Use of intermittent preventive treatment for malaria in pregnancy in a rural area of western Kenya with high coverage of insecticide-treated bed nets

Authors

  • A. M. van Eijk,

    1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya
    2. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • I. E. Blokland,

    1. University of Amsterdam, The Netherlands
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  • L. Slutsker,

    1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya
    2. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • F. Odhiambo,

    1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya
    2. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • J. G. Ayisi,

    1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya
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  • H. M. Bles,

    1. University of Amsterdam, The Netherlands
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  • D. H. Rosen,

    1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya
    2. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • K. Adazu,

    1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya
    2. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • K. A. Lindblade

    1. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Authors
A. M. van Eijk (corresponding author), Laurence Slutsker, Frank Odhiambo, John G. Ayisi and Kubaje Adazu, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Tel.: +254 35 22983/21036; Fax: +254 35 22981; E-mail AMvanEijk@yahoo.com, lslutsker@ke.cdc.gov, fodhiambo@ke.cdc.gov, jayisi@kisian.mimcom.net, Kadazu@ke.cdc.gov
Kim A. Lindblade, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. E-mail kil2@cdc.gov
Ilse Blokland and Hanneke Bles, Academic Medical Centre, AMC F4-22, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail ilseblokland@hotmail.com, hannekebles@hotmail.com
Daniel H. Rosen, Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA, USA. E-mail rosend@zimcdc.co.zw

Summary

Kenya established intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) for malaria in pregnancy as national policy in 1998. We assessed the coverage of IPT among women who had recently delivered in a rural area of western Kenya with perennial malaria transmission and high coverage with insecticide treated nets (ITNs) through a cross-sectional, community-based survey in December 2002. Antenatal clinic (ANC) attendance was high (89.9% of the 635 participating women); 77.5% of attendees visited an ANC before the third trimester and 91.9% made more than one visit. Delivery of SP by the ANC was reported by 19.1% of all women but only 6.8% reported receiving more than one dose. Given the high rate of use of ANC services, if SP were given at each visit after the first trimester, the potential coverage of IPT (two doses of SP) would be 80.3% in this study population. ITNs were used by 82.4% of women during pregnancy, and almost all mothers (98.5%) who slept under an ITN shared the nets with their newborns after delivery. Women who thought malaria in pregnancy caused foetal problems were more likely to have used an ITN (adjusted odds ratio [AOR] 1.6, 95% confidence interval [CI] 1.0–2.4), and to have visited ANC more than once (AOR 2.4, 95% CI 1.2–4.7) compared to women who thought malaria in pregnancy was either not a problem or caused problems for the mother only. These findings illustrate the need for improved IPT coverage in this rural area. Identification and removal of the barriers to provision of IPT during ANC visits can help to increase coverage. In this area of Kenya, health messages stressing that foetal complications of malaria in pregnancy may occur in the absence of maternal illness may improve the demand for IPT.

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