Utilization and The Factors Associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy in Nambale Sub-County Hospital, Kenya

Utilization and The Factors Associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy in Nambale Sub-County Hospital, Kenya | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Utilization and The Factors Associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy in Nambale Sub-County Hospital, Kenya Collins Omondi Angute, Maurice Owiny, Elvis Oyugi, Diana Menya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6646661/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Malaria remains a significant public health problem globally, with highest morbidity and mortality reported in sub Saharan Africa. In 2022, 12.7 million (36%) Malaria in Pregnancy (MiP) cases in Sub Saharan Africa and 27% were reported from East Africa. In Kenya, 4,080,441 malaria cases and 5% MiP cases reported. Busia County, Kenya, reported 341,886 malaria cases and 22% MiP cases. WHO recommends administering intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) to prevent MIP in malaria-endemic zones. The objective of the study was to determine proportion of pregnant women utilizing IPTp-SP 3 and describe factors influencing utilization of IPTp-SP 3. Methods A cross-sectional study was employed, pregnant women of nine months, aged 14–49 years were interviewed, using questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with p value of ≤ 0.2, were subjected to multivariable logistic regression analysis to identify significant factors (variables with p value of ≤ 0.05) Results 384 pregnant women were interviewed, 90% resided in rural areas; 93% aware of IPTp use, 68% were married, 67% unemployed, 60% utilized IPTp-SP3 and 47% had secondary education. In the bivariate analysis, participant age 21–30 years {cOR = 2.34, 95% CI = 1.4–3.7}, belief in > 3 doses of IPTp preventing MiP {cOR = 3.09, 95% CI = 1.5–6.2}and having tertiary education {cOR = 2.71, 95% CI = 1.4–5.1} were associated with uptake of ≥ 3doses of IPTp. On multivariable logistics regression analysis, attendance of ANC at least 4 times {aOR = 8.42, 95% CI = 4.4–16.0} and uptake of IPTp-SP at 14–17 gestation weeks {aOR = 7.79, 95% CI = 3.2–18.7} independently associated with optimal utilization of IPTp (IPTp-SP3). Conclusion A sub-optimal IPTp-SP 3 utilization (60%) way below WHO target of 80%. ≥4ANC attendance and first IPTp-SP uptake at 14–17 gestation weeks were independently associated with optimal utilization of IPTp. Recommendation: The Maternal and Child Health personnel to follow up all pregnant women attending ANC at their facility to ensure ANC adherence of X4 and take ≥ 3doses of IPTp. FELTP IPTp-SP Kenya Malaria Pregnancy WHO Figures Figure 1 Figure 2 Background Malaria in pregnancy (MIP) is a major public health problem, with substantial risks for the mother, her foetus and the new-born. MIP Effects: maternal anaemia, low birth weight, retarded child growth and death. In 2022, 36% of all pregnancies in WHO African region were exposed to MIP (World Malaria Report 2023). East Africa had MIP prevalence (27%), West Africa (39.3%) and Central Africa (40.1%). In Kenya, there was total of 4,080,441 malaria cases and 5% MIP cases. Busia county reported 341,886 malaria cases and 22% MIP cases. The WHO recommends the administration of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) to pregnant women living in malaria endemic zones. The IPTp-SP should be given at the onset of second trimester (gestational weeks > 13). IPTp-SP averts the adverse effects of MIP. WHO recommends a minimum of at least 3 doses of IPTp-SP, with each dose given one month apart during the ANC visits. Despite increased IPTp utilization in the WHO Africa region in the last two years, optimal use still remains a mirage. Optimal IPTp utilization is set at a target of 80% for the IPTp3 as per the WHO recommendations. In the WHO African region, IPTp utilization was (World Malaria Report 2023): IPTp utilization in 2021; IPTp1 (54%) IPTp2 (45%) and IPTp3 (34%) IPTp utilization in 2022; IPTp1 (64%) IPTp2 (54%) and IPTp3 (42%) IPTp utilization in 2023; IPTp1 (67%) IPTp2 (55%) and IPTp3 (44%) Despite increased IPTp 3 utilization in Kenya in the last 4 years, uptake still fell below the WHO recommendations i.e. 3% (2020), 14% (2021), 17% (2022), 17% (2023) - KHIS 2023 In Busia County, IPTp utilization was: IPTp 1: 96% and IPTp 3: 64% (KHIS, 2022); In Nambale Sub county, IPTp utilization was, IPTp 1: 104% and IPTp 3: 64% (KHIS 2022). In Nambale sub-county Hospital (NSCH), IPTp utilization was, IPTp 1: 96%, and IPTp 3: 64% (KHIS, 2022) below the required set target of 80% set by the WHO. Decreased IPTp uptake increases the risk of pregnant women residing in the malaria-endemic zones acquiring MIP. MIP is a risk factor to maternal and fetal anemia, intrauterine growth retardation, low birth weights, stillbirths, abortions and deaths. MIP may negatively impact on the economic status. Only 49% of women received three or more IPTp-SP in the lake endemic region (NMCP, 2021), way below the target of 100% protection In Busia County, Nambale Sub-County, had the highest decline rate in IPTp-SP3 utilization. Nambale Sub-county Hospital had the highest decline in IPTp-SP 3 utilization among facilities in the sub-county. Objectives for the study was to determine the utilization and assess factors associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) in Nambale Sub-county hospital (NSCH) in Busia county, Kenya; and specifically to determine the proportion of pregnant women of nine months pregnancy utilizing IPTp-SP 3 in NSCH and to assess sociodemographic factors, cultural factors, individual factors, and health facility factors influencing utilization IPTp-SP3 in NSCH. Methodology This was a cross-sectional study that employed consecutive sampling whereby, pregnant women of nine months, aged between 14-49 years were interviewed, using the interviewer- administered questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. A Descriptive of factors was done, Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with p value of ≤0.2, were subjected to multivariable logistic regression analysis to identify variables with p value of ≤0.05 associated with utilization of IPTp-SP among pregnant women. Inclusion and exclusion criteria Inclusion criteria Pregnant women of 36 weeks’ gestation or more attending Antenatal care (ANC) at the Nambale sub-county hospital (NSCH). Pregnant women on another preventive treatment like cotrimoxazole prophylaxis (CTXp) Exclusion criteria Pregnant women allergic to sulphur drugs Sample size determination Cochrane (Cochran, 1977) formula was used for sample size calculations/determination The following assumptions were made: Z: The score at 95% confidence interval (CI) = 1.96. P: Expected proportion of pregnant women taking three or more doses of IPTp-SP = 49% based on the prevalence obtained during Kenya Malaria indicator survey KMIS of 2020. (Program, 2021). d: Degree of precision =0.05 [1.96 x 1.96 x 0.49 (1 – 0.49)]/0.0025 Sample size = 384 ANC clients Sampling Procedure Counties offering IPTp in Kenya listed and utilization of IPTp 3 noted. County with the lowest percentage uptake of IPTp3 identified- Busia county. Then utilization of IPTp 3 within the Sub-counties of Busia county listed. Nambale sub-county was identified, and facilities utilization of IPTp3 listed. Nambale sub-county Hospital (NSCH) was identified as facility with the lowest IPTp 3 utilization. Eligible study participants attending ANC at NSCH were identified and consent sought from them and a consecutive sampling method used. A semi-structured questionnaire on IPTp 3 utilization was administered to consenting participants. Data Management and Analysis Data cleaning done in Ms Excel and analysis in Stata v.15.1 software whereby, frequencies and proportions were calculated for categorical variables and measures for central tendency and dispersion was calculated to summarize continuous variables. Bivariate Analysis (Logistic Regression) was used to calculate; Crude Odds Ratio (cOR), 95% C.I.s and p -value) and those variables with p -value ≤0.2 at bivariate analysis were taken to Multivariate analysis. Multivariate Analysis was also done, whereby, a backward stepwise Logistic Regression analysis technique used to calculate, Adjusted Odds Ratio (aOR), 95% C.I.s and p-values . Those Variables with p -value ≤0.05 were considered statistically significant Results Socio-demographic characteristics of pregnant women A total of 384 study participants were interviewed. All were pregnant women of at least 36 weeks’ gestation. The median age of the study participants was 25 years with a range of 14 - 44 years old. Highest number of participants ( n =206, 54%) were aged 21–30 years and the lowest number of participants (n =3, 1%) were aged above 41 (Table 1). Those with secondary education were the highest ( n =182, 47%) with ones having no formal education being the lowest ( n =3, 1%) (Table 1). Table 1 : Socio-demographic characteristics of the respondents (N=384 ) Variable Frequency Percent (%) Age Below 21 106 28 21–30 206 54 31–40 69 17 Above 40 3 1 Mothers Education No formal education 3 1 Primary 123 32 Secondary 182 47 Tertiary 76 20 Occupation Unemployed 258 67 Self employed 84 22 Employed 42 11 Residence Rural 348 90 Urban 36 10 Marital status Cohabiting /Married 262 68 Single/Divorced/Widowed 122 32 Family structure Nuclear 235 61 Extended 141 37 Single parent 8 2 Individual characteristics of the respondents The highest number of the respondents were Primigravida ( n =196, 51%). On parity, Primipara constituted the highest number ( n= 195, 51%) and nulliparous the lowest number ( n= 7, 2%). On the current gestation weeks of the respondents, those of 38 th gestation week were the majority ( n= 100, 26%) with those above 40 th gestation week constituting the lowest number ( n= 29, 7%). The highest number of respondents began their 1 st ANC at gestation weeks of >21 ( n= 151, 39%), with the least number of them starting at gestation weeks <12 ( n =56, 15%) (Table 4). The highest number of participants had attended more than four ANC visits ( n= 275, 72%) with least number attending only attending to one ANC visit ( n= 5, 1%). On health insurance cover, only 73% ( n= 281) of the respondents were covered by any type of insurance (Table 2) The majority of respondents ( n= 356, 93%) acknowledged being aware of IPTp-SP. A huge number of respondents believed in IPTp-SP protection against MIP ( n= 229, 60%), with only a few dissenting ( n= 38, 10%) (Table 2). Table 2 : Individual factors of the respondents (N=384) Variable Frequency Percent (%) Gravidae Multigravida 188 49 Primigravida 196 51 Parity Multipara 182 47 Primipara 195 51 Nulliparous 7 2 Current Gestation Week 36 64 17 37 50 13 38 100 26 39 66 17 40 75 20 Above 40 29 7 Gestation week of 1 st ANC 21 weeks 151 39 Total No of ANC attended 1 5 1 2 39 10 3 65 17 4 and Above 275 72 Has Health Insurance/cover No 103 27 Yes 281 73 Participants awareness on IPTp-SP No 28 7 Yes 356 93 Belief in IPTp-SP protection against Malaria Agree 229 60 Disagree 38 10 Not sure 117 30 Cultural characteristics of the respondents ( N =384) Only one study participant out of the 384 responded “Yes” to having cultural belief against the IPTp uptake, the rest dissenting ( n= 383, 99%). A large number of the participants reported on making sole decision on matters pertaining to health in their homes ( n= 172, 45%), whereas a small number of respondents reported that their parents contributed towards their decision making in the house ( n= 9, 2%) (Table 3). A large number of participants reported on being accompanied during ANC visits ( n= 301, 78%). Table 3: Cultural characteristics of the respondents (N=384) Variable Frequency Percent (%) House/Home Decision Maker Self 172 45 Husband/spouse 15 4 Both husband and self 121 32 Parents 9 2 Both parents and self 67 17 Accompanied during ANC visit No 301 78 Yes 83 22 Persons accompanying participants during ANC visit N =83 Friends 9 11 Husband or Spouse 51 61 Parents 23 28 Health facility characteristics A huge of respondents reported that clean water was always provided for purposes of direct observational therapy-DOT ( n= 344, 90%) whereas a few dissented ( n= 4, 1%). (Table 4). On the participants’ report of health care workers (HCWs) attitude towards pregnant women, a large number ( n= 323, 83%) reported on being warmly greeted and enough time spent with them by the HCWs and were also allowed to ask pertinent questions concerning their pregnancies. A smaller number ( n= 2, 1%) of respondents reported not being given enough time by the HCWs to ask pertinent questions (Table 4). Table 4: Health facility characteristics (N=384) Variable Frequency Percent (%) Clean water for DOT available Always 344 90 Never 4 1 Sometimes 36 9 Clean glasses for DOT available Always 341 89 Never 4 1 Sometimes 39 10 Glasses for water sufficient in quantity Always 324 84 Never 7 2 Sometimes 53 14 Participants’ report of health care workers (HCWs)attitude towards pregnant women HCWs counsels/educates pregnant women on IPTp benefits 6 2 HCWs avails time for questions by the pregnant mothers 2 1 HCWs acknowledges presence of pregnant women and accords enough client-service provider time interface 25 7 HCWs greets pregnant women warmly, spends enough time with them, and gives chance to ask questions 323 83 HCWs Greets Women warmly & counsels/educates them on IPTp benefits 28 7 IPTp-SP coverage A total of 357/384 (93%) respondents received IPTp-SP doses, with those receiving at least three doses forming the largest number ( n= 232, 60%) (Table 5). Table 5: IPTp-SP coverage (N=384) Variable Frequency Percent (%) Participants who received IPTp-SP doses No 27 7 Yes 357 93 Participants who received at least 3 doses of IPTp-SP Yes 232 60 No 152 40 Total No. of IPTp-SP doses utilised by participants 0 doses 27 7 1 dose 33 9 2 doses 92 24 3 doses 141 37 4 doses 65 17 5 doses and Above 26 6 Factors associated with utilization of IPTp-SP3 among pregnant women of nine months’ pregnancy attending ANC at Nambale sub-county hospital Bivariate analysis: the odds for utilization of IPTp 3was 2.34 higher among study participant aged 21-30 years (p=0.001) as compared to other age groups. Those who believed that >3 doses of IPTp prevented MiP were 3.09 times likely to utilize IPTp 3 than those who had no belief at all (p=0.002). Participant who had attained tertiary education had higher chance of 2.71 to utilize IPTp3 as compared to those with other lower levels of education (p=0.002) (Table 6) On multivariable logistics regression analysis, just three variables were significantly associated with the coverage of three or more doses of IPTp-SP and these were; attendance of more than four ANCs {aOR 8.42 (4.4–16.0) p value 0.000}, gestation of first IPTp-SP uptake, i.e. 14–17 gestation weeks {aOR 7.79 (3.2–18.7) p value 0.000} and gestation weeks 18–21 {aOR 4.03 (1.9–8.4) p value 0.000} (Table 13). These three remaining variables were tested for interaction amongst themselves and were found to have no any interactions. ( Table 6 below ). Table 6: Bivariate and Multivariate analysis of factors associated with IPTp-SP coverage in Nambale Sub-County Hospital, Busia County, 2023 (N=384) Variable IPTp 3 uptake cOR(95% CI) P-value aOR(95% C.I) P-value Total ANCs attended Yes(%) No(%) ≤3 21(19) 88 (81) Ref Ref Ref Ref ≥4 211 (77) 64 (23) 13.8 (7.9–23.9) <0.001 8.42 (4.4-16.0.) 21 gestation weeks 67 (39) 103 (61) Ref Ref Ref Ref 14–17 gestation weeks 96 (92) 8 (8) 18.45 (8.4–40.4) <0.001 7.79 (3.2–18.7) <0.001 18–21 gestation weeks 69 (83) 14 (17) 7.58 (3.9–14.5) <0.001 4.03 (1.9–8.4) <0.001 Belief in IPTp-SP protection against Malaria Disagree 79 (51) 76 (49) Ref Ref Ref Ref Agree 153 (67) 76 (33) 3.09 (1.5–6.2 ) 0.002 1.47 (0.7–2.7) 0.217 Age of Mother Below 21 51 (48) 55 (52) Ref Ref Ref Ref 21–30 141 (68) 65 (32) 2.34 (1.4–3.7) 0.001 1.63 (0.8–3.2) 0.160 31–40 39 (57) 30 (43) 1.40 (0.7–2.5) 0.277 0.67 (0.2–1.7) 0.415 Above 40 1 (33) 2 (67) 0.53 (0.0–6.1) 0.618 1.49 (0.0–36.0) 0.807 Mothers Education level Primary 69 (56) 54 ( 44) Ref Ref Ref Ref No formal education 1 (33) 2 (67) 0.39 (0.0–4.4) 0.449 1.90 (0.0–61.3) 0.717 Secondary 103 (57) 79 (43) 1.02 (0.6–1.6) 0.932 0.75 (0.3–1.5) 0.422 Tertiary 59 (78) 17 (22) 2.71 (1.4–5.1) 0.002 1.06 (0.4–2.7) 0.904 Health care workers (HCWs) counsels pregnant women on IPTp-SP No 51 (46) 61 (54) Ref Ref Ref Ref Yes 181 (67) 91 (33) 2.38 (1.5–3.7) <0.001 1.22 (0.6–2.2 0.528 HCWs avails chance for asking questions No 93 (53) 81 (47) Ref Ref Ref Ref Yes 139 (66) 71 (34) 1.71 (1.1–2.5 ) 0.011 0.99 (0.5–1.9) 0.989 Discussion Ideally the uptake of Intermittent Preventive Treatment of Malaria in pregnancy by Sulfadoxine –Pyrimethamine (IPTp –SP) by pregnant women in malaria endemic areas is targeted at 100% for IPTp 1 and at least 80% for IPTp 3. The IPTp 3 is used as the gold standard for assessment of IPTp coverage and access as per guidelines for the World Health organization (WHO) and the National Malaria Control Program (NMCP). Despite the set targets for IPTp utilization, both by WHO and NMCP, several factors seem to influence the uptake of the same. The purpose of this cross-sectional research, was to explore the factors associated with adequate utilization of IPTp-SP which is recommended at three doses and above by the WHO and ministry of health (MoH) Kenya. In this study, only 60% of pregnant women eligible for the IPTp uptake, received the recommended three doses of IPTp-SP as per the WHO requirements. The factors that were statically significant with the uptake of more than three doses were the attendance of more than four (4) ANC visits and commencement of IPTp utilization earlier in the second trimester. This study finding revealed a sub-optimal IPTp3 uptake way below the WHO targets of 80%. Similar findings, were found too in a study done of 12 countries of Sub-Saharan Africa (SSA) which also showed a sub-optimal IPT3 uptake, they used a multilevel analysis data analysis and still found similar results, i.e. they found out that uptake of more than 3 dose of IPTp was 59.64% and 57.46% for Ghana and Burkina respectively (Darteh1 et al., 2021 ). However, this study results differ from a number of previous studies. One such study was that done in Sabatia in Western Kenya, a cross sectional study, that reported an optimal utilization of more than three doses of IPTp-SP at 79.6% (Mutanyi et al., 2021 ). Another cross sectional study, on the determination of IPTp-SP utilization in Sub-Saharan Africa, found out a suboptimal utilization of IPTp-SP of 29.5% (Yaya, n.d.). Also a sub optimal uptake of IPTp-3, i.e. 8% was noted in a study of a cross sectional done in Tanzania in 2021(Mushi et al., 2021 ), 53% in a cross sectional study done in western Kenya (Dellicour et al., 2016 ), 46.6% in a cross sectional study in Tema Metropolis in Ghana (Amankwah & Anto, 2019 ), 22.3% in a study done in East-Central Uganda (Martin et al., 2020 ). In conclusion, this study finding of 60% utilization for IPTp3 by pregnant women at Nambale Sub-county hospital in Busia County is a sub-optimal utilization. Therefore, this means that at the time of the study, of all pregnant women commencing their ANC attendance at the facility only 60% end up taking the recommended doses of IPTp-SP of three or more, with the rest missing out, either due one or more reasons. This therefore means that the population that misses on IPTp-SP, the 40%, are more likely to contract malaria in pregnancy (MIP) and suffer its adverse effects i.e. abortions, still births, low birth weights among others; if these occurs, then mortality and morbidity related to MIP would be experienced, thus affecting the socio-economic status of the region and county at large. Therefore, our study settings should put in place accelerated interventions for IPTp-SP utilization in order to reach the recommended targets by World Health Organization (WHO). Limitations Recall bias on the exact gestation week of pregnancy among pregnant women at the ANC clinic in Nambale Sub-County Hospital (NSCH). However, this was solved by checking on the individual ANC booklets and Hospital register, MOH 405. In addition , the study only explored client level perspective leaving out health system variables (Key informant interviews –KII) that significantly contribute to deficiencies in health service delivery. However, we do believe that our findings generated evidence on the optimal IPTp-service utilization and will therefore guide future policy direction not only in Busia County, but also nationally and regionally As a cross-sectional study, our factors identified may not necessarily represent causal factors as may better be identified through a cohort study following clients’ /study participants over time, however, the factors we identified are in line with other studies on IPTp utilization. Conclusion and recommendation This research aimed at looking at the utilization of IPTp-SP 3 among pregnant women of 36 + gestation weeks attending Nambale Sub-County hospital in Busia County; and also looked at various factors influencing the uptake of IPTp-SP. From the study findings, the utilization of IPTp-SP 3, it evidenced that the proportion of women receiving optimal IPTp-SP (> 3 doses of SP) was at 60%, which falls way below the WHO recommended levels and also the target of the country’s program, MOH Kenya set at 80%. On factors associated with utilization of IPTp-SP 3, two major factors were found to influence the uptake of IPTp-SP 3, these were individual factors, i.e., the attendance of ANC at least four times during the pregnancy period and the uptake of IPTp-SP as early as gestation weeks of 14–17 weeks. In addition, a total of 384 clients were interviewed, majority were aged between 21–30 years old, and had secondary education as their highest qualification. A majority were unemployed, 90% lived in rural areas, either cohabited or married and came from nuclear families. About 73% study participants had health insurance cover. IPTP awareness amongst study participants was at 93%, with those having faith on IPTp being at 60%. Only 22% of study participants were accompanied during ANC; out of which 61%were accompanied by their husband. The study attempted to identify the key bottlenecks from the clients’ perspective regarding the acceptability and uptake of IPTp-SP during pregnancy. These findings add to the existing pool of evidence of IPTp-SP utilization and also forms the basis for designing and prioritizing of new or existing high impact interventions. The study shows that while associations between potential determinants and IPTp-SP 3 uptake were observed, most of these independent variables did not show statistical significance to predict the optimal utilization of the service. In contrast to findings from previous studies that IPTp-SP 3 is dependent on socio-demographic factors, this study did not find such findings. Rather, findings from this study suggest that optimal IPTp-SP utilization is dependent on individual factors like; the total ANC visits attended by the pregnant women, and the gestation weeks of first IPTp-SP uptake, which were found to be statistically significant. Based on comparisons made with previous studies, these findings highlight contextual variations and similarities regarding obstacles to access, delivery and utilization of IPTp-SP across different socio-economic and geographic borders. These findings provide important insights on the delivery and utilization of the intervention, however, while they may be generalizable to the study area, similar conclusions may not be applicable to the whole or parts of the country. Therefore, in order to fully understand the influence of different determinants of optimal IPTp-SP utilization, a large scale community based study is proposed. To achieve maximum impact on IPTp-SP coverage, stakeholders should also conduct thorough barrier analysis before settling for specific bottlenecks to address. For the individual factors that show association with IPTp-SP utilization, there is need for stakeholders to intensify health communication programs to create demand and build trust for this life saving intervention. Past efforts have mostly focused on investigating the influence of attitude, beliefs, knowledge and practices at community on IPTp-SP optimization. However, it is equally paramount to explore the effect of these variables on service delivery from the policy makers’ and health practitioners’ perspective (WHO, 2014 ). Findings from such studies would help identify the critical barriers to national level planning, decision making and overall performance of health care workers in terms of IPTp-SP. In addition, the results can provide insights into existing barriers that hinder adapting suitable, context specific and needs-based strategies that accelerate effective coverage of IPTp-SP. Recommendations This study highlighted the various factors that impede utilization of IPTp-SP in the study area. This research recommends continuous advocacy by the Maternal and Child Health (MCH) personnel to follow up all pregnant women attending ANC at their facility to ensure that they attend ANC at least four times and take at least three doses of IPTp for maximum prevention against malaria in pregnancy. Enhanced risk communication and community engagement by the community health volunteers on IPTp-SP awareness and importance. Abbreviations ACT Artemisinin-based combination therapy aOR Adjusted odds ratio CHV Community health volunteer FELTP Field epidemiology and laboratory training program IPTp Intermittent preventive therapy in pregnancy IREC Institutional research and ethics committee ITN Insecticidal-treated net KMIS Kenya malaria indicator survey KMS Kenya malaria strategy NMCP: National Malaria Control Program WHO World Health Organization Declarations Acknowledgements We acknowledge the faculty and staff at Moi University and the Kenya Field Epidemiology and Laboratory Training Programme (FELTP) for their exemplary dedication to training, guidance, and mentorship. We appreciate the head and staff of the NMCP for effective collaboration in research and outstanding mentorship. We appreciate the County Government of Busia approvals through the County Director of Health (Dr Melsa Lutomia), the county health management team, and Nambale sub-county health management teams. We are very grateful to the management and staff of the Nambale sub-county hospital for the support accorded to us and study participants for allowing us to collect the data them. Many thanks to Professor Diana Menya (MBChB, Ph.D., MSc), Elvis Oyugi (MSc, BSc) , and Emmah Indeke for supporting various stages of this work. Author contributions All authors participated in developing the concept, reviewing the protocol, analysing data, writing the formal report, and developing the manuscript. In addition, FOO participated in data collection. All authors read and approved the final manuscript. Funding This study was partially funded by the United States Presidents Malaria Initiative (PMI) through the Field Epidemiology and Laboratory Training Program. However, the funder did not participate in the design of the study, data collection, data analysis, data interpretation, or manuscript writing. Ethics approval and consent to participate This study was conducted as part of the corresponding author’s thesis work for an MSc degree in Field Epidemiology. Ethical Approval was sought from the Moi University Institutional Research and Ethics Committee (IREC, approval number FAN: 0004433). A research license was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI, license number NACOSTI/P/23/26928). Clearance was also sought from the Busia County Department of Health. Consent to participate in the study was sought, and an informed consent form was administered to the study participants before the interview. Respondent confidentiality and anonymity were maintained by ensuring the privacy of interviews, securing data storage of completed questionnaires, and preventing data sharing between outlets. At the same time Voluntary participation was encouraged Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1 Busia County Department of Health, Busia, Kenya. 2 School of Public Health, Moi University, Eldoret, Kenya, 3 Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya. 4 National Malaria Control Programme, Nairobi, Kenya. References Aberese-Ako, M., Magnussen, P., Ampofo, G. D., Gyapong, M., Ansah, E., & Tagbor, H. (2021). An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context. PLoS ONE , 16 (10 October), 1–30. https://doi.org/10.1371/journal.pone.0257666 Addai-Mensah, O., Annani-Akollor, M. E., Fondjo, L. A., Sarbeng, K., Anto, E. O., Owiredu, E. W., & Arthur, S. N. (2018). 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BMC Research Notes , 9 (1), 1–7. https://doi.org/10.1186/s13104-016-2265-2 Exavery, A., Mbaruku, G., Mbuyita, S., Makemba, A., Kinyonge, I. P., & Kweka, H. (2014). Factors affecting uptake of optimal doses of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy in six districts of Tanzania. Malaria Journal , 13 (1), 1–9. https://doi.org/10.1186/1475-2875-13-22 Hill, J., Hoyt, J., van Eijk, A. M., D’Mello-Guyett, L., ter Kuile, F. O., Steketee, R., Smith, H., & Webster, J. (2013). Factors Affecting the Delivery, Access, and Use of Interventions to Prevent Malaria in Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. PLoS Medicine , 10 (7). https://doi.org/10.1371/journal.pmed.1001488 Kibusi, S. M., Kimunai, E., & Hines, C. S. (2015). Predictors for uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Tanzania. BMC Public Health , 15 (1), 1–8. https://doi.org/10.1186/s12889-015-1905-0 Klein, M. C., Harvey, S. A., Diarra, H., Hurley, E. A., Rao, N., Diop, S., & Doumbia, S. (2016). “There is no free here, you have to pay”: actual and perceived costs as barriers to intermittent preventive treatment of malaria in pregnancy in Mali. Malaria Journal , 15 (1), 1–8. https://doi.org/10.1186/s12936-016-1210-0 Martin, M. K., Venantius, K. B., Patricia, N., Bernard, K., Keith, B., Allen, K., Godfrey, A., & Twesigye Rogers5, K. T. D. and B. M. D. (2020). Correlates of uptake of optimal doses of sulfadoxine‑pyrimethamine for prevention of malaria during pregnancy in East‑Central Uganda. Malaria Journal , 19:153 . Mchwampaka, W. M., Tarimo, D., Chacky, F., Mohamed, A., Kishimba, R., & Samwel, A. (2019). Factors affecting uptake of ≥ 3 doses of Sulfadoxine-Pyrimethamine for malaria prevention in pregnancy in selected health facilities, Arusha region, Tanzania. BMC Pregnancy and Childbirth , 19 (1), 1–8. https://doi.org/10.1186/s12884-019-2592-0 Mkubwa, B., Kagura, J., Chirwa, T., Ibisomi, L., & Kinyanjui, S. (2022). Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020. Malaria Journal , 21 (1), 1–9. https://doi.org/10.1186/s12936-022-04425-x MOPHS. (2016). President’s Malaria Initiative Kenya: Malaria Operational Plan FY 2016. President’s Malaria Initiative , 1–75. https://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-15/fy-2015-nigeria-malaria-operational-plan.pdf?sfvrsn=6 Mubyazi, G. M., & Bloch, P. (2014). Psychosocial, behavioural and health system barriers to delivery and uptake of intermittent preventive treatment of malaria in pregnancy in Tanzania - Viewpoints of service providers in Mkuranga and Mufindi districts. BMC Health Services Research , 14 . https://doi.org/10.1186/1472-6963-14-15 Mubyazi, G. M., Bloch, P., Magnussen, P., Olsen, Ø. E., Byskov, J., Hansen, K. S., & Bygbjerg, I. C. (2010). Women’s experiences and views about costs of seeking malaria chemoprevention and other antenatal services: A qualitative study from two districts in rural Tanzania. Malaria Journal , 9 (1), 1–13. https://doi.org/10.1186/1475-2875-9-54 Mushi, V., Mbotwa, C. H., Zacharia, A., Ambrose, T., & V., M. F. (2021). Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: further analysis of the data of the 2015–2016 Tanzania demographic and health survey and malaria indicat . 20;75 . https://doi.org/10.1186/s12936-021-03616-2 Mutanyi, J. A., Onguru, D. O., Ogolla, S. O., & Adipo, L. B. (2020). Improvement cues of lesion absorption using the adjuvant therapy of traditional Chinese medicine Qinbudan tablet for retreatment pulmonary tuberculosis with standard anti-tuberculosis regimen . https://doi.org/10.1186/s40249-021-00887-4 Mutanyi, J. A., Onguru, D. O., Ogolla, S. O., & Adipo, L. B. (2021). Determinants of the uptake of intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine in Sabatia Sub County, Western Kenya. 10:106 . Ogba, P., Baumann, A., Chidwick, H., Banfield, L., & DiLiberto, D. D. (2022). Barriers and facilitators to access and uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Nigeria: a scoping review. MalariaWorld Journal , 13 , 4. http://www.ncbi.nlm.nih.gov/pubmed/35813271%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC9242533 Okeke, G., Id, K., Msafiri, J., Id, F., Ibisomi, L., Chirwa, T., & Kagura, J. (2023). PLOS GLOBAL PUBLIC HEALTH Factors associated with the uptake of Intermittent Preventive Treatment ( IPTp-SP ) for malaria in pregnancy : Further analysis of the 2018 Nigeria Demographic and Health Survey . 1–20. https://doi.org/10.1371/journal.pgph.0000771 Sangho, O., Tounkara, M., Whiting-Collins, L. J., Beebe, M., Winch, P. J., & Doumbia, S. (2021). Determinants of intermittent preventive treatment with sulfadoxine–pyrimethamine in pregnant women (IPTp-SP) in Mali, a household survey. Malaria Journal , 20 (1), 1–11. https://doi.org/10.1186/s12936-021-03764-5 Stephen, A. A. I., Wurapa, F., Afari, E. A., Sackey, S. O., Malm, K. L., & Nyarko, K. (2016). Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013. Pan African Medical Journal , 25 (Supp 1), 6–9. https://doi.org/10.11604/PAMJ.SUPP.2016.25.1.6169 Thiam, S., Kimotho, V., & Gatonga, P. (2013). Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers. Malaria Journal , 12 (1), 1–7. https://doi.org/10.1186/1475-2875-12-353 Tran, E. E., Tran, E. E., Cheeks, M. L., Kakuru, A., Muhindo, M. K., Natureeba, P., Nakalembe, M., Ategeka, J., Nayebare, P., Kamya, M., Havlir, D., Feeney, M. E., Dorsey, G., & Gaw, S. L. (2020). The impact of gravidity, symptomatology and timing of infection on placental malaria. Malaria Journal , 19 (1), 1–11. https://doi.org/10.1186/s12936-020-03297-3 WHO. (2014). WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy April 2013 ( revised January 2014 ). WHO Department of Maternal, Newborn, Child and Adolescent Health , October 2012 , 1–13. http://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf WHO. (2021). WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) . https://www.who.int/publications/i/item/WHO-HTM-GMP-2014.4 WHO. (2022a). World malaria report 2022 . WHO. (2022b). World malaria report 2022 . WHO Global Malaria Programme. (2011). Intermittent preventive treatment for infants using sulfadoxine- for malaria control in Africa : Implementation field guide. WHO Department of Immunization, Vaccines and Biologicals , 6. Yaya, S. (n.d.). Use of Intermittent Preventive Treatment among Pregnant Women in Sub-Saharan Africa : Evidence from Malaria Indicator Surveys . https://doi.org/10.3390/tropicalmed3010018 Additional Declarations No competing interests reported. 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16:20:20","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159137,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6646661/v1/78c985df13ba7d477ac539d8.html"},{"id":92733494,"identity":"d67b33a2-7c21-46fc-b522-8ec67f062d2e","added_by":"auto","created_at":"2025-10-03 16:20:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65811,"visible":true,"origin":"","legend":"\u003cp\u003eA conceptual framework showing the possible relationship between independent factors and the dependent factors (IPTp-SP) uptake\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6646661/v1/d6dcfdf3622c40b86b7614d2.png"},{"id":92733496,"identity":"99f00303-0ba1-4ce8-85ca-1adff4d29671","added_by":"auto","created_at":"2025-10-03 16:20:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":266389,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA Kenya map showing Busia county, its sub-counties, and the location of Nambale Sub-county hospital in Nambale. (source: created using QGIS 3.16 Hannover)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6646661/v1/53ef56eb39e536b3ef7af8e9.png"},{"id":92736472,"identity":"f4829a2d-a209-4fbe-bde2-bae73ecfe56b","added_by":"auto","created_at":"2025-10-03 16:36:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2227869,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6646661/v1/c59eaf9b-4c03-4e45-af3c-13bdbb17a39a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Utilization and The Factors Associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy in Nambale Sub-County Hospital, Kenya","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria in pregnancy (MIP) is a major public health problem, with substantial risks for the mother, her foetus and the new-born. MIP Effects: maternal anaemia, low birth weight, retarded child growth and death. In 2022, 36% of all pregnancies in WHO African region were exposed to MIP (World Malaria Report 2023). East Africa had MIP prevalence (27%), West Africa (39.3%) and Central Africa (40.1%). In Kenya, there was total of 4,080,441 malaria cases and 5% MIP cases. Busia county reported 341,886 malaria cases and 22% MIP cases.\u003c/p\u003e\u003cp\u003eThe WHO recommends the administration of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) to pregnant women living in malaria endemic zones. The IPTp-SP should be given at the onset of second trimester (gestational weeks\u0026thinsp;\u0026gt;\u0026thinsp;13). IPTp-SP averts the adverse effects of MIP. WHO recommends a minimum of at least 3 doses of IPTp-SP, with each dose given one month apart during the ANC visits.\u003c/p\u003e\u003cp\u003eDespite increased IPTp utilization in the WHO Africa region in the last two years, optimal use still remains a mirage. Optimal IPTp utilization is set at a target of 80% for the IPTp3 as per the WHO recommendations. In the WHO African region, IPTp utilization was (World Malaria Report 2023):\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIPTp utilization in 2021; IPTp1 (54%) IPTp2 (45%) and IPTp3 (34%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIPTp utilization in 2022; IPTp1 (64%) IPTp2 (54%) and IPTp3 (42%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIPTp utilization in 2023; IPTp1 (67%) IPTp2 (55%) and IPTp3 (44%)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eDespite increased IPTp 3 utilization in Kenya in the last 4 years, uptake still fell below the WHO recommendations i.e. 3% (2020), 14% (2021), 17% (2022), 17% (2023) - KHIS 2023\u003c/p\u003e\u003cp\u003eIn Busia County, IPTp utilization was: IPTp 1: 96% and IPTp 3: 64% (KHIS, 2022); In Nambale Sub county, IPTp utilization was, IPTp 1: 104% and IPTp 3: 64% (KHIS 2022). In Nambale sub-county Hospital (NSCH), IPTp utilization was, IPTp 1: 96%, and IPTp 3: 64% (KHIS, 2022) below the required set target of 80% set by the WHO. Decreased IPTp uptake increases the risk of pregnant women residing in the malaria-endemic zones acquiring MIP.\u003c/p\u003e\u003cp\u003eMIP is a risk factor to maternal and fetal anemia, intrauterine growth retardation, low birth weights, stillbirths, abortions and deaths. MIP may negatively impact on the economic status. Only 49% of women received three or more IPTp-SP in the lake endemic region (NMCP, 2021), way below the target of 100% protection\u003c/p\u003e\u003cp\u003eIn Busia County, Nambale Sub-County, had the highest decline rate in IPTp-SP3 utilization. Nambale Sub-county Hospital had the highest decline in IPTp-SP 3 utilization among facilities in the sub-county. Objectives for the study was to determine the utilization and assess factors associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) in Nambale Sub-county hospital (NSCH) in Busia county, Kenya; and specifically to determine the proportion of pregnant women of nine months pregnancy utilizing IPTp-SP 3 in NSCH and to assess sociodemographic factors, cultural factors, individual factors, and health facility factors influencing utilization IPTp-SP3 in NSCH.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis was a cross-sectional study that employed consecutive sampling whereby, pregnant women of nine months, aged between 14-49 years were interviewed, using the interviewer- administered questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. A Descriptive of factors was done, Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with \u003cem\u003ep value\u003c/em\u003e of \u0026le;0.2, were subjected to multivariable logistic regression analysis to identify variables with \u003cem\u003ep value\u003c/em\u003e of \u0026le;0.05 associated with utilization of IPTp-SP among pregnant women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant women of 36 weeks\u0026rsquo; gestation \u0026nbsp; or more attending Antenatal care (ANC) at the Nambale sub-county hospital (NSCH).\u003c/p\u003e\n\u003cp\u003ePregnant women on another preventive treatment like cotrimoxazole prophylaxis (CTXp) \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant women allergic to sulphur drugs\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCochrane (Cochran, 1977) formula was used for sample size calculations/determination\u003c/p\u003e\n\u003cp\u003eThe following assumptions were made:\u003c/p\u003e\n\u003cp\u003eZ: The score at 95% confidence interval (CI) = 1.96.\u003c/p\u003e\n\u003cp\u003eP: Expected proportion of pregnant women taking three or more doses of IPTp-SP = 49% based on the prevalence obtained during Kenya Malaria indicator survey KMIS of 2020. (Program, 2021).\u003c/p\u003e\n\u003cp\u003ed: Degree of precision =0.05\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1759496558.png\" width=\"285\" height=\"65\"\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;[1.96 x 1.96 x 0.49 (1 \u0026ndash; 0.49)]/0.0025\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sample size = 384 ANC clients\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCounties offering IPTp in Kenya listed and utilization of IPTp 3 noted. County with the lowest percentage uptake of IPTp3 identified- Busia county. Then utilization of IPTp 3 within the Sub-counties of Busia county listed. Nambale sub-county was identified, and facilities utilization of IPTp3 listed. Nambale sub-county Hospital (NSCH) was identified as facility with the lowest IPTp 3 utilization. Eligible study participants attending ANC at NSCH were identified and consent sought from them and a consecutive sampling method used. A semi-structured questionnaire on IPTp 3 utilization was administered to consenting participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Management and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData cleaning done in Ms Excel and analysis in Stata v.15.1 software whereby, frequencies and proportions were calculated for categorical variables and measures for central tendency and dispersion was calculated to summarize continuous variables.\u003c/p\u003e\n\u003cp\u003eBivariate Analysis (Logistic Regression) was used to calculate; Crude Odds Ratio (cOR), 95% C.I.s and \u003cem\u003ep\u003c/em\u003e-value) and those variables with \u003cem\u003ep\u003c/em\u003e-value \u0026le;0.2 at bivariate analysis were taken to Multivariate analysis.\u003c/p\u003e\n\u003cp\u003eMultivariate Analysis was also done, whereby, a backward stepwise Logistic Regression analysis technique used to calculate, Adjusted Odds Ratio (aOR), 95% C.I.s and p-values . Those Variables with \u003cem\u003ep\u003c/em\u003e-value \u0026le;0.05 were considered statistically significant\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of pregnant women\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 384 study participants were interviewed. All were pregnant women of at least 36 weeks\u0026rsquo; gestation.\u003c/p\u003e\n\u003cp\u003eThe median age of the study participants was 25 years with a range of 14 - 44 years old. Highest number of\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eparticipants (\u003cem\u003en\u003c/em\u003e=206, 54%) were aged 21\u0026ndash;30 years and the lowest number of participants \u003cem\u003e(n\u003c/em\u003e=3, 1%) were aged above 41 (Table 1). Those with secondary education were the highest (\u003cem\u003en\u003c/em\u003e=182, 47%) with ones having no formal education being the lowest (\u003cem\u003en\u003c/em\u003e=3, 1%) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc153181707\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Socio-demographic characteristics of the respondents (N=384\u003cem\u003e)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eBelow 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e31\u0026ndash;40 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eAbove 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eNo \u0026nbsp; \u0026nbsp; formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eCohabiting /Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eSingle/Divorced/Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily structure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eExtended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eSingle parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eIndividual characteristics of the respondents \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe highest number of the respondents were Primigravida (\u003cem\u003en\u003c/em\u003e=196, 51%). On parity, Primipara constituted the highest number (\u003cem\u003en=\u003c/em\u003e195, 51%) and nulliparous the lowest number (\u003cem\u003en=\u003c/em\u003e7, 2%). On the current gestation weeks of the respondents, those of 38\u003csup\u003eth\u003c/sup\u003e gestation week were the majority (\u003cem\u003en=\u003c/em\u003e100, 26%) with those above 40\u003csup\u003eth\u003c/sup\u003e gestation week constituting the lowest number (\u003cem\u003en=\u003c/em\u003e29, 7%). The highest number of respondents began their 1\u003csup\u003est\u003c/sup\u003e ANC at gestation weeks of \u0026gt;21 (\u003cem\u003en=\u003c/em\u003e151, 39%), with the least number of them starting at gestation weeks \u0026lt;12 (\u003cem\u003en\u003c/em\u003e=56, 15%) (Table 4). The highest number of participants had attended more than four ANC visits (\u003cem\u003en=\u003c/em\u003e275, 72%) with least number attending only attending to one ANC visit (\u003cem\u003en=\u003c/em\u003e5, 1%). On health insurance cover, only 73% (\u003cem\u003en=\u003c/em\u003e281) of the respondents were covered by any type of insurance (Table 2)\u003c/p\u003e\n\u003cp\u003eThe majority of respondents (\u003cem\u003en=\u003c/em\u003e356, 93%) acknowledged being aware of IPTp-SP. A huge number of respondents believed in IPTp-SP protection against MIP (\u003cem\u003en=\u003c/em\u003e229, 60%), with only a few dissenting (\u003cem\u003en=\u003c/em\u003e38, 10%) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003cem\u003e2\u003c/em\u003e: Individual factors of the respondents (N=384)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidae\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePrimipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Gestation Week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAbove 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Gestation week of 1\u003csup\u003est\u003c/sup\u003e ANC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026lt;12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e13\u0026ndash;16 \u0026nbsp; \u0026nbsp; \u0026nbsp;weeks\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e17\u0026ndash;20 \u0026nbsp; \u0026nbsp; weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026gt;21 weeks\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No of ANC attended\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e4 and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas Health Insurance/cover\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants awareness on \u0026nbsp;IPTp-SP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBelief in IPTp-SP protection against Malaria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eCultural characteristics of the respondents (\u003cem\u003eN\u003c/em\u003e=384)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly one study participant out of the 384 responded \u0026ldquo;Yes\u0026rdquo; to having cultural belief against the IPTp uptake, the rest dissenting (\u003cem\u003en=\u003c/em\u003e383, 99%). A large number of the participants reported on making sole decision on matters pertaining to health in their homes (\u003cem\u003en=\u003c/em\u003e172, 45%), whereas a small number of respondents reported that their parents contributed towards their decision making in the house (\u003cem\u003en=\u003c/em\u003e9, 2%) (Table 3). A large number of participants reported on being accompanied during ANC visits (\u003cem\u003en=\u003c/em\u003e301, 78%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Cultural characteristics of the respondents (N=384)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHouse/Home Decision Maker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eSelf\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eHusband/spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eBoth husband and self\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eBoth parents and self\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Accompanied during ANC visit\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersons accompanying participants during ANC visit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e=83\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eFriends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eHusband or Spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eHealth facility characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA huge of respondents reported that clean water was always provided for purposes of direct observational therapy-DOT (\u003cem\u003en=\u003c/em\u003e344, 90%) whereas a few dissented (\u003cem\u003en=\u003c/em\u003e4, 1%). (Table 4). On the participants\u0026rsquo; report of health care workers (HCWs) attitude towards pregnant women, a large number (\u003cem\u003en=\u003c/em\u003e323, 83%) reported on being warmly greeted and enough time spent with them by the HCWs and were also allowed to ask pertinent questions concerning their pregnancies. A smaller number (\u003cem\u003en=\u003c/em\u003e2, 1%) of respondents reported not being given enough time by the HCWs to ask pertinent questions (Table 4).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Health facility characteristics (N=384)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClean water for DOT available\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClean glasses for DOT \u0026nbsp;available\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGlasses for water sufficient in quantity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u0026rsquo; report of health care workers (HCWs)attitude towards pregnant women\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eHCWs counsels/educates pregnant women on IPTp benefits\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eHCWs avails time for questions by the pregnant mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eHCWs acknowledges presence of pregnant women and accords enough client-service provider time interface\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eHCWs greets pregnant women warmly, spends enough time with them, and gives chance to ask questions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eHCWs Greets Women warmly \u0026amp; counsels/educates them on IPTp benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eIPTp-SP coverage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 357/384 (93%) respondents received IPTp-SP doses, with those receiving at least three doses forming the largest number (\u003cem\u003en=\u003c/em\u003e232, 60%) (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc153181712\"\u003e\u003cstrong\u003eTable 5: IPTp-SP coverage (N=384)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants who received IPTp-SP \u0026nbsp;doses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants who received at least 3 doses of IPTp-SP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No. of \u0026nbsp;IPTp-SP doses utilised by participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e0 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e1 dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e2 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e3 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e4 doses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 386px;\"\u003e\n \u003cp\u003e5 doses and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with utilization of IPTp-SP3 among pregnant women of nine months\u0026rsquo; pregnancy attending ANC at Nambale sub-county hospital\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBivariate analysis: the odds for utilization of IPTp 3was 2.34 higher among study participant\u0026nbsp;aged 21-30\u0026nbsp;years\u0026nbsp;(p=0.001) as compared to other age groups. Those who\u0026nbsp;believed that \u0026gt;3 doses of IPTp prevented MiP were 3.09 times likely to utilize IPTp 3 than those who had no belief at all (p=0.002). Participant who had attained tertiary\u0026nbsp;education had higher chance of 2.71 to utilize IPTp3 as compared to those with other lower levels of education (p=0.002) (Table 6)\u003c/p\u003e\n\u003cp\u003eOn multivariable logistics regression analysis, just three variables were significantly associated with the coverage of three or more doses of IPTp-SP and these were; attendance of more than four ANCs {aOR 8.42 (4.4\u0026ndash;16.0) p value 0.000}, gestation of first IPTp-SP uptake, i.e. 14\u0026ndash;17 gestation weeks {aOR 7.79 (3.2\u0026ndash;18.7) p value 0.000} and gestation weeks 18\u0026ndash;21 {aOR 4.03 (1.9\u0026ndash;8.4) p value 0.000} (Table 13). These three remaining variables were tested for interaction amongst themselves and were found to have no any interactions. (\u003cstrong\u003eTable 6\u003c/strong\u003e \u003cstrong\u003ebelow\u003c/strong\u003e).\u003c/p\u003e\n\u003cp id=\"_Toc153181719\"\u003e\u003cstrong\u003eTable 6: Bivariate and Multivariate analysis of factors associated with IPTp-SP coverage in Nambale Sub-County Hospital, Busia County, 2023 (N=384)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse;border: none;width: 642px;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border: 1pt solid windowtext;padding: 0cm 5.4pt;height: 49.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eVariable\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 97pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0cm 5.4pt;height: 49.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eIPTp 3 uptake\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0cm 5.4pt;height: 49.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003ecOR(95% CI)\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0cm 5.4pt;height: 49.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0cm 5.4pt;height: 49.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eaOR(95% C.I)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:0cm;font-size:11.0pt;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0cm 5.4pt;height: 49.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eTotal ANCs attended\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eYes(%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eNo(%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026le;3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e21(19)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e88 (81)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026ge;4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e211 (77)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e64 (23)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e13.8 (7.9\u0026ndash;23.9)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e8.42 (4.4-16.0.)\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 59.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eGestation week of 1\u003csup\u003est\u003c/sup\u003e receipt of IPTp-SP dose\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e\u0026gt;21 gestation weeks\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e67 (39)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e103 (61)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e14\u0026ndash;17 \u0026nbsp;gestation weeks\u003c/span\u003e\u003c/p\u003e\n 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none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:red;\"\u003e18.45 (8.4\u0026ndash;40.4)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:red;\"\u003e7.79 (3.2\u0026ndash;18.7)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e18\u0026ndash;21 \u0026nbsp;gestation weeks\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e69 (83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e14 (17)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:red;\"\u003e7.58 (3.9\u0026ndash;14.5)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:red;\"\u003e4.03 (1.9\u0026ndash;8.4)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003eBelief in IPTp-SP protection against Malaria\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n 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style=\"font-size:11px;color:black;\"\u003eDisagree\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e79 (51)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003e76 (49)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New 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style=\"font-size:11px;line-height:200%;color:red;\"\u003e0.002\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e1.47 (0.7\u0026ndash;2.7)\u003c/span\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp 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81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003eBelow 21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e51 (48)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e55 (52)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid 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style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1.63 (0.8\u0026ndash;3.2)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.160\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e31\u0026ndash;40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e39 (57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e30 (43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1.40 (0.7\u0026ndash;2.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.277\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.67 (0.2\u0026ndash;1.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.415\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;color:black;\"\u003eAbove 40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1 (33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e2 (67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.53 (0.0\u0026ndash;6.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.618\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1.49 (0.0\u0026ndash;36.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.807\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family: \"Times New Roman\";color:black;'\u003eMothers Education level\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003ePrimary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e69 (56)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e54 ( 44)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003eNo formal education\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1 (33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e2 (67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.39 (0.0\u0026ndash;4.4)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.449\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1.90 (0.0\u0026ndash;61.3)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid 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none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e1.02 (0.6\u0026ndash;1.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e0.932\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: 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46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e51 (46)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e61 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Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e181 (67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e91 (33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e2.38 (1.5\u0026ndash;3.7)\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e1.22 (0.6\u0026ndash;2.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e0.528\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family: \"Times New Roman\";color:black;'\u003e\u0026nbsp;HCWs avails chance \u0026nbsp;for asking questions\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:0cm;font-size:11.0pt;line-height:normal;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:0cm;font-size:11.0pt;line-height:normal;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e93 (53)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e81 (47)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:0cm;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:.0001pt;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003eRef\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84.8pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e139 (66)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:0cm;margin-left:0cm;font-size:16px;font-family:\"Calibri\",sans-serif;margin-top:0cm;margin-bottom:8.0pt;font-size:11.0pt;margin:0cm;'\u003e\u003cspan style=\"font-size:11px;font-family: Calibri;color:black;\"\u003e71 (34)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:center;line-height:200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height: 200%;color:red;\"\u003e1.71 (1.1\u0026ndash;2.5\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e)\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:200%;color:red;\"\u003e0.011\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e0.99 (0.5\u0026ndash;1.9)\u003c/span\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-right:5.2pt;margin-left:5.65pt;font-size:15px;font-family:\"Times New Roman\",serif;margin-top:0cm;margin-bottom:0cm;text-align:justify;line-height: 200%;'\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e0.989\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIdeally the uptake of Intermittent Preventive Treatment of Malaria in pregnancy by Sulfadoxine –Pyrimethamine (IPTp –SP) by pregnant women in malaria endemic areas is targeted at 100% for IPTp 1 and at least 80% for IPTp 3. The IPTp 3 is used as the gold standard for assessment of IPTp coverage and access as per guidelines for the World Health organization (WHO) and the National Malaria Control Program (NMCP). Despite the set targets for IPTp utilization, both by WHO and NMCP, several factors seem to influence the uptake of the same. The purpose of this cross-sectional research, was to explore the factors associated with adequate utilization of IPTp-SP which is recommended at three doses and above by the WHO and ministry of health (MoH) Kenya.\u003c/p\u003e\u003cp\u003eIn this study, only 60% of pregnant women eligible for the IPTp uptake, received the recommended three doses of IPTp-SP as per the WHO requirements. The factors that were statically significant with the uptake of more than three doses were the attendance of more than four (4) ANC visits and commencement of IPTp utilization earlier in the second trimester.\u003c/p\u003e\u003cp\u003eThis study finding revealed a sub-optimal IPTp3 uptake way below the WHO targets of 80%. Similar findings, were found too in a study done of 12 countries of Sub-Saharan Africa (SSA) which also showed a sub-optimal IPT3 uptake, they used a multilevel analysis data analysis and still found similar results, i.e. they found out that uptake of more than 3 dose of IPTp was 59.64% and 57.46% for Ghana and Burkina respectively (Darteh1 et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, this study results differ from a number of previous studies. One such study was that done in Sabatia in Western Kenya, a cross sectional study, that reported an optimal utilization of more than three doses of IPTp-SP at 79.6% (Mutanyi et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Another cross sectional study, on the determination of IPTp-SP utilization in Sub-Saharan Africa, found out a suboptimal utilization of IPTp-SP of 29.5% (Yaya, n.d.). Also a sub optimal uptake of IPTp-3, i.e. 8% was noted in a study of a cross sectional done in Tanzania in 2021(Mushi et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), 53% in a cross sectional study done in western Kenya (Dellicour et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), 46.6% in a cross sectional study in Tema Metropolis in Ghana (Amankwah \u0026amp; Anto, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), 22.3% in a study done in East-Central Uganda (Martin et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn conclusion, this study finding of 60% utilization for IPTp3 by pregnant women at Nambale Sub-county hospital in Busia County is a sub-optimal utilization. Therefore, this means that at the time of the study, of all pregnant women commencing their ANC attendance at the facility only 60% end up taking the recommended doses of IPTp-SP of three or more, with the rest missing out, either due one or more reasons. This therefore means that the population that misses on IPTp-SP, the 40%, are more likely to contract malaria in pregnancy (MIP) and suffer its adverse effects i.e. abortions, still births, low birth weights among others; if these occurs, then mortality and morbidity related to MIP would be experienced, thus affecting the socio-economic status of the region and county at large. Therefore, our study settings should put in place accelerated interventions for IPTp-SP utilization in order to reach the recommended targets by World Health Organization (WHO).\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eRecall \u003cb\u003ebias on the exact gestation week of pregnancy among pregnant women at the ANC clinic in Nambale Sub-County Hospital (NSCH). However, this was solved by checking on the individual ANC booklets and Hospital register, MOH 405.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn addition\u003c/b\u003e, the study only explored client level perspective leaving out health system variables (Key informant interviews –KII) that significantly contribute to deficiencies in health service delivery. However, we do believe that our findings generated evidence on the optimal IPTp-service utilization and will therefore guide future policy direction not only in Busia County, but also nationally and regionally\u003c/p\u003e\u003cp\u003eAs a cross-sectional study, our factors identified may not necessarily represent causal factors as may better be identified through a cohort study following clients’ /study participants over time, however, the factors we identified are in line with other studies on IPTp utilization.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eThis research aimed at looking at the utilization of IPTp-SP 3 among pregnant women of 36 + gestation weeks attending Nambale Sub-County hospital in Busia County; and also looked at various factors influencing the uptake of IPTp-SP. From the study findings, the utilization of IPTp-SP 3, it evidenced that the proportion of women receiving optimal IPTp-SP (\u0026gt; 3 doses of SP) was at 60%, which falls way below the WHO recommended levels and also the target of the country’s program, MOH Kenya set at 80%. On factors associated with utilization of IPTp-SP 3, two major factors were found to influence the uptake of IPTp-SP 3, these were individual factors, i.e., the attendance of ANC at least four times during the pregnancy period and the uptake of IPTp-SP as early as gestation weeks of 14–17 weeks.\u003c/p\u003e\u003cp\u003eIn addition, a total of 384 clients were interviewed, majority were aged between 21–30 years old, and had secondary education as their highest qualification. A majority were unemployed, 90% lived in rural areas, either cohabited or married and came from nuclear families. About 73% study participants had health insurance cover. IPTP awareness amongst study participants was at 93%, with those having faith on IPTp being at 60%. Only 22% of study participants were accompanied during ANC; out of which 61%were accompanied by their husband.\u003c/p\u003e\u003cp\u003eThe study attempted to identify the key bottlenecks from the clients’ perspective regarding the acceptability and uptake of IPTp-SP during pregnancy. These findings add to the existing pool of evidence of IPTp-SP utilization and also forms the basis for designing and prioritizing of new or existing high impact interventions. The study shows that while associations between potential determinants and IPTp-SP 3 uptake were observed, most of these independent variables did not show statistical significance to predict the optimal utilization of the service. In contrast to findings from previous studies that IPTp-SP 3 is dependent on socio-demographic factors, this study did not find such findings. Rather, findings from this study suggest that optimal IPTp-SP utilization is dependent on individual factors like; the total ANC visits attended by the pregnant women, and the gestation weeks of first IPTp-SP uptake, which were found to be statistically significant.\u003c/p\u003e\u003cp\u003eBased on comparisons made with previous studies, these findings highlight contextual variations and similarities regarding obstacles to access, delivery and utilization of IPTp-SP across different socio-economic and geographic borders. These findings provide important insights on the delivery and utilization of the intervention, however, while they may be generalizable to the study area, similar conclusions may not be applicable to the whole or parts of the country. Therefore, in order to fully understand the influence of different determinants of optimal IPTp-SP utilization, a large scale community based study is proposed. To achieve maximum impact on IPTp-SP coverage, stakeholders should also conduct thorough barrier analysis before settling for specific bottlenecks to address. For the individual factors that show association with IPTp-SP utilization, there is need for stakeholders to intensify health communication programs to create demand and build trust for this life saving intervention.\u003c/p\u003e\u003cp\u003ePast efforts have mostly focused on investigating the influence of attitude, beliefs, knowledge and practices at community on IPTp-SP optimization. However, it is equally paramount to explore the effect of these variables on service delivery from the policy makers’ and health practitioners’ perspective (WHO, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Findings from such studies would help identify the critical barriers to national level planning, decision making and overall performance of health care workers in terms of IPTp-SP. In addition, the results can provide insights into existing barriers that hinder adapting suitable, context specific and needs-based strategies that accelerate effective coverage of IPTp-SP.\u003c/p\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eThis study highlighted the various factors that impede utilization of IPTp-SP in the study area.\u003c/p\u003e\u003cp\u003eThis research recommends continuous advocacy by the Maternal and Child Health (MCH) personnel to follow up all pregnant women attending ANC at their facility to ensure that they attend ANC at least four times and take at least three doses of IPTp for maximum prevention against malaria in pregnancy. Enhanced risk communication and community engagement by the community health volunteers on IPTp-SP awareness and importance.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACT Artemisinin-based combination therapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eaOR Adjusted odds ratio\u003c/p\u003e\n\u003cp\u003eCHV Community health volunteer\u003c/p\u003e\n\u003cp\u003eFELTP Field epidemiology and laboratory training program\u003c/p\u003e\n\u003cp\u003eIPTp Intermittent preventive therapy in pregnancy\u003c/p\u003e\n\u003cp\u003eIREC Institutional research and ethics committee\u003c/p\u003e\n\u003cp\u003eITN Insecticidal-treated net\u003c/p\u003e\n\u003cp\u003eKMIS Kenya malaria indicator survey\u003c/p\u003e\n\u003cp\u003eKMS Kenya malaria strategy\u003c/p\u003e\n\u003cp\u003eNMCP: National Malaria Control Program\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the faculty and staff at Moi University and the Kenya Field Epidemiology and Laboratory Training Programme (FELTP) for their exemplary dedication to training, guidance, and mentorship. We appreciate the head and staff of the NMCP for effective collaboration in research and outstanding mentorship. We appreciate the County Government of Busia approvals through the County Director of Health (Dr Melsa Lutomia), the county health management team, and Nambale sub-county\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ehealth management teams. We are very grateful to the management and staff of the Nambale sub-county hospital for the support accorded to us and study participants for allowing us to collect the data\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;them. Many thanks to Professor Diana Menya (MBChB, Ph.D., MSc), Elvis Oyugi (MSc, BSc) , and Emmah Indeke for supporting various stages of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in developing the concept, reviewing the protocol, analysing data, writing the formal report, and developing the manuscript. In addition, FOO participated in data collection. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was partially funded by the United States Presidents Malaria Initiative (PMI) through the Field Epidemiology and Laboratory Training Program. However, the funder did not participate in the design of the study, data collection, data analysis, data interpretation, or manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted as part of the corresponding author\u0026rsquo;s thesis work for an MSc degree in Field Epidemiology. Ethical Approval was sought from the Moi University Institutional Research and Ethics Committee (IREC, approval number FAN:\u0026nbsp;0004433). A research license was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI, license number NACOSTI/P/23/26928). Clearance was also sought from the Busia County Department of Health. Consent to participate in the study was sought, and an informed consent form was administered to the study participants before the interview. Respondent confidentiality and anonymity were maintained by ensuring the privacy of interviews, securing data storage of completed questionnaires, and preventing data sharing between outlets. At the same time Voluntary participation was encouraged\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eBusia County Department of Health, Busia, Kenya. \u003csup\u003e2\u003c/sup\u003eSchool of Public Health, Moi University, Eldoret, Kenya, \u003csup\u003e3\u003c/sup\u003eField Epidemiology and Laboratory Training Programme, Nairobi, Kenya.\u003csup\u003e4\u003c/sup\u003e National Malaria Control Programme, Nairobi, Kenya.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAberese-Ako, M., Magnussen, P., Ampofo, G. 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(2020). \u003cem\u003eImprovement cues of lesion absorption using the adjuvant therapy of traditional Chinese medicine Qinbudan tablet for retreatment pulmonary tuberculosis with standard anti-tuberculosis regimen\u003c/em\u003e. https://doi.org/10.1186/s40249-021-00887-4\u003c/li\u003e\n \u003cli\u003eMutanyi, J. A., Onguru, D. O., Ogolla, S. O., \u0026amp; Adipo, L. B. (2021). Determinants of the uptake of intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine in Sabatia Sub County, Western Kenya. \u003cem\u003e10:106\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eOgba, P., Baumann, A., Chidwick, H., Banfield, L., \u0026amp; DiLiberto, D. D. (2022). Barriers and facilitators to access and uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Nigeria: a scoping review. \u003cem\u003eMalariaWorld Journal\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 4. http://www.ncbi.nlm.nih.gov/pubmed/35813271%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC9242533\u003c/li\u003e\n \u003cli\u003eOkeke, G., Id, K., Msafiri, J., Id, F., Ibisomi, L., Chirwa, T., \u0026amp; Kagura, J. (2023). \u003cem\u003ePLOS GLOBAL PUBLIC HEALTH Factors associated with the uptake of Intermittent Preventive Treatment ( IPTp-SP ) for malaria in pregnancy : Further analysis of the 2018 Nigeria Demographic and Health Survey\u003c/em\u003e. 1\u0026ndash;20. https://doi.org/10.1371/journal.pgph.0000771\u003c/li\u003e\n \u003cli\u003eSangho, O., Tounkara, M., Whiting-Collins, L. J., Beebe, M., Winch, P. J., \u0026amp; Doumbia, S. (2021). Determinants of intermittent preventive treatment with sulfadoxine\u0026ndash;pyrimethamine in pregnant women (IPTp-SP) in Mali, a household survey. \u003cem\u003eMalaria Journal\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(1), 1\u0026ndash;11. https://doi.org/10.1186/s12936-021-03764-5\u003c/li\u003e\n \u003cli\u003eStephen, A. A. I., Wurapa, F., Afari, E. A., Sackey, S. O., Malm, K. L., \u0026amp; Nyarko, K. (2016). Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013. \u003cem\u003ePan African Medical Journal\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(Supp 1), 6\u0026ndash;9. https://doi.org/10.11604/PAMJ.SUPP.2016.25.1.6169\u003c/li\u003e\n \u003cli\u003eThiam, S., Kimotho, V., \u0026amp; Gatonga, P. (2013). Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers. \u003cem\u003eMalaria Journal\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 1\u0026ndash;7. https://doi.org/10.1186/1475-2875-12-353\u003c/li\u003e\n \u003cli\u003eTran, E. E., Tran, E. E., Cheeks, M. L., Kakuru, A., Muhindo, M. K., Natureeba, P., Nakalembe, M., Ategeka, J., Nayebare, P., Kamya, M., Havlir, D., Feeney, M. E., Dorsey, G., \u0026amp; Gaw, S. L. (2020). The impact of gravidity, symptomatology and timing of infection on placental malaria. \u003cem\u003eMalaria Journal\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 1\u0026ndash;11. https://doi.org/10.1186/s12936-020-03297-3\u003c/li\u003e\n \u003cli\u003eWHO. (2014). WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy April 2013 ( revised January 2014 ). \u003cem\u003eWHO Department of Maternal, Newborn, Child and Adolescent Health\u003c/em\u003e, \u003cem\u003eOctober 2012\u003c/em\u003e, 1\u0026ndash;13. http://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf\u003c/li\u003e\n \u003cli\u003eWHO. (2021). \u003cem\u003eWHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP)\u003c/em\u003e. https://www.who.int/publications/i/item/WHO-HTM-GMP-2014.4\u003c/li\u003e\n \u003cli\u003eWHO. (2022a). \u003cem\u003eWorld malaria report 2022\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eWHO. (2022b). \u003cem\u003eWorld malaria report 2022\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eWHO Global Malaria Programme. (2011). Intermittent preventive treatment for infants using sulfadoxine- for malaria control in Africa : Implementation field guide. \u003cem\u003eWHO Department of Immunization, Vaccines and Biologicals\u003c/em\u003e, 6.\u003c/li\u003e\n \u003cli\u003eYaya, S. (n.d.). \u003cem\u003eUse of Intermittent Preventive Treatment among Pregnant Women in Sub-Saharan Africa : Evidence from Malaria Indicator Surveys\u003c/em\u003e. https://doi.org/10.3390/tropicalmed3010018\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"maternal-health-neonatology-and-perinatology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mhnp","sideBox":"Learn more about [Maternal Health, Neonatology and Perinatology](http://mhnpjournal.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mhnp/default.aspx","title":"Maternal Health, Neonatology and Perinatology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"FELTP, IPTp-SP, Kenya, Malaria, Pregnancy, WHO","lastPublishedDoi":"10.21203/rs.3.rs-6646661/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6646661/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMalaria remains a significant public health problem globally, with highest morbidity and mortality reported in sub Saharan Africa. In 2022, 12.7\u0026nbsp;million (36%) Malaria in Pregnancy (MiP) cases in Sub Saharan Africa and 27% were reported from East Africa. In Kenya, 4,080,441 malaria cases and 5% MiP cases reported. Busia County, Kenya, reported 341,886 malaria cases and 22% MiP cases. WHO recommends administering intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) to prevent MIP in malaria-endemic zones. The objective of the study was to determine proportion of pregnant women utilizing IPTp-SP 3 and describe factors influencing utilization of IPTp-SP 3.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional study was employed, pregnant women of nine months, aged 14\u0026ndash;49 years were interviewed, using questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with \u003cem\u003ep value\u003c/em\u003e of \u0026le;\u0026thinsp;0.2, were subjected to multivariable logistic regression analysis to identify significant factors (variables with \u003cem\u003ep value\u003c/em\u003e of \u0026le;\u0026thinsp;0.05)\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003e384 pregnant women were interviewed, 90% resided in rural areas; 93% aware of IPTp use, 68% were married, 67% unemployed, 60% utilized IPTp-SP3 and 47% had secondary education. In the bivariate analysis, participant age 21\u0026ndash;30 years {cOR\u0026thinsp;=\u0026thinsp;2.34, 95% CI\u0026thinsp;=\u0026thinsp;1.4\u0026ndash;3.7}, belief in \u0026gt;\u0026thinsp;3 doses of IPTp preventing MiP {cOR\u0026thinsp;=\u0026thinsp;3.09, 95% CI\u0026thinsp;=\u0026thinsp;1.5\u0026ndash;6.2}and having tertiary education {cOR\u0026thinsp;=\u0026thinsp;2.71, 95% CI\u0026thinsp;=\u0026thinsp;1.4\u0026ndash;5.1} were associated with uptake of \u0026ge;\u0026thinsp;3doses of IPTp. On multivariable logistics regression analysis, attendance of ANC at least 4 times {aOR\u0026thinsp;=\u0026thinsp;8.42, 95% CI\u0026thinsp;=\u0026thinsp;4.4\u0026ndash;16.0} and uptake of IPTp-SP at 14\u0026ndash;17 gestation weeks {aOR\u0026thinsp;=\u0026thinsp;7.79, 95% CI\u0026thinsp;=\u0026thinsp;3.2\u0026ndash;18.7} independently associated with optimal utilization of IPTp (IPTp-SP3).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA sub-optimal IPTp-SP 3 utilization (60%) way below WHO target of 80%. \u0026ge;4ANC attendance and first IPTp-SP uptake at 14\u0026ndash;17 gestation weeks were independently associated with optimal utilization of IPTp.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendation:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Maternal and Child Health personnel to follow up all pregnant women attending ANC at their facility to ensure ANC adherence of X4 and take\u0026thinsp;\u0026ge;\u0026thinsp;3doses of IPTp.\u003c/p\u003e","manuscriptTitle":"Utilization and The Factors Associated with the uptake of Intermittent Preventive Treatment of Malaria in Pregnancy in Nambale Sub-County Hospital, Kenya","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:20:15","doi":"10.21203/rs.3.rs-6646661/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-08T15:59:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T22:12:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T13:28:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T00:38:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254868219954280766238164160215995645590","date":"2025-09-24T13:03:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142107719633284792409467715554613875592","date":"2025-09-23T17:42:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158575663206581385794979850985917062210","date":"2025-09-22T19:16:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312519936213965893534056741568322071701","date":"2025-09-21T17:52:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-21T17:38:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-29T22:18:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-14T22:21:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Maternal Health, Neonatology and Perinatology","date":"2025-05-12T12:26:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"maternal-health-neonatology-and-perinatology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mhnp","sideBox":"Learn more about [Maternal Health, Neonatology and Perinatology](http://mhnpjournal.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mhnp/default.aspx","title":"Maternal Health, Neonatology and Perinatology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"56b862ac-090f-4546-a138-0986e611af18","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T14:08:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 16:20:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6646661","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6646661","identity":"rs-6646661","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}