Factors associated with the uptake of intermittent preventive treatment of malaria in pregnancy in the Bamenda health districts, Cameroon.

INTRODUCTION: The World Health Organization (WHO) recommends that in malaria endemic areas with moderate to high transmission rates, pregnant women presenting for antenatal clinic (ANC) should receive at least three doses of intermittent preventive treatment in pregnancy (IPTp) for malaria between the 16th and 36th weeks of pregnancy at intervals of 4 weeks between doses. Several challenges remain in effective implementation of IPTp policy making the targeted coverage (80%) of the third doses of IPTp far from being achieved. The main objective of this study was to assess factors associated with the uptake of IPTp among pregnant women attending ANCs in the Bamenda Health District. METHODS: To reach our objectives, we carried out a cross-sectional study following informed consent with thirty-nine (39) healthcare workers (HCW) and four hundred (400) pregnant women who were either in the third trimester of pregnancy or had recently given birth in any of thirty-six (36) health facilities (HF) within the Bamenda Health District (BHD) from May to August 2014. All sites within the BHD were included. The participants were selected by simple random sampling. The principal research instrument was a structured and pre-tested questionnaire that was designed to capture socio-demographic data and data related to stage of pregnancy and knowledge about IPTp. Data was entered using Ms Excel and analysed using SPSS v20.0. Descriptive statistics (frequencies and percentages) was used to report findings. We used Chi-Square test to compare the categorical variables (Fischer's exact test was used in cases were conditions for Chi-Square test were not met). RESULTS: Uptake for at least one dose of IPTp was 95.3% (381/400) and 54.9% (209/400) had received all three doses, 15.5% (59/400) received only one dose and 4.8% (19/400) did not receive any of the doses of IPTp. Knowledge about IPTp was associated with an increase uptake of IPTp (P<0.001). All health care providers were knowledgeable about the importance and use of IPTp. However, 35.9% reported not receiving any training on IPTp. Among the health providers, 28.2% did not know when to start IPTp and 43.59% did not know when to stop IPTp. Out of all the health care providers, 30.77% complained of medication (sulfadoxine-Pyrimethamine) stock out and 84.62% practiced the policy of direct observed therapy. CONCLUSION: The uptake of the third dose of IPTp is poor in the Bamenda Health District and this may be attributed to medication stock out and inadequacy of routine trainings for the health providers. The good practice observed was that of direct observed therapy by HCWs. Patient knowledge about IPTp in our study was associated with better uptake of IPTp. Encouraging education of pregnant women on the importance of IPTp, providing routine training to HCWs and promoting direct observation of therapy may improve on IPTp uptake during pregnancy.

Factors associated to the use of insecticide treated nets and intermittent preventive treatment for malaria control during pregnancy in Cameroon.

BACKGROUND: Malaria in pregnancy has been shown to cause both maternal and infant morbidity and mortality especially in sub Saharan Africa. The World Health Organization therefore recommends the use of insecticide treated nets (ITNs), intermittent preventive treatment (IPT) and effective management of clinical malaria. The main aim of this study was to assess the coverage of ITN and IPT among pregnant women and the factors associated with their use in the Buea Health District of Cameroon. METHODS: A cross sectional study was carried out from April to July 2014, in the Buea Health District which included 292 pregnant women attending antenatal care at clinics in the area. A structured questionnaire was use to obtain demographic data of participants and information on IPT and ITN use. RESULTS: The Overall coverage rate of IPT was 88.7 % and 43.8 % for ITN while the overall non usage rate for IPT and ITN was 11.3 % and 17.5 % respectively. Occupation, educational level, trimester and number of ANC were statistically significant to ITN use by bivariate analyses while being a student/ unemployed (OR = 0.25, 95 % CI = 0.07-0.95)) was negatively associated to ITN use by multivariate analysis. For IPTp-SP, occupation of participants, educational level, trimester of pregnancy and number of ANC were statistically significantly by bivariate analyses while attending ANC just once (OR = 0.006, 95 % CI = 0.00-0.04) was negatively associated to IPTp-SP use by multivariate analyses. CONCLUSION: This study identified that the use of IPT was fairly good, while ITN use was still low despite their free distribution. Therefore, frequent antenatal care visits and involvement of participants in a potential income generating venture (Business or earning a salary) will increase IPT and ITN usage.