MALARIA CONTROL IN PREGNANCY: AN EVALUATION OF THE EFFECTIVENESS OF IPTp POLICY ON MATERNAL AND NEONATAL HEALTH IN THE TAMALE METROPOLIS OF NORTHERN GHANA

Abstract

Background: Malaria in pregnancy can have a negative impact on maternal and neonatal health, if not properly managed. One of the interventions for controlling the bad impact of unhealthy birth outcomes is through the use of Intermittent Preventive Treatment of Malaria (IPTp) using Sulphadoxine Pyrimethamine (SP). The World Health Organization (WHO) currently recommends the use of maximum five (5) doses of IPTp-SP during the second and third trimester of pregnancy at four weeks interval from 16 week to 38 weeks. However, no study has been done since its implementation in 2014. The aim of the study was to evaluate the effectiveness of IPTp policy on maternal and neonatal health in the Tamale Metropolis of Northern Ghana. Methods and Materials: The study was a Prospective Cohort with a quantitative approach from the four selected hospitals (Seventh Day Adventist (SDA), Tamale Teaching Hospital (TTH), Central and West hospitals) within the Tamale Metropolis from September, 2016 to August 2017. A cross-section of pregnant women who attended ANC were recruited at 16 weeks of gestation and also at quickening of the baby though the pregnancy may not be up to 16 weeks (at quickening) from the four selected health facilities. The register at the facilities served as a sampling frame and respondents were randomly sampled out of the numbers of pregnant women available during each clinic visit to obtain the predetermined sample size. Microscopy was used to check malaria parasitaemia at 36 weeks of gestation, however, haemoglobin level estimation was extracted from the Maternal Health Book at registration (booking) and at 36 weeks of gestation. Validated weighing scales were used to weigh the babies within 6 hours of delivery and the birth outcome recorded immediately after delivery. Chi-square and logistic regression were used to determine the odds association between the independent variable (IPTp-SP) and the dependent outcomes (maternal malaria infection, haemoglobin, low birth weight and and stillbirth) Statistical significance was set at p< 0.05. Results: A total pf 1181 participants were used in the final analysis. Almost half of the pregnant women (42.4%) reported uptake of ≥3 doses of SP up to the revised WHO acceptable doses. The prevalence of malaria (16.9%), anaemia (54.1%) LBW (7.1%) and stillbirth (7.4%) were high among the pregnant women who reported usage of ≥3 doses of SP. Pregnant women who reported uptake of ≥3 doses were 56% less likely of having malaria (aOR 0.44; CI 0.27-0.70; p=0.001) and 63% less likely to give birth to babies with low weight (aOR 0.37; CI 0.21-0.68; p=0.001). However, the effect of taking three or more doses did not translate into protection against maternal anaemia (aOR 0.89; CI 0.55-1.45; p=0.65) and stillbirth delivery (aOR 1.15; CI 0.55-2.42; p=0.71). A laboratory-based content analysis was performed on the 23 SP samples. A significant proportion of the drugs contained the right amount of Sulphadoxine but inadequate amount of the pyrimethamine. Conclusion: The revised WHO IPTp-SP policy of taking at least 3 doses of SP was associated with reduced odds of peripheral malaria parasitaemia and low birth weight but this effect did not translate into the benefits on maternal anaemia and stillbirths. It is highly recommended that, the Ministry of Health should find innovative ways to help increase the usage of IPTp 3 and above. Further research is required to provide answers to the deficiencies related with intervention use and the increased risk of anaemia during late gestation.