Knowledge and Practice Pattern of Malaria Prevention and Control in Pregnancy by Healthcare Providers within the Context of Focused Antenatal Care in Enugu State, Nigeria

Aim: To assess the knowledge and practice pattern of malaria prevention and control in pregnancy by healthcare providers within the context of focused antenatal care.
Study Design: A prospective cross-sectional survey study.
Place and Duration of Study: Health facilities from the three levels of care in Enugu, Southeast Nigeria, between July to September, 2011.
Methodology: Data collection was with a pre-tested structured questionnaire administered to the healthcare providers that were directly involved in antenatal care services. They consisted of 113 respondents (Doctors, Pharmacists and Nurses). The questionnaire elicited information on their knowledge about malaria, treatment and prevention practices.
Results: Many providers had high knowledge of malaria in pregnancy. Malaria diagnosis was mainly by symptom recognition 102 (90.3%). Treatment of uncomplicated malaria was mainly with Artemisinin-Combination Therapies (ACTs) both in the 1st 43 (38.1%), 2nd and 3rd 55 (48.7%) trimesters. Severe malaria was also treated with ACTs 24 (24.8%) by majority of the providers. Quinine was used by only few providers in treating 1st trimester uncomplicated malaria 8 (7.1%) and severe malaria 19 (16.8%). Sulphadoxine-Pyrimethamine (SP) was mostly used by the providers 88 (77.9%) for malaria prevention while proguanil 29 (25.4%) was usually given as an alternative to SP. SP was given by directly-observed treatment by 55.8% of the providers while only 18.6% actually withheld folic acid supplementation for the recommended two weeks following SP administration. Other antenatal care (ANC) - MIP integrated services rendered by the providers were Iron folate supplementation 90 (79.6%), Insecticide-Treated-Nets (ITNs) Provision 87 (77.0%) and Deworming 30 (26.5%).
Conclusion: The level of knowledge on malaria in pregnancy was high among the providers. However, there was sub-optimal delivery of current best practices, especially in the area of drug prescriptions for both treatment and prevention. Multiple strategies are required to improve healthcare providers’ practices in MIP prevention and control.