Factors Affecting the Adoption of Malaria Interventions for Pregnant Women in Tanzania: Tanzania Demographic Health Survey 2022

Authors

Melisa Nyamukondiwa, National Institute of Health Research (NIHR), Ministry of Health and Child Care, 65 Josiah Tongogara, Harare Street, Harare P.O. Box CY 1122, ZimbabweFollow
Asri C. Adisasmita, Department of Epidemiology, Faculty of Public Health, Universitas IndonesiaFollow
Renti Mahkota, Department of Epidemiology, Faculty of Public Health, Universitas IndonesiaFollow
Same Betera, Environmental Health Department, Ministry of Health and Child Care, Kaguvi Building, 4th Floor, Causeway, Harare P.O. Box CY 1122, ZimbabweFollow

Abstract

Tanzania is endemic to malaria and pregnant women due to their vulnerability are among the high-risk groups. The adoption of malaria interventions targeted to pregnant women is affected by a number of factors. A cross-sectional study using secondary data from Tanzania Demographic Health Survey (TDHS) for 2022 was used. A logistic regression was used for bivariate analysis to identify factors affecting the adoption of malaria interventions during pregnancy in Tanzania. Data from pregnant women between 15 to 49 years (N=1408) were analyzed in this study. Insecticide treated nets (ITNs) and intermittent preventive therapy in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) were the main malaria prevention methods identified from the TDHS 2022. The results showed that insecticide treated nets ownership (83.0%) and its usage (85.5% of those who had ITN) was relatively high among pregnant women. More than half of the pregnant women (60.6%) received IPTp-SP during pregnancy. Marital status (OR_{married compared to not married}=1.60; 95% CI: 1.15-2.24), education (OR_{secondary level and higher compared to no education}=1.43; 95% CI: 1.04-2.00) and Antenatal Care (ANC) visits (OR_{at least four ANC visits compared to no ANC}=2.60, 95% CI: 1.40-4.82), and higher level wealth status and parity had statistically significant association with higher odds of using ITN. Age (OR_{≥35 years compared to 15-19 years}=0.15, 95% CI: 0.05-0.50), education level (OR_{secondary level and higher compared to no school}=0.47, 95% CI: 0.27-0.79) and wealth status (at all levels, compared to the poorest) had statistically significant association with lower IPTp-SP uptake. Antenatal care visits should be maximized as an opportunity to distribute insecticide treated nets, give intermittent preventive medicine and education on malaria prevention. Future research should conduct multivariate analysis to determine independent predictors.

References

1. WHO. World malaria World malaria report report [Internet]. 2023. 283 p. Available from: https://www.wipo.int/amc/en/mediation/%0Ahttps://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023

2. Mkombachepa M, Khamis B, Rwegasira G, Urio F, Makani J, Luzzatto L. High incidence of malaria in patients with sickle cell disease. Am J Hematol. 2022;97(10):E380–1.

3. Iqmer A, Mohd N. Effectiveness of health education interventions to improve malaria knowledge and insecticide-treated nets usage among populations of sub-Saharan Africa : systematic review and meta-analysis. 2023;(August).

4. Paul P, Kangalawe RYM, Mboera LEG. Land-use patterns and their implication on malaria transmission in Kilosa District, Tanzania. Trop Dis Travel Med Vaccines. 2018;4(1):1–10.

5. Liheluka EA, Massawe IS, Chiduo MG, Mandara CI, Chacky F, Ndekuka L, et al. Community knowledge , attitude , practices and beliefs associated with persistence of malaria transmission in North ‑ western and Southern regions of Tanzania. Malar J [Internet]. 2023;1–16. Available from: https://doi.org/10.1186/s12936-023-04738-5

6. Kabuya JBB, Ippolito MM, Sikalima J, Tende C, Champo D, Mwakazanga D, et al. Safety and efficacy of intermittent presumptive treatment with sulfadoxine-pyrimethamine using rapid diagnostic test screening and treatment with dihydroartemisinin-piperaquine at the first antenatal care visit (IPTp-SP+): study protocol for a randomized . Trials. 2021;22(1):1–12.

7. Kencanawati DAPM, Namangjabar OL, Mirong ID, Batbual B, Sebasastianus Y, Martha E. Systematic Scoping Review of Innovation on Malaria Prevention Programs in Pregnancy During Pandemic. Int J Health Sci (Qassim). 2022;6(April):8627–41.

8. Oladimeji KE, Tsoka-Gwegweni JM, Anyiam FE, Yaya S, Nutor JJ, Abiodun G, et al. Socio-economic predictors of uptake of malaria interventions among pregnant women and mothers of under 5 children in Oyo State, Nigeria: a cross-sectional study. Pan Afr Med J. 2023;44:65.

9. Winskill P, Walker PG, Cibulskis RE, Ghani AC. Prioritizing the scale-up of interventions for malaria control and elimination. Malar J [Internet]. 2019;18(1):1–11. Available from: https://doi.org/10.1186/s12936-019-2755-5

10. Matindo AY, Kalolo A, Kengia JT, Kapologwe NA, Munisi DZ. The Role of Community Participation in Planning and Executing Malaria Interventions: Experience from Implementation of Biolarviciding for Malaria Vector Control in Southern Tanzania. Biomed Res Int. 2022;2022.

11. Account LM, Guidelines S, Access O. Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa : a review. Malar J. 2013;12(268):1–10.

12. World Health Organization. World Malaria Report. Vol. WHO/HTM/GM, World Health. 2010. 238 p.

13. Owusu-Boateng I, Anto F. Intermittent preventive treatment of malaria in pregnancy: a cross-sectional survey to assess uptake of the new sulfadoxine-pyrimethamine five dose policy in Ghana. Malar J. 2017;16(1):323.

14. Doumbia I, Seydou F, Diakalia K, Bennis I. The provider’s checklist to improve pregnant women coverage by intermittent preventive malaria treatment in Mali: a pilot implementation study. Malar J [Internet]. 2021;20(1):1–10. Available from: https://doi.org/10.1186/s12936-021-03940-7

15. Darteh EKM, Dickson KS, Ahinkorah BO, Owusu BA, Okyere J, Salihu T, et al. Factors influencing the uptake of intermittent preventive treatment among pregnant women in sub-Saharan Africa: a multilevel analysis. Arch Public Heal. 2021;79(1):1–9.

16. Health C. 2023 REPORT Tanzania. 2023;1–45.

17. Addis D, Gebeyehu Wondmeneh T. Assessment of malaria prevention knowledge, attitude, and practice and associated factors among households living in rural malaria-endemic areas in the Afar Pastoral Region of Ethiopia. Front Public Heal. 2023;11.

18. Bamou R, Tchuinkam T, Kopya E, Awono-Ambene P, Njiokou F, Mwangangi J, et al. Knowledge, attitudes, and practices regarding malaria control among communities living in the south Cameroon forest region. IJID Reg [Internet]. 2022;5(November):169–76. Available from: https://doi.org/10.1016/j.ijregi.2022.11.003

19. Lopez AR, Brown CA. Knowledge, attitudes and practices regarding malaria prevention and control in communities in the Eastern Region, Ghana, 2020. PLoS One [Internet]. 2023;18(8 August):1–17. Available from: http://dx.doi.org/10.1371/journal.pone.0290822

20. Kalu GO, Francis JM, Ibisomi L, Chirwa T, Kagura J. Factors associated with the uptake of Intermittent Preventive Treatment (IPTp-SP) for malaria in pregnancy: Further analysis of the 2018 Nigeria Demographic and Health Survey. PLOS Glob Public Heal [Internet]. 2023;3(2):e0000771. Available from: http://dx.doi.org/10.1371/journal.pgph.0000771

21. Wafula ST, Mendoza H, Nalugya A, Musoke D, Waiswa P. Determinants of uptake of malaria preventive interventions among pregnant women in eastern Uganda. Malar J [Internet]. 2021;20(1):1–8. Available from: https://doi.org/10.1186/s12936-020-03558-1

22. Mwangu LM, Mapuroma R, Ibisomi L. Factors associated with non-use of insecticide-treated bed nets among pregnant women in Zambia. Malar J [Internet]. 2022;21(1):1–9. Available from: https://doi.org/10.1186/s12936-022-04313-4

23. Mutanyi JA, Onguru DO, Ogolla SO, Adipo LB. Determinants of the uptake of intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine in Sabatia Sub County, Western Kenya. Infect Dis Poverty [Internet]. 2021;10(1):1–13. Available from: https://doi.org/10.1186/s40249-021-00887-4

24. Dun-Dery F, Kuunibe N, Meissner P, Winkler V, Jahn A, Müller O. Determinants of the use of insecticide-treated mosquito nets in pregnant women: a mixed-methods study in Ghana. Int Health. 2022;14(6):619–31.

25. Berhe AD, Doritchamou JYA, Duffy PE. Malaria in pregnancy: adverse pregnancy outcomes and the future of prevention. Front Trop Dis. 2023;4(August):1–9.

26. Kitojo C, Gutman JR, Chacky F, Kigadye E, Mkude S, Mandike R, et al. Articles Estimating malaria burden among pregnant women using data from antenatal care centres in Tanzania : a population-based study. Lancet Glob Heal [Internet]. 7(12):e1695–705. Available from: http://dx.doi.org/10.1016/S2214-109X(19)30405-X

27. Arikawa S, Tchankoni MK, Gbeasor-Komlanvi FA, Atekpe SP, Atcha-Oubou T, Figueroa-Romero A, et al. Prevalence and risk factors associated with malaria infection in children under two years of age in southern Togo prior to perennial malaria chemoprevention implementation. Malar J [Internet]. 2023;22(1):1–13. Available from: https://doi.org/10.1186/s12936-023-04793-y

28. Heuschen AK, Abdul-Mumin A, Abubakari A, Agbozo F, Lu G, Jahn A, et al. Effects of the COVID-19 pandemic on general health and malaria control in Ghana: a qualitative study with mothers and health care professionals. Malar J [Internet]. 2023;22(1):1–11. Available from: https://doi.org/10.1186/s12936-023-04513-6

29. Hussein MIH, Albashir AAD, Elawad OAMA, Homeida A. Malaria and COVID-19: unmasking their ties. Malar J [Internet]. 2020;19(1):1–10. Available from: https://doi.org/10.1186/s12936-020-03541-w

30. Chepkemoi Ng’etich Mutulei A. Factors Influencing the Uptake of Intermittent Preventive Treatment for Malaria in Pregnancy: Evidence from Bungoma East District, Kenya. Am J Public Heal Res. 2013;1(5):110–23.

31. Green EC, Murphy EM, Gryboski K. The Health Belief Model. Wiley Encycl Heal Psychol. 2020;(May 2022):211–4.

32. National Bureau of Statistics (NBS) O of the CGS (OCGS). Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 Key Indicators Report. 2023;1–23.

Bahasa Abstract

Tanzania merupakan negara endemis malaria dan ibu hamil termasuk dalam kelompok berisiko tinggi karena kerentanan mereka. Penerapan intervensi malaria yang ditargetkan pada ibu hamil dipengaruhi oleh sejumlah faktor. Oleh sebab itu, dilakukan penelitian cross-sectional ini, menggunakan data sekunder dari Survei Demografi dan Kesehatan Tanzania (Tanzania Demographic and Health Survey/TDHS) tahun 2022. Regresi logistik digunakan untuk analisis bivariat mengidentifikasi faktor-faktor yang berhubungan dengan penerapan intervensi malaria selama kehamilan di Tanzania. Data dari ibu hamil berusia antara 15 hingga 49 tahun (N=1408) dianalisis dalam penelitian ini. Kelambu berinsektisida (insecticide-treated bed net/ITN) dan terapi pencegahan intermiten pada kehamilan menggunakan sulfadoxine-pyrimethamine (intermittent preventive therapy in pregnancy using sulfadoxine-pyrimethamine/IPTp-SP) merupakan metode pencegahan malaria utama yang diidentifikasi dalam TDHS 2022. Hasil analisis menunjukkan kepemilikan kelambu berinsektisida (83,0%) dan penggunaannya (85,5% diantara yang memiliki kelambu berinsektisida) tergolong tinggi di kalangan ibu hamil. Lebih dari separuh ibu hamil (60,6%) mendapatkan IPTp-SP selama kehamilan. Status pernikahan (OR_{menikah dibanding tidak menikah}=1,60; 95% CI: 1,15–2,24), pendidikan (OR_{pendidikan menengah dan tinggi dibanding tidak sekolah}=1,43; 95% CI: 1,04–2,00), dan kunjungan antenatal care/ANC (OR_{empat kali kunjungan ANC dibanding tidak ANC}=2,60; 95% CI: 1,40–4,82), serta semakin tingginya status kekayaan dan paritas secara statistik berhubungan signifikan dengan penggunaan ITN yang lebih tinggi. Usia (OR_{usia ≥35 tahun dibanding usia 15-19 tahun}=0,15; 95% CI: 0,05–0,50), tingkat pendidikan (OR_{pendidikan menengah dan tinggi dibanding tidak sekolah}=0,47; 95% CI: 0,27–0,79), dan tingkat status kekayaan (pada semua tingkat, dibandingkan kelompok ekonomi terendah) secara statistik berhubungan signifikan dengan penggunaan IPTp-SP yang lebih rendah. Kunjungan antenatal harus dimaksimalkan sebagai kesempatan untuk mendistribusikan kelambu berinsektisida, memberikan pengobatan pencegahan berkala serta memberikan edukasi mengenai pencegahan malaria. Penelitian selanjutnya sebaiknya melakukan analisis multivariat untuk dapat mengetahui faktor-faktor yang secara independen mempengaruhi penggunaan ITN dan IPTp-SP.

Recommended Citation

Nyamukondiwa, Melisa; Adisasmita, Asri C.; Mahkota, Renti; and Betera, Same (2024) "Factors Affecting the Adoption of Malaria Interventions for Pregnant Women in Tanzania: Tanzania Demographic Health Survey 2022," Jurnal Epidemiologi Kesehatan Indonesia: Vol. 8: Iss. 2, Article 11.
DOI: 10.7454/epidkes.v8i2.1129
Available at: https://scholarhub.ui.ac.id/epidkes/vol8/iss2/11