Factors influencing the utilization of intermittent preventative treatment in pregnant women for malaria in the African region: A literature review

Introduction: Malaria is a mosquito borne, infection that can lead to anemia in pregnant women, low birth weight, still birth and other adverse birth outcomes. Despite many preventative measures, it is a major cause of maternal and infant mortality in the African region. The World Health Organization (WHO) recommends that women receive 3 doses of Sulfadoxine-pyrimethamine, as intermittent preventative treatment in pregnancy (IPTp). There is a large gap between the number of women attending antenatal visits and the number receiving IPTp, as well as a large attrition between the first and third dose. 

Methods: A literature review was conducted using the PubMed database between 8/21/2017 and 9/4/17.

Results: Rates of IPTp utilization and adherence lag far behind national targets across the African region. The cited literature elucidated several factors that consistently affected women in accessing the recommended 3 doses of IPTp. Knowledge of IPTp, the timing of ANC, and inconsistent guidelines for providers were the largest barriers, and these were exacerbated by factors like limited autonomy, mistrust or dislike of medication, stock outs of the drug, and poor patient/ provider interactions. 

Conclusions: Although the body of literature and geographical spread of the cited studies are small, these findings were reached using validated measures and representative samples, and may be generalized to the African region. These findings are significant to public health because they can inform interventions to increase rates of utilization and adherence by reducing barriers to ANC, implementing consistent guidelines for administration, and incorporating IPTp into malaria education. This in turn could drastically reduce maternal and child mortality from malaria.