Uptake and Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during Pregnancy in Africa: A Scoping Review
Abstract
:1. Introduction
2. Methods
2.1. Research Design
2.2. Research Questions
- What is the level of IPTp-SP uptake during pregnancy in Africa?
- What are the facilitators and barriers to IPTp-SP access among pregnant women in Africa?
- What is the effectiveness of IPTp-SP among pregnant women in Africa?
- What are the adverse effects of IPTp-SP on maternal and neonatal outcomes in Africa?
2.3. Search Strategy
2.4. Inclusion Criteria
2.5. Exclusion Criteria
2.6. Study Selection
2.7. Data Extraction
2.8. Collating, Summarising and Reporting the Results
2.9. Consultation
3. Results
3.1. Search Results
3.2. Characteristics of Included Studies
3.3. Rate of Uptake of IPTp-SP Based on Reported Doses
3.4. Factors Affecting the Uptake of IPTp-SP
3.4.1. Facilitators of IPTp-SP Uptake
Individual Factors
Interpersonal Factors
Institutional Factors
Community/Societal Factors
3.4.2. Barriers to IPTp-SP Uptake
Individual
Interpersonal
Institutional Factors
Community/Societal Factors
3.5. Effectiveness of IPTp-SP during Pregnancy
3.5.1. Effectiveness of IPTp-SP on Pregnancy and Maternal Health Outcomes
3.5.2. Effectiveness of IPTp-SP Based on Doses
3.6. Adverse Effects of IPTp-SP
4. Discussion
4.1. Summary of Findings
4.2. Uptake of IPTp-SP
4.3. Facilitators and Barriers to IPTp-SP Uptake in Africa
4.3.1. Facilitators
4.3.2. Barriers
4.4. Effectiveness of IPTp-SP
4.5. Adverse Effects of IPTp-SP
4.6. Limitations
4.7. Implications for Policy and Practice
4.8. Recommendations for Future Studies
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Item | Planned Search Terms |
---|---|
#1: Search to find IPTp-SP | Intermittent Preventive Treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) OR IPTp with SP OR SP-IPTp OR Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment in pregnancy OR Malaria prophylaxis in pregnancy with SP OR Sulfadoxine-Pyrimethamine for malaria prevention in pregnant women OR Antimalarial treatment in pregnancy with SP OR IPTp using Sulfadoxine-Pyrimethamine OR Sulfadoxine-Pyrimethamine as intermittent preventive therapy in pregnancy OR IPTp-SP regimen |
#2: Search to identify uptake of IPTp-SP during pregnancy | Uptake OR Utilization OR Intake |
#3: Search to identify effectiveness | Effectiveness OR Efficacy OR Potency OR Usefulness OR Effect |
#4: Search to identify pregnancy | Pregnancy, OR Antenatal period OR Gestation period OR Conception OR Prenatal period |
#5: Search to identify Africa | Africa OR sub-Saharan Africa OR Eastern Africa OR Western Africa OR Central Africa OR Southern Africa OR Northern Africa OR Sure, here’s a list of all countries in Africa separated by OR Algeria OR Angola OR Benin OR Botswana OR Burkina Faso OR Burundi OR Cabo Verde OR Cameroon OR Central African Republic OR Chad OR Comoros OR Democratic Republic of the Congo OR Djibouti OR Egypt OR Equatorial Guinea OR Eritrea OR Eswatini OR Ethiopia OR Gabon OR Gambia OR Ghana OR Guinea OR Guinea-Bissau OR Ivory Coast OR Kenya OR Lesotho OR Liberia OR Libya OR Madagascar OR Malawi OR Mali OR Mauritania OR Mauritius OR Morocco OR Mozambique OR Namibia OR Niger OR Nigeria OR Republic of the Congo OR Rwanda OR Sao Tome and Principe OR Senegal OR Seychelles OR Sierra Leone OR Somalia OR South Africa OR South Sudan OR Sudan OR Tanzania OR Togo OR Tunisia OR Uganda OR Zambia OR Zimbabwe |
Overall search strategy | #1 AND #2 AND #4 AND #5 Not animal * (Uptake of IPTp-SP) #1 AND #3 AND #4 AND 5 Not animal * (Effectiveness of IPTp-SP) |
Filters | English language; From 1 January 2000 to 13 May 2024 |
Databases | Search Strategy |
Search in PubMed to identify uptake and effectiveness of IPTp-SP in Africa | Uptake of IPTp-SP: (intermittent [All Fields] AND preventive [All Fields] AND (“therapy” [Subheading] OR “therapy” [All Fields] OR “treatment” [All Fields] OR “therapeutics” [MeSH Terms] OR “therapeutics” [All Fields]) AND (“pregnancy” [MeSH Terms] OR “pregnancy” [All Fields]) AND (“fanasil, pyrimethamine drug combination” [Supplementary Concept] OR “fanasil, pyrimethamine drug combination” [All Fields] OR “sulfadoxine pyrimethamine” [All Fields])) OR IPTp-SP [All Fields] AND uptake [All Fields] AND (“pregnancy” [MeSH Terms] OR “pregnancy” [All Fields]) AND (“africa” [MeSH Terms] OR “africa” [All Fields]) Effectiveness of IPTp-SP: (intermittent [All Fields] AND preventive [All Fields] AND (“therapy” [Subheading] OR “therapy” [All Fields] OR “treatment” [All Fields] OR “therapeutics” [MeSH Terms] OR “therapeutics” [All Fields]) AND (“pregnancy” [MeSH Terms] OR “pregnancy” [All Fields]) AND (“fanasil, pyrimethamine drug combination” [Supplementary Concept] OR “fanasil, pyrimethamine drug combination” [All Fields] OR “sulfadoxine pyrimethamine” [All Fields])) OR IPTp-SP [All Fields] AND effectiveness [All Fields] AND (“pregnancy” [MeSH Terms] OR “pregnancy” [All Fields]) AND (“africa” [MeSH Terms] OR “africa” [All Fields]) |
Search in Embase to identify uptake and effectiveness of IPTp-SP in Africa | Uptake of IPT-SP: (‘intermittent’:ti,ab,kw AND ‘preventive’:ti,ab,kw AND (‘therapy’:sb,ti,ab,kw OR ‘therapy’:ti,ab,kw OR ‘treatment’:ti,ab,kw OR ‘therapeutics’:mh,ti,ab,kw OR ‘therapeutics’:ti,ab,kw) AND (‘pregnancy’:mh,ti,ab,kw OR ‘pregnancy’:ti,ab,kw) AND (‘fanasil, pyrimethamine drug combination’:sc,ti,ab,kw OR ‘fanasil, pyrimethamine drug combination’:ti,ab,kw OR ‘sulfadoxine pyrimethamine’:ti,ab,kw)) OR ‘IPTp-SP’:ti,ab,kw AND ‘uptake’:ti,ab,kw AND (‘pregnancy’:mh,ti,ab,kw OR ‘pregnancy’:ti,ab,kw) AND (‘africa’:mh,ti,ab,kw OR ‘africa’:ti,ab,kw) Effectiveness of IPTp-SP: (‘intermittent’:ti,ab,kw AND ‘preventive’:ti,ab,kw AND (‘therapy’:sb,ti,ab,kw OR ‘therapy’:ti,ab,kw OR ‘treatment’:ti,ab,kw OR ‘therapeutics’:mh,ti,ab,kw OR ‘therapeutics’:ti,ab,kw) AND (‘pregnancy’:mh,ti,ab,kw OR ‘pregnancy’:ti,ab,kw) AND (‘fanasil, pyrimethamine drug combination’:sc,ti,ab,kw OR ‘fanasil, pyrimethamine drug combination’:ti,ab,kw OR ‘sulfadoxine pyrimethamine’:ti,ab,kw)) OR ‘IPTp-SP’:ti,ab,kw AND ‘effectiveness’:ti,ab,kw AND (‘pregnancy’:mh,ti,ab,kw OR ‘pregnancy’:ti,ab,kw) AND (‘africa’:mh,ti,ab,kw OR ‘africa’:ti,ab,kw) |
Search in Scopus to identify uptake and effectiveness of IPTp-SP in Africa | Uptake of IPTp-SP: TITLE-ABS-KEY(intermittent AND preventive AND (therapy OR treatment OR therapeutics) AND (pregnancy) AND (“fanasil, pyrimethamine drug combination” OR “sulfadoxine pyrimethamine”)) OR TITLE-ABS-KEY (IPTp-SP AND uptake AND pregnancy AND africa) Effectiveness of IPTp-SP: TITLE-ABS-KEY (intermittent AND preventive AND (therapy OR treatment OR therapeutics) AND (pregnancy) AND (“fanasil, pyrimethamine drug combination” OR “sulfadoxine pyrimethamine”)) OR TITLE-ABS-KEY (IPTp-SP AND effectiveness AND pregnancy AND africa) |
Search in Web of science to identify uptake and effectiveness of IPTp-SP in Africa | Uptake of IPT-p-SP: TS = (intermittent AND preventive AND (therapy OR treatment OR therapeutics) AND (pregnancy) AND (“fanasil, pyrimethamine drug combination” OR “sulfadoxine pyrimethamine”)) OR TS = (IPTp-SP AND uptake AND pregnancy AND africa) Effectiveness of IPTp-SP: TS = (intermittent AND preventive AND (therapy OR treatment OR therapeutics) AND (pregnancy) AND (“fanasil, pyrimethamine drug combination” OR “sulfadoxine pyrimethamine”)) OR TS = (IPTp-SP AND effectiveness AND pregnancy AND africa) |
E.g., Search in JSTOR to identify uptake and effectiveness of IPTp-SP in Africa | Uptake of IPTp-SP: (ti:(intermittent AND preventive AND (therapy OR treatment OR therapeutics) AND (pregnancy) AND (“fanasil, pyrimethamine drug combination” OR “sulfadoxine pyrimethamine”))) OR (ti:(IPTp-SP AND uptake AND pregnancy AND africa)) Effectiveness of IPTp-SP: (ti:(intermittent AND preventive AND (therapy OR treatment OR therapeutics) AND (pregnancy) AND (“fanasil, pyrimethamine drug combination” OR “sulfadoxine pyrimethamine”))) OR (ti:(IPTp-SP AND effectiveness AND pregnancy AND africa)) |
Dose | Rate of Uptake (%) | Sample Size | Country | Authors |
---|---|---|---|---|
At least 1 dose of IPTp-SP | 5.3 | 1926 | Ghana | [30] |
6.0 | 1922 | Ghana | [33] | |
24.0 | 487 | Ghana | [32] | |
35.8 | 565 | Uganda | [34] | |
38.0 | 201 | Cameroon | [41] | |
41.0 | 724 | Kenya | [42] | |
75.5 | 391 | Malawi | [43] | |
82.0 | 2232 | Ghana | [44] | |
84.1 | 1030 | Gabon | [45] | |
92.4 | 2785 | Uganda | [46] | |
95.3 | 8131; 439 | Malawi; Cameroon | [47,48] | |
97.7 | 1820 | Uganda | [49] | |
98.9 | 375 | Ghana | [31] | |
At least 2 doses of IPTp-SP | 15.0 | 487 | Ghana | [32] |
15.5 | 1926 | Ghana | [30] | |
19.2 | 8131 | Malawi | [47] | |
21.0 | 724 | Kenya | [42] | |
31.3 | 500 | Uganda | [50] | |
44.8 | 500 | Uganda | [50] | |
54.9 | 439 | Cameroon | [48] | |
56.6 | 565 | Uganda | [34] | |
57.4 | 1030 | Gabon | [45] | |
70.2 | 426 | Malawi | [51] | |
95.5 | 1922 | Ghana | [33] | |
At least 3 doses of IPTp-SP | 6.0 | 565 | Uganda | [34] |
9.0 | 487 | Malawi | [32] | |
18.0 | 5901 | Uganda | [52] | |
29.8 | 426 | Malawi | [51] | |
33.2 | 1926 | Ghana | [30] | |
34.3 | 6143 | Gambia | [53] | |
45.3 | 4254 | Ghana | [54] | |
46.5 | 1141 | Mozambique | [55] | |
47.0 | 465 | Cameroon | [56] | |
58.9 | 2174 | Gabon | [57] | |
61.4 | 500 | Tanzania | [58] | |
63.7 | 1021 | Mali | [59] | |
64.5 | 1922 | Ghana | [33] | |
66.2 | 692 | Ghana | [60] | |
80.8 | 375 | Ghana | [31] | |
93.2 | 8526 | Sierra Leone | [35] | |
At least 4 doses of IPTp-SP | 7.5 | 3686 | Zambia | [36] |
39.5 | 375 | Ghana | [31] | |
42.3 | 1926 | Ghana | [30] | |
At least 5 doses of IPTp-SP | 17.1 | 375 | Ghana | [31] |
Full dose (as reported in studies) | 8.0 | 4111 | Tanzania | [61] |
14.5 | 255 | Ghana | [62] | |
14.5 | 255 | Benin | [63] | |
17.5 | 888 | Cameroon | [64] | |
29.5 | 18603 | Burkina Faso, Ghana, Mali, Malawi, Kenya, Nigeria, Sierra Leone, and Uganda | [65] | |
41.0 | 400 | Nigeria | [66] | |
97.0 | 2419 | Tanzania | [67] |
Main Theme | Specific Factor | Author |
---|---|---|
Individual | Any level of education | [59,71,84] |
Primary or higher education | [61] | |
Secondary or higher education | [34,35,52,73,74] | |
No education | [53] | |
Women between age 15–19 | [54] | |
Women aged 30–39 years | [75] | |
25–29 years | [76] | |
Women 15 and 24 years | [49] | |
Higher age (36–39 years) | [77] | |
Age more than 19 years | [84] | |
Married or living with a partner | [75] | |
Knowledge about IPTp-SP | [31,48,49] | |
Knowledge about prophylaxis for malaria prevention | [78] | |
Knowledge of the recommended dose of IPTp-SP | [59] | |
Knowledge about malaria in pregnancy | [51] | |
Awareness of the dangers of malaria in pregnancy | [51] | |
Awareness about malaria prevention programs | [75] | |
Awareness about IPTp-SP | [55] | |
Low awareness of IPTp-SP | ||
Attendance ANC in the first trimester | [61] | |
ANC in the first or second trimester | [56,75] | |
Early initiation of ANC (First or second trimester) | [59] | |
Attendance at government health facilities | [61] | |
3 or more ANC visits | [59] | |
4 or more visits | [51,52,56,61,63] | |
8 or more ANC visits | [31] | |
Increase ANC visits | [85] | |
Increased ANC attendance | [57] | |
Having 3 or more children | [49] | |
Women with advanced pregnancy (24–40 weeks) | [77] | |
Secundigavida | [72] | |
Having 3 or more children | [49] | |
Parity 0–3 | [53] | |
Women who tested positive for malaria | [77] | |
Anaemic pregnant women l | [77] | |
Use of ITN | [68] | |
Interpersonal | Husband’s education | [74] |
Richer households | [34,65,71] | |
Education of man on dangers of malaria in pregnancy | [70] | |
Education and counselling on malaria and ANC attendance | [79] | |
Institutional | Proximity of health facility | [51] |
Trust in the healthcare system | [80] | |
Continuous training of HCPs to improve their knowledge | [70] | |
High stock levels | [62,63] | |
Distribution of IPT-SP at ANC | [69,74] | |
Exposure to media messages | [36,37,53,56,71] | |
Utilising DOTS strategy | [81] | |
Wider coverage of ANC | [80] | |
≥8 ANC visits | [31] | |
4 ANC visits | [80] | |
Increased ANC attendance | [35,45,57] | |
Seen by skilled attendant | [49] | |
Nurses persuade mothers to take SP | [81] | |
Supervision of HCPs | [70] | |
Community/Societal | Rural dwelling | [50] |
Residence | [53] | |
Urban dwellers | [82] | |
Being a resident in an urban area | [77] | |
Encouragement of social networks | [80] | |
Favourable social norms for IPTp-SP | [83] | |
Community sensitisation | [72] | |
Cost of IPTp-SP delivery | [46] | |
Community delivery/distribution of IPTp-SP | [79,86] | |
High resistance areas | [68] | |
Presence of health centres | [59] | |
Distance from the nearest health centre (0–5 km) | [72] |
Main Theme | Specific Factor | Author |
---|---|---|
Individual | Poor knowledge about IPTp-SP | [95] |
Women who had higher knowledge about malaria prevention were less likely to take adequate IPTp-SP | [36] | |
Inadequate knowledge of malaria | [50] | |
Low knowledge on IPTp-SP services | [89] | |
Low awareness of IPTp-SP | [55,82,89] | |
Fear of side effect | [81] | |
The perception that IPTp-SP has adverse effect on pregnant women | [93] | |
Refusal to take SP | [80] | |
Late enrolment | [94] | |
Skipping ANC appointment | [80] | |
Initiating ANC attendance late | [80] | |
Irregular ANC attendance | [85] | |
At least three ANC visit | [35] | |
Late 1st ANC visit | [81] | |
Lack of ANC attendance | [32] | |
Receiving first dose in the third trimester | [63] | |
Multigravida women are less likely to complete the recommended dose | [43] | |
Higher parity of more than four | [35] | |
Higher parity | [76] | |
At least one delivery | [76] | |
Pregnant woman testing HIV positive | [81] | |
History of child death | [42] | |
Pregnant woman presenting with malaria | [81] | |
Women with less than 8 years of education | [42] | |
Women with less than 8 years of education | [42] | |
No formal education | [76] | |
Having no or only primary education | [55] | |
Lower educational attainment | [50] | |
Poor women | [54] | |
Being single | [42] | |
Interpersonal | Least poor households | [84] |
Richer Households | [65] | |
Lack of autonomy or freedom to receive IPTp-SP | [66] | |
Institutional | Lack of training and supervision for health care workers | [91] |
Inadequate information provided to women on IPTp-SP | [48,80,85] | |
Inadequacy of routine training of HCP | [48] | |
HCP refusing services to women | [91] | |
Frequent absences and staffing changes mandated on the job | [90] | |
HCP uncertainty about the safety and efficacy of IPTp-SP | [91] | |
Inconsistent provision of ANC, | [91] | |
Perception that IPTp has adverse pregnant women | [93] | |
Inadequate counselling or support for pregnant women | [92] | |
Cost of ANC | [80] | |
Health financing challenges | [77] | |
HCP absenteeism | [51] | |
User fees charged by HCW | [88] | |
HCW ask for bribes from clients | [88] | |
Not being offered IPTp-SP | [80,83,85] | |
Frequent stock out | [57,66,82,89,92] | |
Inadequate information provided to women on IPTp-SP | [48,80,85] | |
Misinformation standard doses | [88] | |
Lack of comprehensive knowledge on IPTP policy | [77] | |
Inadequate supply of SP to the health sector | [91] | |
Demand and supply bottlenecks | [77] | |
Inadequate supply for SP for private sector | [91] | |
Limited healthcare infrastructure | [92] | |
Long waiting time | [89,92] | |
Poor implementations of DOTs | [66] | |
Non-institutional births | [55] | |
Inconsistent guidelines for IPTP | [91] | |
Inadequate guidelines for HCP | [91] | |
More than 30 min working distance to the ANC clinic | [50] | |
Community/Societal | Remote region/disadvantaged region/rural area | [36,51,54,76,77,89] |
Long distance to Health facilities | [51,88,92] | |
Lack of transport | [51] | |
Cultural beliefs | [92] |
Design | What Indicates Effectiveness |
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At last 2 or more doses |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Berchie, G.O.; Doe, P.F.; Azu, T.D.; Agyeiwaa, J.; Owusu, G.; Boso, C.M.; Yeboa, N.K.; Agyare, D.F.; Aboh, I.K.; Nabe, B.; et al. Uptake and Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during Pregnancy in Africa: A Scoping Review. Diseases 2024, 12, 203. https://doi.org/10.3390/diseases12090203
Berchie GO, Doe PF, Azu TD, Agyeiwaa J, Owusu G, Boso CM, Yeboa NK, Agyare DF, Aboh IK, Nabe B, et al. Uptake and Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during Pregnancy in Africa: A Scoping Review. Diseases. 2024; 12(9):203. https://doi.org/10.3390/diseases12090203
Chicago/Turabian StyleBerchie, Gifty Osei, Patience Fakornam Doe, Theodora Dedo Azu, Joyce Agyeiwaa, Gifty Owusu, Christian Makafui Boso, Naomi Kyeremaa Yeboa, Dorcas Frempomaa Agyare, Irene Korkoi Aboh, Bernard Nabe, and et al. 2024. "Uptake and Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during Pregnancy in Africa: A Scoping Review" Diseases 12, no. 9: 203. https://doi.org/10.3390/diseases12090203