Implementation fidelity of the guidelines of intermittent preventive treatment of malaria in pregnancy and its determinants in Sokoto State, Nigeria

Abstract

Background Intermittent preventive treatment of malaria in pregnancy using sulphadoxine-pyrimethamine (IPTp-SP) is an evidence-based intervention for the prevention of malaria in pregnancy, but healthcare providers’ adherence to IPTp-SP guidelines and its determinants in Sokoto State have not been fully explored. This quantitative study, therefore, measured implementation fidelity of IPTp-SP guidelines and its determinants. The relationship between implementation fidelity of IPTp-SP guidelines and its determinants was also examined. Methodology In this cross-sectional study, 91 healthcare providers from government healthcare facilities supported by the US President Malaria Initiative (PMI), government healthcare facilities not supported by the US President Malaria Initiative (nPMI), and private healthcare facilities were interviewed using an interviewer-administered questionnaire. The quantitative data were analysed using descriptive statistical analysis and chi-square test. General linear regression models were fitted to determine the relationship between implementation fidelity of IPTp-SP guidelines and the determinants.Results The mean score of implementation fidelity for all the participants was 60%, and the median interquartile range (IQR) was 60% (55 – 70). The minimum score of implementation fidelity of IPTp-SP guidelines was 25%, and the maximum was 95%. The highest mean fidelity (63%) was from healthcare facilities supported by PMI, followed by (60%) from nPMI and the lowest (49%) was from private healthcare facilities. All the scores of determinants, except for facilitation strategy, were above 60%. The score of facilitation strategy was 39% with a standard deviation of 37, and the scores ranged from 0 to 100%. The level of knowledge of healthcare providers on IPTp-SP, educational qualification, cadre of healthcare providers, and type of healthcare facility were significant determinants of implementation fidelity of IPTp-SP guidelines (p<0.05). Content of IPTp-SP guidelines was significantly influenced by facilitation strategies in addition to the above determinants (p<0.05). Conclusion This study has shown that adherence to all the components of IPTp-SP guidelines can be improved by improving the level of knowledge of healthcare providers on IPTp-SP. And this can be achieved by training of healthcare providers on IPTp-SP, receiving of supervisory visits after training and making IPTp-SP guidelines available to them. Therefore, findings from this research can help to guide further planning and policy decisions on prevention of malaria in pregnancy.