women in the poorest socioeconomic status quintile were less likely to receive IPTp than those in the least poor quintile [aOR 0.68 (95 % CI 0.48-0.97)]. In all, 53 % of WOCBA used an ITN the previous night. Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39-0.69) and aOR 0.67 (95 % CI 0.47-0.95), respectively]. In addition, age [aOR 0.61 (95 % CI 0.45-0.83) for women 15-19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2-2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1-2.8)] were associated with ITN use.

Conclusion: In Malawi in 2009, IPTp and ITN use in WOCBA fell short of national and international goals. Adoption of new guidelines encouraging administration of IPTp at every scheduled ANC visit might increase IPTp use. Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use.

No MeSH data available.


Related in: MedlinePlus