Project – Effect of Intermittent Preventive Treatment (IPT) on Malaria Parasitaemia and Birth Outcomes

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa where transmission is intense and persistent. Among the most vulnerable groups are pregnant women, whose physiological and immunological changes during pregnancy reduce their resistance to malaria infection. This increased susceptibility exposes both the mother and fetus to severe health risks, including maternal anaemia, placental parasitaemia, low birth weight, preterm delivery, and even fetal loss .

Malaria in pregnancy is primarily caused by Plasmodium falciparum, which has the ability to sequester in the placenta, thereby interfering with nutrient and oxygen transfer to the fetus. This condition, known as placental malaria, is strongly associated with adverse birth outcomes such as intrauterine growth restriction and neonatal mortality. The burden is particularly high in malaria-endemic countries like Nigeria, where environmental and socio-economic factors contribute to sustained transmission.

To combat malaria in pregnancy, the World Health Organization recommends a comprehensive prevention strategy that includes the use of insecticide-treated nets (ITNs), prompt diagnosis and treatment, and intermittent preventive treatment in pregnancy (IPTp). IPT involves the administration of therapeutic doses of antimalarial drugs, typically sulfadoxine-pyrimethamine (SP), at scheduled intervals during pregnancy regardless of whether the woman is infected or not.

Evidence has shown that IPTp is a safe, effective, and cost-efficient intervention for reducing malaria burden in pregnancy. Studies indicate that IPTp significantly reduces maternal malaria parasitaemia, maternal anaemia, and the incidence of low birth weight infants while improving overall pregnancy outcomes . Furthermore, WHO recommends that pregnant women in malaria-endemic regions receive at least three doses of IPTp-SP starting from the second trimester, with doses given at least one month apart .

Despite these recommendations, the uptake and effectiveness of IPTp remain suboptimal in many developing countries due to factors such as late antenatal booking, poor adherence, drug resistance concerns, inadequate health education, and weak healthcare systems. Reports indicate that a significant proportion of pregnant women in Africa do not receive the recommended number of IPTp doses, thereby increasing their vulnerability to malaria and its complications .

Empirical studies conducted in Nigeria and other parts of Africa have demonstrated that pregnant women who do not receive IPTp or receive inadequate doses are more likely to have higher malaria parasitaemia and poorer birth outcomes compared to those who adhere to the recommended regimen. For instance, research has shown a significantly higher prevalence of malaria infection among women who did not receive IPTp compared to those who received two or more doses, alongside notable differences in birth weights of their infants .

In tertiary healthcare institutions such as University of Nigeria Teaching Hospital, antenatal care services provide an opportunity to implement IPTp strategies effectively. However, variations in compliance, accessibility, and awareness among pregnant women may influence the overall effectiveness of IPTp in reducing malaria parasitaemia and improving fetal outcomes.

Given the persistent burden of malaria in pregnancy and the critical role of IPTp, there is a need to continuously evaluate its effectiveness in real clinical settings. This study therefore seeks to examine the effect of intermittent preventive treatment on malaria parasitaemia and birth outcomes among pregnant women attending antenatal care at the University of Nigeria Teaching Hospital.

1.2 Statement of the Problem

Malaria in pregnancy continues to pose a serious threat to maternal and neonatal health in Nigeria despite the availability of effective preventive strategies such as intermittent preventive treatment in pregnancy (IPTp). The persistence of high rates of malaria parasitaemia among pregnant women suggests that existing interventions may not be achieving their full potential.

Although IPTp has been widely recommended and implemented as a key malaria control strategy, evidence indicates that many pregnant women either do not receive the recommended doses or begin treatment late due to delayed antenatal booking. This reduces the protective effect of IPTp and increases the risk of malaria infection during critical stages of pregnancy.

Furthermore, inconsistencies in adherence to IPTp protocols, coupled with issues such as drug resistance, poor health education, and limited access to quality antenatal care services, continue to undermine its effectiveness. As a result, adverse pregnancy outcomes such as maternal anaemia, low birth weight, preterm delivery, and increased neonatal morbidity and mortality remain prevalent.

In addition, there is limited context-specific data evaluating the actual impact of IPTp on malaria parasitaemia and birth outcomes in tertiary healthcare settings like the University of Nigeria Teaching Hospital. Without such data, it becomes difficult to assess the effectiveness of current interventions or to design improved strategies tailored to local conditions.

Therefore, this study seeks to address these gaps by investigating the effect of intermittent preventive treatment on malaria parasitaemia and birth outcomes among pregnant women, with the aim of providing evidence-based recommendations for improving maternal and child health outcomes.

1.3 Objectives of the Study

The main objective of this study is to examine the effect of intermittent preventive treatment (IPT) on malaria parasitaemia and birth outcomes.

The specific objectives are to:

1. Determine the prevalence of malaria parasitaemia among pregnant women receiving IPT.
2. Examine the relationship between IPT dosage and malaria parasitaemia.
3. Assess the effect of IPT on maternal outcomes such as anaemia.
4. Evaluate the effect of IPT on birth outcomes such as low birth weight and preterm delivery.

1.4 Research Questions

1. What is the prevalence of malaria parasitaemia among pregnant women receiving IPT?
2. What relationship exists between IPT dosage and malaria parasitaemia?
3. How does IPT influence maternal anaemia during pregnancy?
4. What effect does IPT have on birth outcomes?

1.5 Research Hypothesis

H₀: Intermittent preventive treatment (IPT) has no significant effect on malaria parasitaemia and birth outcomes among pregnant women.

1.6 Significance of the Study

This study will be beneficial to healthcare providers, policymakers, and researchers. It will provide empirical evidence on the effectiveness of IPTp in reducing malaria burden and improving pregnancy outcomes. The findings will also help in improving antenatal care practices and strengthening malaria prevention programs in Nigeria.

1.7 Scope of the Study

This study focuses on pregnant women attending antenatal care at the University of Nigeria Teaching Hospital. It examines the effect of intermittent preventive treatment on malaria parasitaemia and selected birth outcomes.

1.8 Definition of Terms

• Malaria Parasitaemia: Presence of malaria parasites in the blood.
• Intermittent Preventive Treatment (IPT): Administration of antimalarial drugs at specified intervals during pregnancy to prevent malaria infection.
• Anaemia: A condition characterized by low haemoglobin levels in the blood.
• Low Birth Weight (LBW): Birth weight less than 2.5 kg.
• Preterm Delivery: Delivery before 37 weeks of gestation.

Project – Effect of Intermittent Preventive Treatment (IPT) on Malaria Parasitaemia and Birth Outcomes