Effectiveness of intermittent preventive treatment with sulphadoxine-pyrimethamine and insecticide treated nets on the prevention of malaria in pregnancy in non-malarial endemic area in Kenya

Background: Malaria prevention strategies have significantly reduced the prevalence of malaria in pregnant women in several studies done in malaria endemic regions.Objective: To determine the effectiveness of Intermittent preventive treatment with sulphadoxine-pyrimethamine and Insecticide treated nets on the prevention of malaria in pregnancy in a non-malaria endemic area.Design: Comparative study.Setting: Kapsabet District Hospital in Nandi County.Subjects: One hundred and fourty three non-randomised pregnant women were followed through the Antenatal clinic before 28 weeks gestation until delivery and compared with records of 600 pregnant women ( non-intervention arm), who attended ANC and delivered at the hospital.Results: The incidence of malaria infection in pregnancy was 21% in the non-intervention group compared with 8% in the intervention group, (p-value 0.000). The incidence of low birth weight was 12.5% in the non-intervention group compared with 5.6% in the intervention group (p-value 0.018); with a reduction of low birth weight by 50% in the intervention group. The incidence of Still births was 6% in the non-intervention group and 1.4% in the intervention group (p-value 0.025). There were two (0.3%) cases of maternal mortality in the non-intervention group and no mortality in the intervention group which was statistically not significant but clinically significant.Conclusion: The use of intermittent preventive treatment with sulphadoxinepyrimethamine and Insecticide Treated Nets is effective in prevention of malaria in pregnancy in non-malaria endemic region and is associated with reduction of adverse pregnancy outcome. There is therefore a need of up scaling the use of sulphadoxinepyrimethamineduring pregnancy, and availing subsidised long lasting insecticide treated bed nets to pregnant women countrywide

The Effect of two levels of counselling on acceptance, uptake and early outcomes of post-placental intra-uterine contraceptive device

Objective: To determine the effect of two levels of counselling on the provision of Intrauterine Contraceptive Device (IUCD) at six weeks post-partum of the postplacental intrauterine deviceSetting: Embu Provincial General Hospital, Kenya.Subjects: One hundred and thirty seven pregnant women at the gestation of 36 weeks to term, who attended Antenatal clinic and were followed until delivery and at six weeks post-partum.Design: A randomised “open-label” clinical trial.Results: One hundred and twenty seven study participants were enrolled and randomised to intensive (64 women) or routine FP counselling (63 women). Seventy eight per cent of women in the intensive FP counselled group and 66% in the routine FP counselled group accepted to have the post-placental IUCD inserted. There was no significant difference in uptake in the two-randomisation arms (p-value 0.232). Complications included expulsion (3.7%), allergic reaction (1.8%), pelvic infection (1.8%) and abdominal pain (1.8%).The post-placental IUCD is a favourable methodwith continuation rates (91%), client (88%) and reported partner (77%) satisfaction were notably high at six weeks. The most critical barrier to uptake was lack of trained medical personnel to insert the post-placental IUCD, which occurred in (60%) clients who had consented.Conclusion: The post-placental IUCD is an acceptable method among women irrespective of level of counselling. Intensive counselling did not significantly increase acceptance and uptake rates of post-placental IUCD insertion in comparison to routine counselling