Missed Opportunities for Uptake of Intermittent Preventative Treatment for Malaria in Pregnancy in Tanzania

A major reason that coverage targets for intermittent treatment of malaria in pregnancy fall short are missed opportunities at health service sites. Jasmine Chadewa, Yusuph Kulindwa, Dunstan Bishanga, Mary Drake, Jeremie Zoungrana, Elaine Roman, Hussein Kidanto, Naomi Kaspar, Kristen Vibbert, and Lauren Borsa share what they have learned about this issue at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene.

About 35 million people in Tanzania are at risk of malaria, with pregnant women and under five children being the most vulnerable. The Tanzania National Malaria Control Program’s (NMCP) Strategic Plan for 2007–2012 reports that malaria accounts for 30% of the national disease burden, with about 1.7 million cases per year among pregnant women.

To prevent the effect of malaria in pregnancy, the Tanzania Government adopted IPTp3+ therapy for pregnant women per the WHO recommendations for IPTp-SP. This study explores missed opportunities to deliver IPT by looking at predictors causing the drop between coverage of IPTp2 (34%) and IPTp3+ (7%).

The study examined Tanzania Demographic and Health Survey (TDHS) 2015/2016 data on women aged 15-49 with a live birth in the two years preceding the survey and at least 2 doses or more of IPTp during ANC (n=4219) to identify factors associated with differences in IPTp uptake. Variables of interest were identified, recoded and generated as required. Data was analyzed using STATA v14, whereby frequency distributions were calculated and cross-tabs and logistic regressions were done comparing dependent and independent variables.

The analysis shows the factors contributing to the drop of IPTp uptake include wealth (the richest people are 2.5 times more likely to take at least three doses of IPTp) and education (those with no education are less likely to take more doses of IPTp compared to those who are educated). Residency is the largest contributing factor: 50% of pregnant mothers in rural areas are less likely to take three or more doses of SP.

Clients living within 5 km of health facilities have higher uptake of IPTp3+ compared to their counterparts who live further from the health facilities (33% less likely). However, our analysis shows that there is no correlation between IPTp3+ uptake and number of ANC visits, health insurance or number of children.

Based on these results, it is important to strategize to make health services and education more accessible to the population in order to increase IPTp uptake among pregnant women.

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