A COMPARISON OF UPTAKE OF INTERMITTENT PREVENTIVE TREATMENT OF MALARIA IN PREGNANCY IN URBAN AND RURAL PUBLIC PRIMARY HEALTH CARE CENTERS IN RIVERS

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A COMPARISON OF UPTAKE OF INTERMITTENT PREVENTIVE TREATMENT OF MALARIA IN PREGNANCY IN URBAN AND RURAL PUBLIC PRIMARY HEALTH CARE CENTERS IN RIVERS

Abstract

Introduction/ Background
Malaria in pregnancy contributes significantly to perinatal morbidity and mortality. According to the 2014 world malaria report, Nigeria and Democratic Republic of Congo accounted for 39% of the global estimates of malaria deaths and 34% of malaria cases in 2013. In Nigeria, intermittent preventive treatment of malaria in pregnancy (IPTp) coverage has been persistently low though higher in the urban compared with the rural areas. In the health facilities, deviations from prescribed standards in the national guidelines have been observed. The challenges of IPTp implementation in Nigeria are multi-factorial and may vary from place to place. This study aimed at comparing IPTp uptake at antenatal clinics (ANC), health workers’ practice and factors affecting IPTp uptake in urban and rural Primary Health Care Centres (PHCs) in Rivers State.
Methodology
This study was conducted in Okrika (rural LGA) and Obio/Akpor (Urban LGA) in Rivers State. A comparative cross sectional study design employing both quantitative methods of data collection was employed. Multistage sampling technique was employed in the quatitative aspect of this study. First simple random sampling technique was used to select an urban and a rural LGA. Subsequently, simple random sampling technique was used to select five and eight PHCs in the urban and rural LGAs respectively. In these PHCs, a checklist was employed to carry out a non-participant observation of IPTp practice. Furthermore systematic sampling was carried out to select a total of 415 and 420 ANC attendees in the urban and rural LGAs respectively. Exit interviews using an interviewer administered questionnaire was conducted with all selected ANC attendees. IPTp uptake was determined for both urban and rural groups. Client factors that may affect IPTp uptake were identified using bivariate and multivariate analysis.
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For the qualitative study, participants for focus group discussions and interviews were purposively selected. A total of 13 FGDs (five in the urban and eight in the rural groups respectively) were conducted with selected ANC attendees to explore client factors that may affect IPTp uptake. A total of 13 in-depth interviews (five in the urban and eight in the rural groups respectively) were conducted with all heads of selected ANCs. Two key informant interviews were conducted with Roll Back Malaria Managers in both selected LGAs. These interviews explored the health service factors affecting IPTp uptake.
Ethical approval was sought from the Ethics Committee of the University of Port Harcourt Teaching Hospital before the study commenced. Written permission to conduct the study was obtained from the Rivers State Primary Health Care Management Board (RPHCMB) and the Medical Officer of Health as well as the Local Government Council in the selected LGAs. Informed consent was obtained from all participants after the nature of the study was explained to them and confidentiality assured.
Results
Uptake of two or more doses of IPTp was higher in the urban PHCs 199 (48.0%) compared with the rural PHCs 161 (38.3%). The factors associated with IPTp uptake in the urban setting were marital status, number of ANC visits and time spent in getting to the ANC. While in the rural group, marital status, experience of side effects with SP tablets and number of ANC visits were factors affecting IPTp uptake.
In the focus group discussion the key findings on IPTp were that ANC attendees had reasons why they may not take two doses of IPTp. In the rural group, unavailability of the drug at the ANC, the side effects of the drug and receipt of SP tablets from other sources other than ANC were the reasons given. In the rural group, lack of money, receipt of SP tablets from other
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sources other than ANC and ANC attendees not feeling sick and as such did not think it was necessary to take SP tablets were reasons given.
A total of 13 parameters were used to assess IPTp practice at the PHCs. All PHCs in the urban group had ≥ 50% aggregate practice score. While six out of eight PHCs in the rural group had ≥ 50% aggregate practice score.
From the in-depth interviews with heads of ANC, lack of training on IPTp and lack of free SP tablets at the ANC were identified as health facility factors affecting IPTp uptake in both urban and rural groups. In addition poor monitoring and supervision was also identified as health facility factors affecting IPTp uptake by ANC heads in the urban group.
Conclusion
IPTp uptake values obtained in the current study were far below the national target of 100%. This may be due to deficiencies in key aspects of IPTp practice observed at the ANC. In the urban setting, marital status, number of ANC visits and time spent in getting to the ANC were factors affecting IPTp uptake. While marital status, experience of side effects with SP tablets and number of ANC visits were factors affecting IPTp uptake in the rural group. It is thus recommended that concerted effort be made to address the health service factors affecting IPTp uptake.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

A COMPARISON OF UPTAKE OF INTERMITTENT PREVENTIVE TREATMENT OF MALARIA IN PREGNANCY IN URBAN AND RURAL PUBLIC PRIMARY HEALTH CARE CENTERS IN RIVERS

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