FACTORS INFLUENCING COMPLIANCE OF INTERMITTENT PREVENTIVE TREATMENT OF MALARIA AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN ALIMOSHO GENERAL HOSPITAL IGANDO LAGOS STATE

Abstract

This study examined the various factors that affect adherence to Intermittent Preventive Treatment in pregnancy (IPTp) among women receiving care at antenatal clinics in Lagos State, Nigeria. The research adopted a quantitative survey design, gathering data through a structured questionnaire distributed to 120 participants. The questionnaire addressed socio-demographic characteristics, knowledge and awareness of malaria prevention strategies and IPTp, barriers related to healthcare service accessibility, attitudes toward IPTp, previous encounters with malaria and preventive strategies, and the influence of healthcare providers on encouraging IPTp adherence. Data were analyzed with SPSS version 27, emphasizing descriptive statistics as well as inferential statistics such as one-sample t-tests to assess relationships among variables. The results revealed notable links between socio-demographic characteristics (including age, education level, socioeconomic status, and marital status) and levels of IPTp compliance among pregnant women. Greater knowledge and awareness of malaria prevention and IPTp were positively linked to improved compliance. Better access to healthcare facilities providing IPTp also supported stronger compliance behaviors. Favorable attitudes, beliefs, and views regarding IPTp were connected to higher rates of adherence. In addition, prior experiences with malaria, IPTp, and other preventive approaches shaped current adherence patterns. Strong engagement by healthcare providers played a key role in boosting IPTp compliance. In summary, the research highlights the complex range of factors determining IPTp adherence among pregnant women in Lagos State, Nigeria. Suggested actions include focused educational initiatives to increase understanding of IPTp advantages, enhancements to healthcare service accessibility, tackling cultural beliefs via community involvement, and bolstering training for healthcare providers on effective communication and IPTp protocols. These measures are vital for improving maternal and newborn health results through broader adherence to IPTp guidelines. Future studies might utilize longitudinal designs and qualitative methods to gain deeper insights into the dynamics of IPTp compliance and to develop more context-specific interventions that respond to local realities and obstacles.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria continues to pose a major public health issue globally, with particularly severe effects on vulnerable groups such as pregnant women and young children in areas where the disease is endemic. In sub-Saharan Africa, including Nigeria, malaria significantly contributes to rates of maternal and infant deaths even though effective preventive options exist (WHO, 2020). A primary strategy endorsed by the World Health Organization (WHO) to prevent malaria during pregnancy is Intermittent Preventive Treatment (IPTp). This approach consists of giving pregnant women a complete course of antimalarial medication during scheduled antenatal clinic appointments, irrespective of whether they currently have a malaria infection (WHO, 2012).

In Nigeria, the rate of malaria among pregnant women is quite high, with estimates around 20% (NPC & ICF, 2019). Although national guidelines support the use of IPTp with sulfadoxine-pyrimethamine (SP) throughout pregnancy, actual adherence and compliance levels to this measure are still below expectations (Federal Ministry of Health Nigeria, 2020). The elements affecting compliance with IPTp among pregnant women include a broad spectrum of challenges, such as socio-demographic characteristics, obstacles related to knowledge, difficulties accessing health services, cultural attitudes, and issues connected to healthcare providers (Ankomah et al., 2014).

Gaining insight into these varied factors is essential for raising compliance levels with IPTp, which would help lessen the impact of malaria on pregnant women and improve health outcomes for both mothers and newborns. The success of IPTp depends not just on its availability but also on the degree to which these influencing factors are managed within healthcare environments.

Socio-demographic elements like age, level of education, socioeconomic position, and marital status have important effects on how well pregnant women follow IPTp recommendations (Federal Ministry of Health Nigeria, 2020). For example, educational attainment affects women’s awareness and comprehension of IPTp’s advantages, its dosing schedule, and any associated risks (Ankomah et al., 2014). Furthermore, older pregnant women or those from higher socioeconomic backgrounds often enjoy improved access to health services, making it easier for them to attend antenatal clinics regularly for IPTp (NPC & ICF, 2019).

Additionally, the ease of reaching healthcare services that deliver IPTp is a key determinant of compliance among pregnant women. Issues such as the distance to health centers, the consistent availability of services, and the standard of care offered greatly affect IPTp utilization (WHO, 2012). Pregnant women encountering obstacles in reaching health facilities are more prone to skipping planned IPTp doses, which diminishes the treatment’s ability to prevent malaria (Ankomah et al., 2014).

Cultural views and understandings of malaria and its prevention also shape adherence to IPTp. Certain cultural perspectives may discourage pregnant women from pursuing preventive care or sticking to recommended treatments (NPC & ICF, 2019). Recognizing these cultural aspects is important for creating interventions that honor local traditions while encouraging greater IPTp use (Ankomah et al., 2014).

Moreover, the contribution of healthcare providers is indispensable in encouraging IPTp compliance. Strong communication abilities, sufficient expertise in malaria prevention, and following established treatment protocols are vital for building trust and encouraging participation among pregnant women (WHO, 2020). Providers who show empathy and communicate clearly can greatly increase pregnant women’s confidence in IPTp and their commitment to the full treatment schedule (Federal Ministry of Health Nigeria, 2020).

In conclusion, tackling the multiple factors affecting IPTp compliance among pregnant women is vital for advancing maternal and neonatal health in malaria-prone areas such as Nigeria. By recognizing and responding to socio-demographic, knowledge-based, accessibility, cultural, and provider-related influences, health programs can be customized to effectively promote IPTp adoption. Reinforcing health systems and adopting culturally appropriate methods represent essential actions toward decreasing malaria’s effects on pregnant women and securing improved health results for mothers and their babies (Ankomah et al., 2014; NPC & ICF, 2019).

This overview emphasizes the value of an all-encompassing strategy in malaria prevention activities, highlighting the necessity for specific interventions that account for local conditions and personal circumstances to achieve the greatest public health benefits from IPTp for pregnant women in Nigeria and comparable environments worldwide.

1.2 Statement of Problem

Malaria persists as a serious danger to the health of mothers and children in Nigeria, placing pregnant women at particular risk because of lowered immunity. Even with Intermittent Preventive Treatment in pregnancy (IPTp) readily available, adherence rates remain unsatisfactory (Federal Ministry of Health Nigeria, 2020). Contributing elements to this low compliance include socio-demographic factors such as age, education, and socioeconomic status, which influence access to and use of healthcare services (NPC & ICF, 2019). Cultural beliefs and views concerning malaria and IPTp among pregnant women also play a substantial part in non-adherence (Ankomah et al., 2014). Challenges related to providers, such as insufficient training and communication abilities, additionally obstruct successful IPTp delivery (WHO, 2020). These interconnected issues demonstrate the pressing requirement to investigate and resolve the diverse barriers affecting IPTp uptake among pregnant women at antenatal clinics in Nigeria, with the ultimate goal of strengthening maternal and neonatal health in regions where malaria is common.

1.3.1 Objectives of the Study

The primary goal of this study is to identify the Factors Influencing Compliance with Intermittent Preventive Treatment of Malaria Among Pregnant Women at Alimosho General Hospital.

1.3.2 Specific Objectives

1. Examine the ways in which socio-demographic variables including age, education level, socioeconomic status, and marital status affect compliance with IPTp.

2. Assess the extent of knowledge and awareness that pregnant women possess about malaria prevention and the significance of IPTp, encompassing their grasp of the dosing schedule and potential advantages.

3. Investigate the accessibility of healthcare services that provide IPTp, taking into account elements such as distance to facilities, service availability, and the quality of care delivered.

4. Explore pregnant women’s attitudes, beliefs, and perceptions regarding IPTp, including perceived risks and benefits, cultural views, and confidence in healthcare providers.

5. Review past experiences of pregnant women with malaria, IPTp, and additional preventive strategies, identifying any obstacles or supports to adherence they have faced.

1.4 Research Questions

1. In what ways do socio-demographic variables such as age, education level, socioeconomic status, and marital status affect compliance with IPTp among pregnant women?

2. What is the current level of knowledge and awareness among pregnant women concerning malaria prevention and the value of IPTp, including their comprehension of the dosing regimen and expected benefits?

3. Which accessibility obstacles do pregnant women encounter when trying to obtain healthcare services that offer IPTp, considering aspects like distance to facilities, service availability, and quality of care?

4. What attitudes, beliefs, and perceptions do pregnant women hold toward IPTp, covering perceived risks and benefits, cultural beliefs, and trust in healthcare providers?

5. What previous experiences have pregnant women had with malaria, IPTp, and other preventive measures, and which barriers or facilitators to adherence did they encounter?

1.5 Research Hypotheses

The following hypotheses were tested:

1. There is no meaningful association between socio-demographic variables (age, education level, socioeconomic status, marital status) and compliance with IPTp among pregnant women.

2. Pregnant women who possess higher knowledge and awareness about malaria prevention and the importance of IPTp will not demonstrate better compliance with IPTp.

3. Enhanced accessibility to healthcare services providing IPTp will not have a positive effect on compliance among pregnant women.

4. Positive attitudes, beliefs, and perceptions toward IPTp will not be associated with higher compliance rates among pregnant women.

5. Earlier experiences with malaria, IPTp, and other preventive measures will not affect current compliance behavior among pregnant women.

1.6 Significance of the Study

This research carries important implications in several areas. First, regarding policy, the outcomes will deliver valuable information to decision-makers at local, regional, and national levels. Grasping the factors that shape compliance with Intermittent Preventive Treatment in pregnancy (IPTp) among women at antenatal clinics in Lagos State is fundamental for creating focused interventions. Policymakers can apply these insights to update current policies and introduce fresh approaches designed to raise IPTp uptake and adherence levels.

Healthcare practice will also gain substantially from this study. Healthcare providers are central to administering IPTp and other malaria prevention services within antenatal care. By pinpointing barriers and supporting elements for IPTp compliance, the research will provide providers with the understanding required to refine their communication methods, respond to cultural beliefs, and upgrade service delivery overall. This can result in more successful IPTp execution and improved health results for pregnant women and their babies.

In the realm of research, this study will contribute meaningful localized information to the current body of knowledge on malaria prevention during pregnancy, especially within Lagos State, Nigeria. Many prior studies concentrate on national or broad regional patterns, yet community-specific data is necessary to comprehend distinctive challenges and possibilities in particular settings. By addressing this shortfall, the study will enhance academic resources and establish a basis for subsequent research and comparisons in analogous environments.

The findings can further support international knowledge exchange and best practices for malaria prevention in pregnant women. Lessons from this investigation can be disseminated to global health bodies, researchers, and professionals operating in other malaria-endemic areas. Such sharing can encourage joint initiatives to boost IPTp adoption worldwide and advance the wider objective of lowering malaria-related illness and death among at-risk populations.

From a public health standpoint, the research results have relevance for strategies aimed at disease control and prevention. Malaria continues to be a critical public health concern globally, with pregnant women facing elevated risk due to weakened immune responses. Successful IPTp rollout is essential not only for personal well-being but also for broader community efforts to manage malaria. By recognizing and mitigating obstacles to IPTp compliance, the study can assist in reducing malaria’s toll on maternal and child health in Lagos State.

On an ethical level, this study respects the principles of beneficence and justice by striving to advance healthcare practices and results for pregnant women. Through careful research and the sharing of evidence-based conclusions, the study aims to foster equity in healthcare provision and guarantee that all pregnant women receive fair access to effective malaria prevention services.

1.7 Scope of the Study

The research took place at Alimosho General Hospital, Igando, Lagos State. Data gathering occurred from [start date] to [end date], concentrating on pregnant women attending antenatal clinics within that timeframe. The study mainly focused on factors affecting IPTp compliance and did not cover other dimensions of malaria prevention or treatment in non-pregnant groups.

1.8 Operational Definition of Terms

Intermittent Preventive Treatment (IPTp): The delivery of a complete therapeutic dose of an antimalarial medication to pregnant women as part of antenatal care appointments.

Compliance: The degree to which pregnant women follow the recommended IPTp dosing timetable.

Socio-demographic variables: Encompasses age, education level, socioeconomic status (assessed via income or occupation), and marital status.

Healthcare providers: Refers to medical staff such as doctors, nurses, and midwives engaged in delivering antenatal care services at Alimosho General Hospital.