Abstract:

Background: Various factors have been demonstrated to contribute to the low uptake of IPTP among pregnant women attending various health facilities in the country. However, the contributions of the health system to the lower uptake of IPTP have received little attention. Here, in the present study, health system related factors that influence the uptake of IPTP during pregnancy were investigated.

Methods: This was a cross sectional study conducted in 30 randomly selected ANC in Sengerema district in June 2012. The study used a pre-tested questionnaire which collected information on health system factors influencing the uptake of IPTP of malaria during pregnancy among health care workers and pregnant women. Descriptive statistics such as mean, standard deviation, frequency and percentage were used to present the results. Additional analysis was done to calculate the 95% CI. Fischer’s exact test was used to assess the significance of observed differences and results with p-value less than 0.05 were considered statistically significant.

Results: In general health care workers were familiar with some aspects concerning IPTP such as drug recommended for IPTP reported by 97.4% (74/76, 95% CI, 94.7-99.9) health care workers, the starting of IPTP reported by 80.3 % (61/76,95% CI, 73.9-86.7) health care workers, and frequency of IPTP consumption reported by 78.9% (60/76, 95% CI, 72.4-85.4) health care workers. Fischer’s exacts test indicate that medical attendants were more partially or not knowledgeable on IPTP 33(97.1%) p-value=0.000 than other health care works cadres. Training about IPTP was found to be a problem as only 19.7% (15/76, 95% CI, 13.3-26.1) of health care workers received formal training on IPTP. More than half 60.5% (46/76, 95% CI, 52.7-68.4) agreed that IPTP is an effective drug on prevention of malaria during pregnancy. The practice of dot was found to be problematic since only 27.5 %( 21/76, 95% ci, 20.4-34.8) of the health care workers reported practicing DOT. Availability of SP was also problematic at the time of study, only 40.8% (31/76, 95% CI, 32.9-48.7) of health care workers had the drugs at the time of study. Supervision was also a problem since only 39.5% (30/76/ 95% CI, 31.6-47.3) of health care workers reported having been supervised in the year 2011 for IPTP. Uptake of IPTP was low among pregnant women, only 43.4% (36/83, 95% CI, 35.8-50.9) reported to have taken at least one dose and 34.9% (29/83, 95% CI, 27.6-42.2) reported to have used two doses.

Conclusion: Uptake of IPTP among pregnant women was found to be low. Lack of SP in the ANC was among the challenges faced by the ANC. It is important that there should be a constant supply of drugs to the ANC poor practice of DOT was also found in the ANC. Efforts should be made to train health care workers on IPTP. Finally supervision and monitoring activities should be improved. Capacity development training and regular supportive supervisory visiting could help improve the provision of IPTP. ©