Use of intermittent presumptive treatment and insecticide treated bed nets by pregnant women in four Kenyan districts

TLDR

The Roll Back Malaria initiative promotes insecticide‑treated bednets and intermittent presumptive treatment for malaria prevention in pregnant women, but commodity supply and client costs are major barriers to achieving these goals in Africa. This study aimed to assess the uptake of ITNs and IPT among recently pregnant women in four Kenyan districts and to emphasize the need for rapid expansion of these services to meet 2005 targets. A community‑based survey of 1,814 randomly selected recently pregnant women was conducted in December 2001 across four districts. Only 5 % of women slept under an ITN, 5 % received two or more IPT doses, and overall coverage of recommended malaria‑prevention strategies was low, though 74 % of women attended antenatal clinics at least twice, indicating potential for scaling up.

Abstract

Summary The roll back malaria (RBM) movement promotes the use of insecticide‐treated bednets (ITNs) and intermittent presumptive treatment (IPT) of malaria infection as preventive measures against the adverse effects of malaria among pregnant women in Africa. To determine the use of these preventive measures we undertook a community‐based survey of recently pregnant women randomly selected from communities in four districts of Kenya in December 2001. Of the 1814 women surveyed, only 5% had slept under an ITN. More than half of the 13% of women using a bednet (treated or untreated) had bought their nets from shops or markets. Women from rural areas used bednets less than urban women (11% vs. 27%; P < 0.001), and 41% of the bednets used by rural women had been obtained free of charge from a research project in Bondo or a nationwide UNICEF donation through antenatal clinics (ANCs). Despite 96% of ANC providers being aware of IPT with sulphadoxine–pyrimethamine (SP), only 5% of women interviewed had received two or more doses of SP as a presumptive treatment. The coverage of pregnant women with at least one dose of IPT with SP was 14%, though a similar percentage also had received at least a single dose as a curative treatment. The coverage of nationally recommended strategies to prevent malaria during pregnancy during 2001 was low across the diverse malaria ecology of Kenya. Rapid expansion of access to these services is required to meet international and national targets by the year 2005. The scaling up of malaria prevention programmes through ANC services should be possible with 74% of women visiting ANCs at least twice in all four districts. Issues of commodity supply and service costs to clients will be the greatest impediments to reaching RBM targets.