Factors associated with completion of Intermittent Preventative Therapy (IPT) among pregnant women in Malawi

Background: The objectives of this study were to determine the factors associated with completion of the recommended number of doses of Intermittent Preventative Therapy (IPT)for malaria and assess compliance with the national protocol for dispensing IPT in pregnant women. Method: A nested case control study was conducted among all pregnant women who had their first antenatal care visit between January and March 2010. The cases were a random sample of 1,159 women who received at least two doses of IPT while the controls were a random sample of 1,042 women who received one dose only. Results: The average gestational age at first visit was 25.1 weeks for the cases and 21.1 weeks among controls (p<0.05). The average number of antenatal visits was higher in cases compared to the controls (3.3 vs. 1.5; p < 0.05). No significant differences were found between the cases and controls according to age, district of residence, or type of facility where ANC care was accessed. Nine percent of the cases and approximately six percent of the controls were given IPT outside of the recommended schedule. Older women and those with higher parity were more likely to start antenatal care later. Primigravidas had significantly fewer ANC visits than multigravidas (P < 0.05). Conclusion: Women who presented early for antenatal care or had a greater number of visits were significantly more likely to have received the recommended two or more doses of IPT. Additional interventions targeting older women are required to encourage attendance for antenatal care.