Health Workers Background Characteristics
Of the 315 health care workers studied, more than two thirds 252 (80.5%) were females. The median age of the health workers was 29 years (26 – 34 years). On education, 149 (48.7%) of the 306 health workers studied were diploma holders, whiles 53 (17.3%) were degree holders. The majority 177 (59.2%) of the 299 health workers studied had been providing obstetric care for less than five years (Table 1)
Table 1: Background Characteristics of Health Workers studied, Northern Region, 2021
Characteristics
|
Frequency (N=315)
|
Percentage (%)
|
Sex
|
|
|
Male
|
61
|
19.5
|
Female
|
252
|
80.5
|
Subtotal
Experience
|
313
|
100.0
|
> 5
|
177
|
59.2
|
5 – 10
|
72
|
24.1
|
10+
|
50
|
16.7
|
Subtotal
|
299
|
100.0
|
Cadre
|
|
|
General nurse
|
124
|
39.7
|
Midwife
|
148
|
47.5
|
Others
|
40
|
12.8
|
Subtotal
|
312
|
100.0
|
Education
|
|
|
Certificate
|
104
|
34.0
|
Diploma
|
149
|
48.7
|
Degree
|
53
|
17.3
|
Subtotal
|
306
|
100.0
|
|
|
|
|
Median (years)
|
IQR (years)
|
Age of HWs
|
29.0
|
26.0 – 34.0
|
Health Workers’ Compliance with the IPTp-SP Recommended Treatment Guidelines
Majority 231 (73.3%) of the 315 health workers properly documented the IPTp-SP services rendered in patients’ ANC cards. Also, 228 (72.4%) of the 315 health workers studied did not ask if pregnant women were on other medications for example co-trimoxazole. On informing pregnant women on the next dose’s date, 179 (56.8%) of the 315 health workers failed to inform the pregnant women they attended (Table 2).
Table 2: Observation of Antenatal Health Workers IPTp-SP practices, Northern Region, 2021 (N=315)
Compliance to IPTp treatment guidelines
|
Frequency (N)
|
Percentage (%)
|
Confirmed gestational period
|
|
|
Yes
|
210
|
66.7
|
No
|
105
|
33.3
|
Report adverse reactions
|
|
|
Yes
|
110
|
34.9
|
No
|
205
|
65.1
|
Proper documentation
|
|
|
Yes
|
231
|
73.3
|
No
|
84
|
26.7
|
DOT practice
|
|
|
Yes
|
277
|
87.9
|
No
|
38
|
12.1
|
Other medications (co-trimoxazole)
|
|
|
Yes
|
87
|
27.6
|
No
|
228
|
72.4
|
Required dosage
|
|
|
Yes
|
306
|
97.1
|
No
|
9
|
2.9
|
Next dose
|
|
|
Yes
|
136
|
43.2
|
No
|
179
|
56.8
|
Stratification of Health Workers’ Compliance level by Health Facility Type
Overall, the majority 56.2% (CI 51.0 – 62.0) of the health workers complied with the recommended IPTp-SP practices adequately. However, lower levels of compliance were recorded in the health centers and CHPS compounds (Table 3).
Table 3: Stratification of Health Workers’ Compliance level by Health Facility type, Northern Region, 2021
Facility type
|
Compliance level (%)
|
95% CI
|
CHPS
|
21.20
|
11.0 - 35.0
|
Health Centre
|
15.60
|
5.0 - 33.0
|
Hospital
|
69.70
|
63.0 - 76.0
|
Association between Health worker-related factors and their Compliance with IPTp-SP guidelines
From the multivariable regression analysis, health workers’ experience, knowledge and use of manuals from personal sources were significantly associated with their compliance with the WHO IPTp-SP guidelines. Health workers who personally sourced and read IPTp-SP manuals had 1.9 times odds of compliance with the recommended guidelines compared to their counterparts (aOR = 1.89, 95% CI 1.04 - 3.43, p < 0.036). Similarly, the odds of complying with the recommended guidelines was 2.8 times among health workers with 5 – 10 years working experience (aOR = 2.78, 95% CI 1.06 - 7.24, p < 0.037) and 10.6 times among those with more than ten years of working experience (aOR = 10.64, 95% CI 5.99 - 18.91, p<0.001) compared with health workers with less than five years working experience.
Regarding the knowledge level of the health workers, the odds of complying with the recommended guidelines was 3.2 times among health workers with moderate knowledge compared to those with low knowledge (aOR = 3.20, 95% CI 2.28 - 4.49, p<0.001). Also, the odds of complying with the recommended guidelines was 7.6 times among health workers with high knowledge compared to those with low knowledge of the guidelines (aOR = 7.64, 95% CI 4.21 - 13.87, p<0.001) (Table 4)
Table 4: Association between Health worker-related factors and their Compliance with IPTp-SP guidelines in the Northern Region
Variable
|
cOR (95 % C.I)
|
P-value
|
aOR (95 % C.I)
|
P-value
|
Age of HWs
|
1.11 (1.1 1.16)
|
0.001
|
0.99 (0.96 1.01)
|
0.325
|
Sex
|
|
|
|
|
Male
|
1.00
|
|
|
|
Female
|
0.85 (0.48 1.51)
|
0.586
|
0.52 (0.15 1.79)
|
0.302
|
Experience
|
|
|
|
|
< 5
|
1.00
|
|
|
|
5 – 10
|
3.23 (1.78 5.85)
|
0.001
|
2.78 (1.06 7.24)
|
0.037++
|
>10
|
5.65 (2.59 12.33)
|
0.001
|
10.64 (5.99 18.91)
|
0.001++
|
Cadre
|
|
|
|
|
General Nurse
|
1.00
|
|
|
|
Midwife
|
1.66 (1.02 2.68)
|
0.041
|
0.15 (0.06 0.37)
|
0.001
|
Others
|
1.98 (0.95 4.15)
|
0.070
|
1.34 (0.65 2.78)
|
0.429
|
Education
|
|
|
|
|
Certificate
|
1.00
|
|
|
|
Diploma
|
1.36 (0.82 2.24)
|
0.232
|
2.37 (0.99 5.68)
|
0.052
|
Degree
|
3.69 (1.74 7.81)
|
0.001
|
2.27 (0.71 7.26)
|
0.165
|
Awareness
|
|
|
|
|
Not Aware
|
1.00
|
|
|
|
Aware
|
1.51 (0.91 2.48)
|
0.108
|
2.56 (0.86 7.78)
|
0.092
|
Knowledge level
|
|
|
|
|
Low
|
1.00
|
|
|
|
Moderate
|
2.90 (1.17 7.17)
|
0.021
|
3.20 (2.28 4.49)
|
0.001++
|
High
|
9.21 (3.54 23.96)
|
0.001
|
7.64 (4.21 13.87)
|
0.001++
|
Access to IPTp materials
|
|
|
|
|
Not Accessed
|
1.00
|
|
|
|
Accessed
|
2.21 (1.39 3.51)
|
0.001
|
1.89 (1.04 3.43)
|
0.036++
|
++statistically significant
Association between Facility-based factors and Health Workers’ Compliance Level
Facility type, job training, staff motivation, supervision and availability of IPTp-SP job aids and manuals were significantly associated with health workers compliance. Health workers who received in-service training on the revised IPTp-SP guidelines had 10.0 times odds of complying with the guidelines compared with those who had not received any training on IPTp-SP administration (aOR 10.11, 95%CI 4.53 - 22.56, p<0.001).
The odds of compliance among health workers satisfied with the ANC unit's conditions were 10.9 times compared with those not satisfied with the conditions of their working environment (aOR 10.87, 95%CI 7.04 - 16.79 p<0.001).
Similarly, health workers who had been supervised had 4.0 times odds of compliance with the recommended practices than those who had not received any supervisory visits (aOR 4.01, 95%CI 2.09 - 7.68, p<0.001). Health workers who received IPTp-SP training manuals from their facilities had 3.6 times odds of compliance compared with their counterparts who did not receive these materials from their facilities (aOR 3.61, 95%CI 2.44 - 5.35, p<0.001) (Table 5).
Table 5: Association between facility-based factors and health workers’ Compliance with IPTp-SP guidelines, Northern Region
Variable
|
cOR (95% CI)
|
P-value
|
aOR (95% CI)
|
P-value
|
Facility type
|
|
|
|
|
Hospital
|
1.00
|
|
|
|
Health Centre
|
0.08 (0.03 0.22)
|
0.001
|
0.03 (0.01 0.07)
|
0.001++
|
CHPS compound
|
0.11 (0.06 0.24)
|
0.001
|
0.03 (0.02 0.05)
|
0.001++
|
Staff workload
|
|
|
|
|
0 – 30
|
1.00
|
|
|
|
>30
|
0.95 (0.60 1.52)
|
0.829
|
-
|
-
|
Training
|
|
|
|
|
No
|
1.00
|
|
|
|
Yes
|
13.11 (7.60 22.62)
|
0.001
|
10.11 (4.53 22.56)
|
0.001++
|
Monitoring
|
|
|
|
|
No
|
1.00
|
|
|
|
Yes
|
16.63 (9.21 30.02)
|
0.001
|
4.01 (2.09 7.68)
|
0.001++
|
Job satisfaction
|
|
|
|
|
Not satisfied
|
1.00
|
|
|
|
Satisfied
|
12.24 (7.04 21.26)
|
0.001
|
10.87 (7.04 16.79)
|
0.001++
|
IPT training manual
|
|
|
|
|
Not provided
|
1.00
|
|
|
|
Provided
|
4.50 (2.55 7.95)
|
0.001
|
3.61 (2.44 5.35)
|
0.001++
|
Shortage of SP
|
|
|
|
|
No
|
1.00
|
|
|
|
Yes
|
0.42 (0.25 0.71)
|
0.001
|
1.08 (0.71 1.64)
|
0.730
|
++statistically significant
Health facility IPTp-SP implementation assessment
Health education programs on malaria in pregnancy were available in 75.0% (12/16) of the facilities visited. The majority 62.5% (10/16), of health facilities visited had their quarterly education programs, including IPTp-SP. Health talks were delivered in 8 of the 16 health facilities visited. Of these eight facilities, five included malaria in pregnancy in their presentation, whereas only three mentioned IPTp-SP in their presentation. SP was available in all the facilities visited, with eight facilities having posters of IPTp-SP pasted on the walls of the ANC unit. DOT was practiced in all the facilities visited; however, only two of these health facilities had potable water available for pregnant women. Pregnant women bought water from a seller in the ANC unit or a nearby provision store in the remaining 14 health facilities.