Evaluation of the Intermittent Preventive Therapy in Pregnancy using Sulphadoxine/ Pyrimethamine (IPTp-SP) Program in Chiredzi District, Zimbabwe, 2021

Background Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulphadoxine/ Pyrimethamine (SP) is used for the prevention of malaria among pregnant women in Zimbabwe. The program is integrated into routine Antenatal care (ANC) where a minimum of three doses is recommended during each pregnancy. The third dose coverage for Chiredzi District has consistently been below the 80% target coverage. We evaluated IPTp implementation in Chiredzi to understand the reasons for underperformance. Methods An analytical cross-sectional study was conducted using a Process-Outcome evaluation with the Logical Framework Approach. We interviewed 50 women in postnatal care and determined ANC services accessed using their ANC booklets. Health workers were interviewed for knowledge of the program. Stock availability and drug delivery records were reviewed using checklists at five high-volume sites. Epi Info 7.2.4.0™ was used for data capturing and analysis. The software was used to calculate frequencies, medians, proportions, odds ratios and p-values at a 95% confidence interval. The outcome variable was receiving ≥3 doses of SP which was computed against the independent variables such as client-related characteristics to determine which factors were contributory using univariate and bivariate analysis. Results Only 12/50 (24%) women received ≥3 doses of SP during their pregnancy. Two (4%) women started their ANC visits in the first trimester. Thirty-three (66%) had missed at least one SP dose during their ANC visit because of medicine unavailability. Knowing the number of times SP is given (OR 11.9; 95% CI 2.54-55.8) and having attended at least 4 ANC visits (OR 13.6; 95% CI 1.59 -116.0) increased the likelihood of receiving adequate SP dosing. Conclusions The IPTp-SP program in Chiredzi District was underperforming, we attributed this largely to health system factors. Erratic supply and stock-outs of SP resulted in clients missing SP doses. Clients also missed SP doses because of late ANC booking and lack of knowledge on IPTp benefits. Improving stock management and raising community awareness on prevention of malaria among pregnant women was recommended.