Maternal and Child Health Journal

, Volume 18, Issue 5, pp 1169–1175 | Cite as

Compliance with Intermittent Presumptive Treatment and Insecticide Treated Nets Use During Pregnancy in Enugu State, Nigeria

  • Nkechi G. OnyenehoEmail author
  • Ngozi Idemili-Aronu
  • Ijeoma Okoye
  • Chidi Ugwu
  • Felicia U. Iremeka


To identify key socio-demographic and knowledge factors associated with compliance with recommended use of commodities for preventing malaria in pregnancy (MIP) in Enugu State, Nigeria. Cross-sectional study of 720 women who delivered within 6 months preceding the survey in three local government areas in Enugu State was conducted using a structured questionnaire. About half (51.6 %) of the women used IPTp1 while 25.9 % took IPTp2 as recommended during their most recent pregnancy. Forty-one percent of the women slept under insecticide treat nets (ITN) during the most recent pregnancy but only 15.4 % did so as recommended every night. Socio-demographic and knowledge factors associated with compliance were identified. Compliance with intermittent presumptive treatment in pregnancy (IPTp) recommendation was more common among those in the rural setting (26.9 %) compared to the peri-urban (20.3 %) and urban (17.3 %) (P = 0.032). Those with good knowledge of the causes, effects and prevention of malaria during pregnancy complied more (23.7 %) than those with poor knowledge (17.0 %) (P = 0.020). With respect to sleeping under ITN, more of those with post secondary education, good knowledge of MIP and currently living with a partner used ITN every night during the last pregnancy. Knowledge about the MIP issues and having a partner influence compliance with relevant preventives. Efforts to increase compliance with recommended practices to prevent MIP should focus on providing health education to pregnant women and their partners, who reinforce what the women are told during antenatal care. More qualitative studies need to be conducted on this subject.


Compliance Malaria Pregnancy Treatment Prevention 


  1. 1.
    World Health Organization (WHO). (2003). Lives at risk: Malaria in pregnancy. Africa Malaria Report.Google Scholar
  2. 2.
    National Population Commission (NPC) [Nigeria] & National Malaria Control Programme (NMCP) [Nigeria], and ICF International. (2012). Nigeria Malaria Indicator Survey 2010. Abuja, Nigeria: NPC, NMCP, and ICF International.Google Scholar
  3. 3.
    Shane, B. (2001). Malaria continues to threaten pregnant women and children. Population Reference Bureau Articles, 2, 15–20.Google Scholar
  4. 4.
    Okeibunor, J. C., Orji, B. C., Brieger, W., Ishola, G., Otolorin, E., Rawlins, B., et al. (2011). Preventing malaria in pregnancy through community-directed interventions: Evidence from Akwa Ibom State, Nigeria. Malaria Journal, 10, 227.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Steketee, R., Nahlen, B., Parise, M., & Menendez, C. (2001). The burden of malaria in pregnancy in malaria-endemic areas. American Journal of Tropical Medicine and Hygiene, 64(1), 28–35.PubMedGoogle Scholar
  6. 6.
    Barker, D. J. P. (1992). Fetal and infant origins of disease. London: BMJ Books.Google Scholar
  7. 7.
    Center for Disease Control and Prevention. (2007). Alternatives for Pregnant women and treatment: Severe malaria. Atlanta: CDC.Google Scholar
  8. 8.
    Wilcox, A. J. (2001). On the importance—and the unimportance—of birthweight. International Journal of Epidemiology, 30(6), 1233–1241.PubMedCrossRefGoogle Scholar
  9. 9.
    Rijken, M. J., Moroski, W. E., Kiricharoen, S., Karunkonkowit, N., Stevenson, G., Ohuma, E. O., et al. (2012). Effect of malaria on placental volume measured using three-dimensional ultrasound: A pilot study. Malaria Journal, 11, 5.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Murphy, S. C., & Breman, J. G. (2001). Gaps in the childhood malaria burden in Africa: Cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy. American Journal of Tropical Medicine and Hygiene, 64(1), 57–67.PubMedGoogle Scholar
  11. 11.
    Guyatt, H. L., & Snow, R. W. (2004). Impact of malaria during pregnancy on low birth weight in sub-Saharan Africa. Clinical Microbiology Reviews, 17, 760–769.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Federal Ministry of Health (FMoH) [Nigeria], and National Malaria Control Programme (NMCP). (2009). Strategic plan 20092013: A road map for malaria control in Nigeria; abridged version. Abuja, Nigeria: Yaliam Press Ltd.Google Scholar
  13. 13.
    Federal Ministry of Health (FMOH). (2004). Malaria situation analysis document. Nigeria: Abuja Federal Ministry of Health.Google Scholar
  14. 14.
    Idowu, O., Mafiana, C., & Dapo, S. (2006). Malaria among pregnant women in Abeokuta, Nigeria. Tanzania Health Research Bulletin, 8(1), 28–31.PubMedGoogle Scholar
  15. 15.
    National Population Commission Nigeria & ICF Macro. (2009). Nigeria: DHS, 2008Final Report (English). Calverton, MD: Macro International.Google Scholar
  16. 16.
    Garner, P., & Gulmezoglu, A. M. (2006). Drugs for preventing malaria in pregnant women. The Cochrane database of systematic reviews, 4, CD000169.PubMedGoogle Scholar
  17. 17.
    Hughes, A. (2011). Methods to protect pregnant women from malaria are still under-utilized in sub-Saharan Africa. Medical News Today. Accessed 20 Nov 2012.
  18. 18.
    WHO/UNICEF. (2003). Malaria in pregnancy. World Health Organization/UNICEF. WHO/CDS/MAL/2003. 1093.Google Scholar
  19. 19.
    Igwe, P. C., Ebuchi, O. M., Imem, V., & Afolabi, B. M. (2007). Effects of the use of insecticide treated dednets on birth outcomes among primigravidae in a peri-urban slum settlement in south east Nigeria. SA Family Practical, 49(6), 15.Google Scholar
  20. 20.
    Jhpiego. (2005). MCH programme spotlight. In: A few steps forward on a long, winding road: Jhpiego’s work in malaria in pregnancy in Nigeria. Accessed 18 Nov 2012.
  21. 21.
    Pfeiffer, J., Johnson, W., Fort, M., Shakow, A., Hagopian, A., Gloyd, S., et al. (2008). Strengthening health systems in poor countries: A code of conduct for nongovernmental organizations. AJPH, 98(12), 2134–2140.CrossRefGoogle Scholar
  22. 22.
    Chen, L., Anand, S., Boufford, J., Brown, H., Chowdury, M., Cueto, M., et al. (2004). Human resources for health: Overcoming the crisis. Lancet, 364, 1984–1990.PubMedCrossRefGoogle Scholar
  23. 23.
    Yuan, Y., L’italien, G., Mukherjee, J., & Iloeje, U. (2006). Determinants of discontinuation of initial highly active antiretroviral therapy regimens in a US HIV-infected patient cohort. HIV Medicine, 7(3), 156–162.PubMedCrossRefGoogle Scholar
  24. 24.
    Iliyasu, Z., Kabir, M., Abubakar, I. S., Babashani, M., & Zubair, Z. A. (2005). Compliance to antiretroviral therapy among AIDS patients in Aminu Kano Teaching Hospital, Kano, Nigeria. Nigerian Journal of Medicine, 14(3), 290–294.PubMedGoogle Scholar
  25. 25.
    Brieger, W. R., Otusanya, S. A., Oke, G. A., Oshiname, F. O., & Adeniyi, J. D. (2002). Factors associated with coverage in community directed treatment with ivermectin for onchocerciasis control in Oyo State, Nigeria. Tropical Medicine & International Health, 7(1), 11–18.CrossRefGoogle Scholar
  26. 26.
    Maduka, C. U., Nweke, L. N., Miri, E. S., Amazigo, U., Emukah, E. C., & Richards, F. O. (2004). Missed treatment opportunities, for pregnant and breast-feeding women, in onchocerciasis mass-treatment programmes in south-eastern Nigeria. Annals Tropical Medicine Parasitol, 98(7), 697–702.CrossRefGoogle Scholar
  27. 27.
    Semiyaga, N. B., Lalobo, O., & Ndyomugyenyi, R. (2005). Refusal to take ivermectin: the associated ‘risk’ factors in Hoima district, Uganda. Annals of Tropical Medicine & Parasitol, 99(2), 165–172.CrossRefGoogle Scholar
  28. 28.
    Lakwo, T. L., & Gasarasi, D. B. (2006). Non-adherence to community directed treatment with ivermectin for onchocerciasis control in Rungwe district, southwest Tanzania. East African Medical Journal, 83(6), 326–332.PubMedCrossRefGoogle Scholar
  29. 29.
    Nuwaha, F., Okware, J., & Ndyomugyenyi, R. (2005). Predictors of compliance with community-directed ivermectin treatment in Uganda: Quantitative results. Tropical Medicine & International Health, 10(7), 659–667.CrossRefGoogle Scholar
  30. 30.
    Akogun, O. B., Akogun, M. K., & Audu, Z. (2000). Community-perceived benefits of ivermectin treatment in Northeastern Nigeria. Social Science and Medicine, 50, 1451–1456.PubMedCrossRefGoogle Scholar
  31. 31.
    Federal Republic of Nigeria. (2007). Legal notice on publication of the details of the breakdown of the national and state provisional total 2006 census. Official Gazette No. 24, Vol. 94, pp. 178–198.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Nkechi G. Onyeneho
    • 1
    Email author
  • Ngozi Idemili-Aronu
    • 1
  • Ijeoma Okoye
    • 1
  • Chidi Ugwu
    • 1
  • Felicia U. Iremeka
    • 2
  1. 1.Department of Sociology/AnthropologyUniversity of NigeriaNsukkaNigeria
  2. 2.Humanities Unit, School of General StudiesUniversity of NigeriaNsukkaNigeria

Personalised recommendations