Utilization of health facilities and maternal malaria prevention strategies by pregnant women in Kajiado County, a highland pastoral area of Kenya with low malaria transmission.

Background: During pregnancy, malaria poses a great health risk to both mother and foetus. In Kenya, to prevent and control infections, mothers receive intermittent preventive treatment during pregnancy (IPTp) and are provided with a bednet (ITN). Uptake of these control strategies, however, is not optimal. In Kajiado County, for instance, only ITNs are given to pregnant women, without IPTp. We assessed utilisation of health facilities and WHO-recommended maternal malaria control strategies in Kajiado County.

Materials and methods: A total of eleven health facilities were recruited, in which 6899 pregnant women were divided in three groups. Group 1 were women attending a clinic and used ITNs, group 2 did not attend a clinic but used ITNs and group 3, which did neither. 86% Of deliveries were assessed; 84% of these in clinics and 16% at home. Throughout pregnancy, data on abortion and premature births were collected. Upon delivery, data on stillbirths, birth weight and neonatal mortality was noted. Mother's cord and placental blood was examined for malaria parasites and parasitaemia using microscopy; haemoglobin levels were determined.

Results: 86% Of the women visited a health facility, 97% used an ITN. Only 3% went without visits or bednet usage. Although the number of cases was low, attending a clinic and using a bednet increased maternal Hb and reduced maternal mortality. Use of nets decreased maternal malaria cases and mortality due to malaria whilst maternal Hb increased. Across the study groups, infant outcomes improved, with fewer abortions, premature births, still births, neonatal mortality and an increase in mean body weight at birth.

Conclusion: Women should be sensitised to visit clinics and use ITNs for better maternal and new-born health outcomes.