Use of Antenatal Care, Maternity Services, Intermittent Presumptive, Treatment and Insecticide...

8/12/2019 Use of Antenatal Care, Maternity Services, Intermittent Presumptive, Treatment and Insecticide Treated Bed Nets by Pregnant Women in Luwero District, Uganda

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Background

Uganda is one of the countries in sub-SaharanAfrica with high maternal and neonatal morbidity

and mortality ratesMMR 504 per 100,000 live

births & NMR 40 per 1000 barely change in 2

decades

Over 90% population live in highly endemic areas

of malaria

Malaria during pregnancy contributes to highmaternal morbidity and mortality (severe anaemia,

low birth weight, fetal loss and still births)


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Occult malaria in pregnancy (womb fever) is known

by the local communities to be responsible for

spontaneous abortions and fetal deaths.

responsible for some of the women's emotional

stress, stigma, superstition, self-hatred, indulgence,

divorce and ostracization in society. Prevalence of malaria parasitaemia in pregnancy to

be 62.1%, severe maternal anemia (Hb < 8 g%)

18%, low birth weight 12.4%


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Sleeping under an insecticide treated bed net (ITN)

reduce the risk being infected with malaria and

maternal anaemia and low birth weight

Another preventive (IPTp-SP)increase both

maternal haemoglobin levels and the infants' birth

weight WHO recommends pregnant women in stable

malaria transmission area receive at least two

doses of IPT after quickening during routinely

scheduled antenatal clinic visits.


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The National Malaria Control Programme included:

(IPTp-SP)

promoting large-scale use of insecticide-treated materials

& indoor residual spraying

improved appropriate case management.

Expects to achieve a target by the year 2010 of 75% pregnant women receiving complete IPTp-SP

70% insecticide treated net (ITN)

100% clinical malaria cases receiving appropriate case

management


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Observed that on average women make only 2

ANC visits during pregnancy, often at late

gestational ages (>28 weeks)

The fact that 2 years after implementationtwo

dose IPTp-SP coverage stood at only 5% in the

central region Pregnant women from rural areas are more likely to

have placental malaria compared to women from

urban areasneed for more studies on antenatal

care performance and IPTp-SP coverage in rural

settings


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A baseline community household survey was

conducted in rural central Uganda among women

who had recently delivered to assess the use of

antenatal care, maternal services, IPTp-SP and

ITNs with the aim of improving uptake of an optimal

antenatal care package.


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MATERIAL AND METHODS

Study set t ing

Luwero district in rural central Uganda because of itsmalaria endemicity, ethnic homogeneity and social stability

Study design

A cross-sectional community survey HSD of Luwero

district namely Bamunanika and Kapeka in May 2005.

Inclusion Criteria All post-natal women who had

delivered their baby within the preceding five months


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Sampelestimated size of 384 mothers in each HSD

was required to calculate the true proportion using IPTwithin 5% points and assuming a 50% prevalence of at

least 4 ANC visits

The research team 6 trained research assistants and 2

field supervisorsThe study population was obtained using a multi stage

sampling technique

Data was collected for a total duration of five days


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MATERIAL AND METHODS Data col lect ion in struments

Participants were interviewed using a pre-tested semi

structured questionnaire

The questionnaire collected information about:

a) Socio-demographic variables including age,

religion, occupation, education level, distance to

health units, marital status

b) antenatal care service utilization including number

of antenatal care visits, health units visited, IPT intake

and ITN use

c) maternity services including delivery process and

place of delivery.


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Complete IPT uptake was defined as provision of at least

two or more SP doses given at the ANC to women who

were not sick

The field supervisors regularly cross-checked on the

completeness the data collected daily

Limitations of the study

imprecise estimates of gestational ages

IPT intake during ANC visits due to potential recall

bias

lack of ANC cards to corroborate some of theinformation obtained by self report


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MATERIAL AND METHODS Data analysis

Data double entered using Epi info version 2000 and

analyzed using SPSS version 10.0

Continuous data presented as means and medians.

Comparison of continuous data was done using the

independent t-test and nonparametric tests (Mann-

Whitney U test)

Proportions were analyzed using the Chi-square test or

Fisher's exact test.

Odds ratios and 95% confidence intervals (CI) were

determined.

Statistical significance was taken as P < 0.05.


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384 Post Partum Woman in

Bamunanika

Continuous data was presented as means (standard deviation) SD and medians

Comparison of continuous data was done using the independent t-test and

nonparametric tests (Mann-Whitney U test) where the assumptions of normalitywere unmet.

Proportions were analyzed using the Chi-square test or Fisher's exact test.

Odds ratios and 95% confidence intervals (CI) were determined. Statistical

significance was taken as P < 0.05.

384 Post Partum Woman in

Kapeka

Interviewed using a pre-tested semi structured

questionnaire

FLOW CHART24,848 Total Population in

Bamunanika

24,068 Total Population in

Kapeka


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RESULTS


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RESULTS


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RESULTS


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DISCUSSION

The study indicates a high rate of antenatal careattendance

6 years after the introduction of IPTonly a small

percentage of women in this rural area are

benefiting from this policy

> 2/3 of women attending antenatal care and

delivering from formal health units received at least

one dose, < 40% received the recommended fulltwo dose SP regimen


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DISCUSSION

In this rural setting, the coverage of pregnantwomen with the recommended malaria preventive

measures (ITNs and IPT was < 5% of the targets

Only 30% of women slept under a bed net and only

36.2% received two or more doses of SP as

presumptive treatment

Only 13% of women being covered by both these

malaria preventive


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DISCUSSION

Primigravidae were more likely to sleep under a netcompared to multigravidae, although this finding

has not been consistent in studies done elsewhere

Previous studies in Uganda have revealed that

perceiving malaria as an important complication in

pregnancy appears to be an important factor in

motivating pregnant women to participate in this

program


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DISCUSSION

The majority of the mothers reported receivingantenatal care from formal health units

However approximately 60% delivered outside a

formal health facility.*

Other studies have reported 55% of women

delivering from home

The possible reasons could be related to costs,

cultural factors, health worker's attitudes towardspregnant women and the perceived quality of care

at the health units.


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DISCUSSION

Given the projected absence of adequate cadres ofskilled birth attendants innovative approaches to

improve perinatal health in this community.

Free LLINs to vulnerable groups countrywide is part

of Ugandan commitment to improve access to ITNs

for pregnant women

It is hoped that through health education and

promotion, some of the socio-economic inequalitiesthat hinder access of rural communities to

healthcare service utilization will be addressed.


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CONCLUSION

In conclusion, this baseline survey confirms that

ANC attendance and delivery of a full IPT regimenare sub-optimal.

This results in limited access to information on

malaria prevention in pregnancy, such as the

benefits of IPT and ITNs Given findings of this baseline study and others to

come in Uganda it is important to identify strategies

to increase IPTp-SP uptake in rural areas

Optimising IPT uptake during ANC services would

be the most rational option given high attendance

rates of the formal health sector


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CONCLUSION

To this end, the malaria control program of the

Ministry of Health, Uganda, designed a program tostrengthen the capacity of the district for improved

ANC performance and hence IPT uptake.

Through the use of trained community owned

resource persons, pregnant women are periodicallymade aware about the consequences of malaria in

pregnancy & the necessity of an early ANC visit so

as to benefit from administration of a full IPT

regimen

The implementation of such a strategy is subject to

further evaluation


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CRITICAL APRAISAL


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CRITICAL APRAISAL

What is the research question and/hypothesis ?

Research question:

How was the used of antenatal care, maternityservices, intermittent presumptive treatment andinsecticide treated bed nets by pregnant women

in Luwero district, Ugandathe authors of this study didnt generatehypothesis

What is the study type?

Cross-sectional community survey What is the reference population?

Luwero district namely Bamunanika and Kapeka


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CRITICAL APRAISAL

What are the sampling frame and sampling methode?

Sampling FrameAll post-natal women who had delivered their babywithin the preceding five months

Sampling Methode

Multi stage sampling technique

What are the study factor and how are they measured?

The use of used of antenatal care, maternity

services, intermittent presumptive treatment and

insecticide treated bed nets by pregnant women in

Luwero district, Uganda

Measured by a pre-tested semi structured

questionnaire


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CRITICAL APRAISAL

What are the outcome factors and how are they measured?

The Relationship between- education and antenatal care visit

- primi/multigravidae and IPTp-SP use

- education and IPTp-SP use

- primi/multigravidae and ITN useThey measured by statistical analysis

Are these sources of bias relevant to the study?

Selection bias: No randomize sample

Recall bias: Yes

IPT intake during ANC & estimate ofgestasional age

Collected bias: Yes lack of ANC cards


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CRITICAL APRAISAL

Are sample size issues considered ? Is the powerof the study indicate?

Yes, the size sample is considered

No, the power of the study is not indicated

Are statistical methods described?

Yes, the statistical methods are describe


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CRITICAL APRAISAL

What conclusion did the author reach about theresearch question ?

ANC attendance and delivery of a full IPT regimenare sub-optimal

Did they generate new hypothesis ?

No, they did not

Do you agree with the conclusions ?Yes, I do


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THANK YOU

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