Socio-Demographic Characteristics of Study Participants
A total of 375 nursing mothers within the reproductive age group (15 – 49 years) in the 4 selected health facilities were interviewed for the study. Table 2 summarizes the socio-demographic characteristics of the participants.
In all, 53.1% (199/375) of the participants were between the ages of 26 – 35 years and the majority (91.7%, 344/375) were married with 41.3% (15/375) having three or more children. Nearly half of them had secondary level education 45.1%, (169/375) and most of the participants (62.9%, 236/375) were self-employed as traders and artisans.
Majority of the participants 88.1% (331/375) were Christians followed by traditionalist (8.0%, 30/375) and then Muslims (3.7%,14/375) (Table 2).
ANC Attendance and Obstetric Characteristics of Participants
Table 3 presents descriptive information on ANC attendance and obstetrics characteristics of the nursing mothers. About two-thirds of the nursing mothers (66.1%, 248/375) had less than the eight WHO recommended ANC visits/contacts during pregnancy, 33.9% (127/375) had eight or more ANC visits during the period of pregnancy. The mean number of ANC was 6.5 ± 2.6 visits.
More than half (53.1%, 199/375) of the participants had their first ANC visit during the second trimester (13-26 weeks), 44.0% (165/375) during the first trimester and only 2.9% (11/375) had their first ANC visit in the third trimester. The mean gestational age at first ANC visit was 14.4 ±
6.5 weeks.
In all, 90.4% (339/375) of the respondents had their first dose of IPTp-Sp during the second trimester between 13 – 26 weeks of gestation and 21 (5.7%) respondents had theirs in the third trimester of pregnancy.
Thirteen respondents (3.5%; 13/375) had one dose of IPTp-SP with the majority (42.7%, 160/375) having three doses of IPTp-SP before delivery. About 17.1% (64/375) had five doses or more of IPTp-SP before delivery. Only four respondents (1.1%) did not take SP during their pregnancy. Some respondents reported side effects and allergies after taking SP tablets.
When asked the number of SP tablets taken per dose, (88.0%, 330/375) reported of receiving three tablets of SP per dose, 29 (7.7%) reported of receiving less than three SP tablets and 12 (3.2%) mentioned more than three SP tablets per dose (Table 3).
Adherence to New IPTp-SP Policy Recommendations and Proportion Of IPTp-SP Coverage
Majority of the participants (82.1%, 308/375) had three or more doses of IPTp-SP during their pregnancy as recommended by WHO and only 17.9% (67/375) had less than three doses.
However, when using Ghana’s five dose IPTp-SP coverage recommendation, only 64 (17.1%) participants adhered
The proportion of IPTp-SP coverage for IPTp1 was 98.9%; IPTp2 95.5%; IPTp3 82.1% IPTp4 39.5%; IPTp5 17.1% (Figure 1).
Individual factors
Over half of the respondents (52.0%) had a fair knowledge about malaria and Malaria in Pregnancy (MiP), 42.8% had poor knowledge and only 5.2% had good knowledge about malaria and MiP. Majority (83.5%, 308/375) of respondents had knowledge about the IPTp-SP and the benefits of it. The main source of information on malaria was from ANC/Health facility followed by the media.
Healthcare System/Institutional Factors
All the selected health facilities offered IPTp services (both static and outreach services).
SP was the drug of choice at these facilities; however, one out of the four facilities did not have SP at the time the study was conducted but was available few months prior to data collection.
SP was given as DOT at all the health facilities where the study was conducted and clean drinking water (sachets) was available for pregnant women. Of the 11 staff interviewed, six (54.6%) of respondents have had training on IPT-SP.
Assessment of Knowledge of ANC staff on IPTp showed that 90.9% of the ANC workers knew the correct definition of IPTp. All respondents (100.0%) knew the recommended drug, the dose and the correct interval for IPTp. However, only 45.5% knew when to start IPTp and 81.8% knew when it was contraindicated during pregnancy. This is shown in table 4.
Factors associated with adherence to IPTp-SP
In the multivariate logistic regression model, after adjusting for characteristics of participants, having ≥ 8 ANC visits (AOR=4.51, 95% CI 1.76- 11.57, p<0.05) and knowledge of IPTp-SP (AOR=2.74, 95% CI 1.29-5.82, p<0.05) were significantly associated to adherence to IPTp-SP. This is shown in Table 5.a