Malaria infection in pregnancy is a public health issue that is affecting the whole world in one way or another. In pregnancy, malaria is linked to adverse pregnancy and worse birth outcomes as it can lead to maternal anemia, stillbirth, miscarriage, increased risk of preterm delivery, and low birth weight together with intrauterine growth restriction. 125 million pregnant women globally are at risk of malaria infection and Sub-Saharan Africa contributes to 35.4 million according to (Dellicour et al., 2010). In 2022, countries with moderate and high malaria transmission cases reported 12.7 million malaria infection in Africa. East and southern Africa recorded 27%, central Africa recorded 40.1% and west Africa recorded 39.3% thus Africa alone recorded 36% cases of malaria in pregnancy globally,(WHO, 2023). Also, annual deaths of 75,000 – 200000 infants and approximately 10000 deaths of women are associated with malaria in pregnancy thus making malaria in pregnancy to be a global issue, (WHO, 2023). In the quest to solve the problem of malaria in pregnancy, the WHO has recommended several ways such as sleeping under insecticide-treated mosquito nets, eight ant-natal visits, and provision of at least ≥ 3 doses of sulfadoxine-pyrimethamine (SP) in conjunction with good management of maternal malaria and anemia. Administration of 3 tablets per dose of SP was recommended to begin in the second trimester and be given during the ant-natal visit which occurs once in every month. It is further advised that the mothers be given under direct observation therapy (DOT), (WHO, 2023). Compliance with the advice has seen some of the endemic areas record low cases of Malaria thus agreeing that ≥ 3 doses of sulfadoxine-pyrimethamine to pregnant women in their gestation period reduces the risk of contracting malaria. Despite the recommendation made by the WHO in the management of malaria in pregnant women, there exists a trend of low uptake of ≥ 3 doses of sulfadoxine-pyrimethamine. This has resulted in more women ending up with malaria and thus suffering from the complications associated with it. The general assessment of how the Sub-Saharan African countries comply with the set guidelines revealed that the overall prevalence of adequate uptake of IPTp-SP was remarkably low, as less than a quarter of the women reported taking at least three doses of SP during their last pregnancy despite the region being a highly endemic malaria zone. (Yaya et al., 2018). Analysis of data from the Uganda Demographic and Health Survey, 2016 showed that only 18% of pregnant women take the optimal dose of the SP country-wide (Okethwangu et al., 2019), which is much below the WHO recommendation and target of at least 80%. Also, a correlates study done in Uganda showed that only 22.3% of women take at least three doses of IPTp – SP which is far below the national target of 93% that was to be achieved by 2026(Martin et al., 2020). In comparison with other Sub-Saharan countries, (E. K. Ameyaw, 2022) Uganda is still performing low in optimum uptake of the IPTp- SP. For instance, a survey done indicated that Ghana recorded a 63% uptake, Mali had 36.7% and Senegal posted 37.51% (Mbengue et al., 2017). Though they are far below the WHO target of 80% they are doing better than Uganda which has 18%. Concerning the need for the exploitation as to why low uptake of IPTp3-SP, studies have shown that even where the ANC compliance is high like in Mali with 84.0% the third dose uptake has still recorded at 24.8% (Diarra et al., 2019). Yet reasons for low uptake of IPTp3 in those areas is still unknown. In eastern Uganda alone, prevalence of malaria among the pregnant women is at 1.4% (3/210) and 9.1% (19/210) which indicates that pregnant women are more prone to malaria infection than their counter part who are not pregnant, (Nekaka et al., 2020). Despite this alarming rate the uptake of optimum dose among the 210 selected participants was 23.3% despite 57.8% ANC compliant. This indicates that there must be underlying problem as to why the compliance with optimum uptake is low. In Eastern Uganda still, an area with high endemisity of malaria, studies indicate that only 14.7% of pregnant women comply with the IPTp3 while at least IPTp2 is at 60%. This clearly depicts the bigger difference among the two doses yet the vital optimum doses recommended by the WHO is the third doses, (S. T. Wafula et al., 2021). This variation in the uptake of optimum dose of IPTp3-SP, has prompted this study to assess factors associated with uptake of the third dose so as to address the gap that will help in achieving the maximum yield recommended by the WHO. Addressing the barriers will help in solving the underlying problem. In addition, the WHO postulates that if the IPTp 3 coverage was increased to tally with that of the first ANC visit, then the low birth weight of 162000 globally would be averted and this will have an effect on Uganda which is contributing to 5% of malaria in pregnancy globally (WHO, 2022). Thus the reason to find out the factors associated with uptake of IPT3 – SP.
Malaria infection in pregnancy is a public health issue that is affecting the whole world in one way or another. In pregnancy, malaria is linked to adverse pregnancy and worse birth outcomes as it can lead to maternal anemia, stillbirth, miscarriage, increased risk of preterm delivery, and low birth weight together with intrauterine growth restriction. 125 million pregnant women globally are at risk of malaria infection and Sub-Saharan Africa contributes to 35.4 million according to (Dellicour et al., 2010).
In 2022, countries with moderate and high malaria transmission cases reported 12.7 million malaria infection in Africa. East and southern Africa recorded 27%, central Africa recorded 40.1% and west Africa recorded 39.3% thus Africa alone recorded 36% cases of malaria in pregnancy globally,(WHO, 2023). Also, annual deaths of 75,000 – 200000 infants and approximately 10000 deaths of women are associated with malaria in pregnancy thus making malaria in pregnancy to be a global issue, (WHO, 2023).
In the quest to solve the problem of malaria in pregnancy, the WHO has recommended several ways such as sleeping under insecticide-treated mosquito nets, eight ant-natal visits, and provision of at least ≥ 3 doses of sulfadoxine-pyrimethamine (SP) in conjunction with good management of maternal malaria and anemia. Administration of 3 tablets per dose of SP was recommended to begin in the second trimester and be given during the ant-natal visit which occurs once in every month. It is further advised that the mothers be given under direct observation therapy (DOT), (WHO, 2023). Compliance with the advice has seen some of the endemic areas record low cases of Malaria thus agreeing that ≥ 3 doses of sulfadoxine-pyrimethamine to pregnant women in their gestation period reduces the risk of contracting malaria.
Despite the recommendation made by the WHO in the management of malaria in pregnant women, there exists a trend of low uptake of ≥ 3 doses of sulfadoxine-pyrimethamine. This has resulted in more women ending up with malaria and thus suffering from the complications associated with it. The general assessment of how the Sub-Saharan African countries comply with the set guidelines revealed that the overall prevalence of adequate uptake of IPTp-SP was remarkably low, as less than a quarter of the women reported taking at least three doses of SP during their last pregnancy despite the region being a highly endemic malaria zone. (Yaya et al., 2018).
Analysis of data from the Uganda Demographic and Health Survey, 2016 showed that only 18% of pregnant women take the optimal dose of the SP country-wide (Okethwangu et al., 2019), which is much below the WHO recommendation and target of at least 80%. Also, a correlates study done in Uganda showed that only 22.3% of women take at least three doses of IPTp – SP which is far below the national target of 93% that was to be achieved by 2026(Martin et al., 2020).
In comparison with other Sub-Saharan countries, (E. K. Ameyaw, 2022) Uganda is still performing low in optimum uptake of the IPTp- SP. For instance, a survey done indicated that Ghana recorded a 63% uptake, Mali had 36.7% and Senegal posted 37.51% (Mbengue et al., 2017). Though they are far below the WHO target of 80% they are doing better than Uganda which has 18%.
Concerning the need for the exploitation as to why low uptake of IPTp3-SP, studies have shown that even where the ANC compliance is high like in Mali with 84.0% the third dose uptake has still recorded at 24.8% (Diarra et al., 2019). Yet reasons for low uptake of IPTp3 in those areas is still unknown.
In eastern Uganda alone, prevalence of malaria among the pregnant women is at 1.4% (3/210) and 9.1% (19/210) which indicates that pregnant women are more prone to malaria infection than their counter part who are not pregnant, (Nekaka et al., 2020). Despite this alarming rate the uptake of optimum dose among the 210 selected participants was 23.3% despite 57.8% ANC compliant. This indicates that there must be underlying problem as to why the compliance with optimum uptake is low.
In Eastern Uganda still, an area with high endemisity of malaria, studies indicate that only 14.7% of pregnant women comply with the IPTp3 while at least IPTp2 is at 60%. This clearly depicts the bigger difference among the two doses yet the vital optimum doses recommended by the WHO is the third doses, (S. T. Wafula et al., 2021). This variation in the uptake of optimum dose of IPTp3-SP, has prompted this study to assess factors associated with uptake of the third dose so as to address the gap that will help in achieving the maximum yield recommended by the WHO. Addressing the barriers will help in solving the underlying problem.
In addition, the WHO postulates that if the IPTp 3 coverage was increased to tally with that of the first ANC visit, then the low birth weight of 162000 globally would be averted and this will have an effect on Uganda which is contributing to 5% of malaria in pregnancy globally (WHO, 2022). Thus the reason to find out the factors associated with uptake of IPT3 – SP.