Maternal and fetal risk factors for stillbirth in Otjozondjupa Region, Namibia: a case-control study.

INTRODUCTION: stillbirth is defined as a baby born with no signs of life. Globally, around 3.2 million stillbirths occur annually, of which, 98% are experienced in low and middle-income countries. Otjozondjupa Region topped the list of regions with high burden of stillbirth in Namibia in 2016. This study sought to elucidate risk factors for stillbirth. METHODS: an unmatched 1:2 case-control study was conducted. A sample of 285, 95 cases and 190 controls were chosen using simple random sampling method. Bivariate and multivariate analyses were done to assess the risk factors of stillbirth. RESULTS: maternal medical and obstetric factors significantly associated with stillbirth are: premature delivery (aOR 0.13 95% CI 0.05, 0.33, P < 0.001), gestational age (aOR 0.04, 95% CI 0.00, 0.25, P < 0.001), high-risk pregnancy (aOR 3.59, 95% CI 1.35, 9.55, P = 0.01), duration of labor (aOR 4.04, 95% CI 1.56, 10.43, P = 0.003) and antenatal care (ANC) attendance (aOR 0.07, 95% CI 0.00, 0.79, P = 0.03). Only low birth weight (≤ 2500 g) was associated with stillbirth amongst fetal related factors (aOR 16.58, 95% CI 8.71, 31.55, P < 0.001). CONCLUSION: this study concludes that stillbirth in Otjozondjupa Region was mostly associated with maternal medical and obstetric factors. It also concluded that attending antenatal care in Otjozondjupa did not improve birth outcome.

Effect of antipyretics on performance of influenza surveillance in Ghana.

BACKGROUND: The World Health Organization's case definition for influenza-like illness (ILI) includes a measured temperature of ≥38°C. We conducted this study to assess the effect of antipyretics on performance of ILI surveillance in Ghana. METHODS: A cross-sectional study was conducted in two districts of Ghana from September 2013 to May 2014. We collected epidemiological data and respiratory specimens from an expanded ILI case definition, which included patients presenting to health facilities with measured temperature ≥38°C or reported fever (but afebrile at the time of evaluation), and cough, with onset in the last 10 days. Specimens were tested for influenza viruses by real time reverse-transcription polymerase chain reaction. RESULTS: Of 321 participants who met our expanded ILI case definition, 236 presented with temperature of <38°C but reported subjective fever. Of these, 17% (39/236) were positive for influenza virus; Of those with fever ≤38°C who took antipyretics, 21%(16/77) were positive for influenza, compared with 14%(23/159) of those who did not take antipyretics. The addition of subjective fever to the standard ILI case definition captured approximately an additional 57% influenza cases but also required testing of approximately four times as many patients. However, including those without fever on presentation that had taken antipyretics found an additional 23% of Influenza cases and only two times as much testing. CONCLUSION: Depending on the goals of surveillance (monitoring virus circulation or determining disease burden) and available resources, a more sensitive case definition including subjective fever and history of use of antipyretics may be warranted.

The first case report of primary thyroid teratocarcinosarcoma: An analog to sinonasal teratocarcinosarcoma.

Teratocarcinosarcoma is a rare and aggressive tumor usually affecting the sinonasal tract. It arises primarily from the nasal cavity, paranasal sinuses with some reported cases arising from the nasopharynx and oral cavity and commonly referred to as Sinonasal Teratocarcinosarcoma (SNTC). We present the first case of teratocarcinosarcoma as a primary thyroid cancer in a 17-year-old male patient who presented with a rapidly growing anterior neck mass with no symptoms. Physical examination revealed circa 4 cm × 5 cm slightly right sided, non-tender, firm anterior neck swelling. A thyroid ultrasound revealed an enlarged thyroid gland with multiple thyroid nodes. Magnetic Resonance Imaging (MRI) of the head and neck showed no sinonasal tract tumor. Thyroidectomy and surgical resection of the tumor was performed. Histological examination revealed teratocarcinosarcoma of the thyroid gland, an analog to SNTC with no primary sinonasal tissue involvement. This implies that, teratocarcinosarcoma can occur in primary tissues other than sinonasal origin contrary to conventional knowledge.

The role of Namibia Field Epidemiology and Laboratory Training Programme in strengthening the public health workforce in Namibia, 2012-2019.

Namibia faces a critical shortage of skilled public health workers to perform emergency response operations, preparedness activities and real-time surveillance. The Namibia Field Epidemiology and Laboratory Training Programme (NamFELTP) increases the number of skilled public health professionals and strengthens the public health system in Namibia. We describe the NamFELTP during its first 7 years, assess its impact on the public health workforce and provide recommendations to further strengthen the workforce. We reviewed disease outbreak investigations and response reports, field projects and epidemiological investigations conducted during 2012-2019. The data were analysed using descriptive methods such as frequencies and rates. Maps representing the geographical distribution of NamFELTP workforce were produced using QGIS software V.3.2. There were no formally trained field epidemiologists working in Namibia before the NamFELTP. In its 7 years of operation, the programme graduated 189 field epidemiologists, of which 28 have completed the Advanced FELTP. The graduates increased epidemiological capacity for surveillance and response in Namibia at the national and provincial levels, and enhanced epidemiologist-led outbreak responses on 35 occasions, including responses to outbreaks of human and zoonotic diseases. Trainees analysed data from 51 surveillance systems and completed 31 epidemiological studies. The NamFELTP improved outcomes in the Namibia's public health systems; including functional and robust public health surveillance systems that timely and effectively respond to public health emergencies. However, the current epidemiological capacity is insufficient and there is a need to continue training and mentorship to fill key leadership and strategic roles in the public health system.

Factors associated with culture proven neonatal sepsis in the Ho municipality 2016.

INTRODUCTION: Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. METHODS: a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. RESULTS: out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI: 1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI: 1.06-7.96) had higher odds of developing culture proven sepsis. CONCLUSION: neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.

Next-generation sequencing of a human-animal reassortant G6P[14] rotavirus A strain from a child hospitalized with diarrhoea.

We previously reported the VP4 and the VP7 genotypes of the first G6P[14] rotavirus strain (RVA/Human-wt/GHA/M0084/2010/G6P[14]) from the stool of an infant with diarrhoea in Ghana. In the current study, we obtained the complete genome sequences using Illumina MiSeq next-generation sequencing to enable us to determine the host species origin of the genes by phylogenetic analysis. The genotype constellation was G6-P[14]-I2-R2-C2-M2-A11-N2-T6-E2-H3. Phylogenetic analysis showed that M0084 was a reassortant strain from RVAs of both artiodactyl and human host species origin. The level of sequence identity of the individual genes of M0084 to other sequences in the GenBank ranged from 95.2 to 99.5%; however, there was no single strain from the GenBank database with a complete genome sequence that was highly similar to that of M0084. To help trace the source of such unique gene pools being introduced into human RVAs, it will be useful to examine RVA sequences from potential reservoirs such as sheep and goats, which are common domestic animals in this locality.

Obstetric determinants of preterm delivery in a regional hospital, Accra, Ghana 2016.

BACKGROUND: Globally, prematurity is a major determinant of morbidity and mortality contributing 30-40% of neonatal mortality. The consequences of preterm deliveries are enormous with developmental and childhood complications as well as high economic and psycho-social burden on the parents (family) and society. Some risk factors include ever having preterm delivery, multiple births and some medical conditions like sexually transmitted infection and urinary tract infections but these have not been ascertained in our study area. Much research into these risk factors is needed in Ghana. We assessed the obstetric determinants of preterm delivery. METHODS: We conducted a 1:2 unmatched case-control study in Greater Accra Regional Hospital (GARH) -Ridge, a secondary referral facility in Accra, Ghana (from October, 2015 -May, 2016). A case was a mother who delivered between 28 and 36 weeks of gestation (preterm) and a control was a mother who delivered after 37 to 42 completed weeks (term). We used structured questionnaire to collect data, reviewed maternal and foetal records using a checklist. Categorical variables were analysed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regression. Significance level of the strength of association was determined at 95% CI and p-value < 0.05. RESULTS: We recruited 390 mothers, 130 had preterm deliveries (cases) and 260 had term deliveries (controls). Experiencing premature rupture of membrane (aOR: 2.3; 95% CI:1.0-5.5), pre-eclampsia/eclampsia (aOR: 3.4; 95% CI: 1.0-11.9) were found to be associated with preterm delivery. However, four or more ANC visit was protective factor for preterm delivery (aOR: 0.2; 95% CI: 0.1-0.4). CONCLUSION: Premature rupture of membrane, hypertensive complications and antepartum haemorrhage were found to be risk factors associated with preterm delivery in Ridge Hospital. Health workforce providing ANC services need to identify risk factors and refer these mothers to the doctor for early management and improved outcome decreasing preterm delivery.

Dog Bites and Rabies in the Eastern Region of Ghana in 2013-2015: A Call for a One-Health Approach.

BACKGROUND: A One-Health approach is advocated to ensure effective rabies surveillance in sub-Saharan Africa. Information is needed to assess the current state of dog bites and rabies in Ghana. We analyzed data on reported events in the Eastern Region of Ghana from 2013 to 2015 to generate information that can be used for rabies elimination in Ghana through the One-Health approach. METHOD: We extracted data on dog bites and rabies from the database of the regional health service and performed descriptive analysis using Epi Info version 7™. We followed up with interviews with three key informants from the health and veterinary services on issues related to surveillance and data quality. RESULTS: Overall, 4821 dog bites were reported over the three-year period. This translated into an annual incidence of 172 cases per a population of 100,000. Most of cases were in children aged less than 10 yrs. Fifteen (53.3% males) cases of rabies were recorded in seven out of the 26 municipalities and districts, translating into a rabies to dog bite ratio of 3: 1000. The median age of victims was 9 years (range: 3-72 years). A parallel and uncoordinated system of rabies surveillance is maintained by the health and veterinary services, with gross disparities in the number of reported events and overall impression of underreporting. CONCLUSION: Rabies remains an important cause of preventable deaths in this region. An integrated approach to surveillance based on the One-Health concept needs to be adopted.

Pneumococcal meningitis outbreak and associated factors in six districts of Brong Ahafo region, Ghana, 2016.

BACKGROUND: Meningitis, a disease of the Central Nervous System is described as inflammation of the covering of the brain and spinal cord (meninges). It is characterised by fever, severe headache, nausea, vomiting, stiff neck, photophobia, altered consciousness, convulsion/seizures and coma. In December, 2015, twelve suspected cases of meningitis were reported in Tain district in Brong Ahafo region (BAR). Subsequently, dozens of suspected cases were hospitalized in five district hospitals in BAR. We investigated to determine the magnitude, causative agent and risk factors for the disease transmission. METHODS: A community-based 1:2 case-control study (with 126 individuals) was conducted form 10/12/15 to 26/4/16 in 27 districts of Brong-Ahafo Region, Ghana. We defined suspected meningitis cases as people presenting with sudden headache and fevers (Temp> 38.0 °C) in combination with one of the following signs: neck stiffness, altered consciousness, convulsions, bulging fontanelle (infants) and other meningeal signs. Controls were selected from the same neighbourhood and defined as individuals with no overt meningitis signs/symptoms. We collected CSF samples and performed serological testing using Pastorex-Meningitis-Kit and culture for bacterial isolation. Moreover, structured questionnaires were used to collect data on socio-demographics, living conditions, health status and other risk factors. We conducted univariate data analysis and logistic regressions to study disease-exposure associations using Stata 15. RESULTS: A total of 969 suspected cases with 85 deaths (CFR = 9.0%) were recorded between December, 2015 and March, 2016. Majority, 55.9% (542/969) were females aged between 10 months-74 years (median 20 years, IQR; 14-34). Of the 969 cases, 141 were confirmed by Laboratory test with Streptococcus pneumoniae identified as the causative agent. Cases were reported in 20 districts but 6 of these districts reported cases above threshold levels. The outbreak peaked in week 6 with 178 cases. Overall attack rate (AR) was 235.0/100,000 population. District specific ARs were; Tain; 143.6/100,000, Wenchi; 110.0/100,000, Techiman; 46.6/100,000, Jaman North; 382.3/100,000 and Nkoranza South; 86.4/100,000. Female and male specific ARs were 251.3/100,000 and 214.5/100,000 respectively. Age group 10-19 years were most affected 33.8% (317/940). We identified sore throat [aOR = 5.2, 95% (CI 1.1-26.1)] and alcohol use [aOR = 9.1, 95%(CI 1.4-55.7)] as factors associated with the disease transmission. CONCLUSION: Meningitis outbreak due to Streptococcus pneumoniae was established in BAR. Upper respiratory tract infection and alcohol use were associated with the outbreak. Mass campaigns on healthy living habits, signs and symptoms of meningitis as well as the need for early reporting were some of the control measures instituted. Moreover, we recommend Pneumococcal vaccination in BAR to prevent future outbreaks.

Meningitis outbreak investigation in Nkoranza South Municipality in Brong Ahafo Region, Ghana, February, 2016.

The occurrence of communicable diseases highlights the need to have well-trained field epidemiologists at the forefront in the fight against these diseases, especially during an outbreak. Training for outbreak investigation is most effective when participants can develop their competencies in a practical exercise. This is a simulation of the steps in meningitis outbreak investigation conducted in Ghana in February 2016 by Ghana Field Epidemiology Training Programme (FELTP) residents and the public health technical team of the Nkoranza South Municipality as a field epidemiologist. This case study is suited to reinforce principles and skills already covered in a lecture or in background reading by providing a practical training beyond the scope of theoretical learning. It is primarily intended for training novice public health practitioners who should be able to complete the exercises in 3 hours.

An outbreak of schistosomiasis in a primary school in Omusati region, Namibia, March, 2016.

Schistosomiasis is endemic in some parts of northern Namibia and there is a control program in the country with the use of mass drug administration to control and prevent the disease. On the 1st March, 2016, there was a report of bloody urine among primary school pupils in a school in Omusati region, Namibia. A team of health professionals was dispatched to investigate. This case study describes steps in conducting a schistosomiasis outbreak investigation and how to determine the risk factors. This describes how to calculate both the basic and analytical measures of association with 95% confidence intervals. This case study provides a step-by-step approach and can be used as a tool to teach the fundamental principles of outbreak investigation and response and how to measure the appropriate measures of association. This case study is targeted at intermediate- and advanced-level residents of the Field Epidemiology and Laboratory Training Program and other epidemiology trainees.

Modeling the environmental suitability of anthrax in Ghana and estimating populations at risk: Implications for vaccination and control.

Anthrax is hyper-endemic in West Africa. Despite the effectiveness of livestock vaccines in controlling anthrax, underreporting, logistics, and limited resources makes implementing vaccination campaigns difficult. To better understand the geographic limits of anthrax, elucidate environmental factors related to its occurrence, and identify human and livestock populations at risk, we developed predictive models of the environmental suitability of anthrax in Ghana. We obtained data on the location and date of livestock anthrax from veterinary and outbreak response records in Ghana during 2005-2016, as well as livestock vaccination registers and population estimates of characteristically high-risk groups. To predict the environmental suitability of anthrax, we used an ensemble of random forest (RF) models built using a combination of climatic and environmental factors. From 2005 through the first six months of 2016, there were 67 anthrax outbreaks (851 cases) in livestock; outbreaks showed a seasonal peak during February through April and primarily involved cattle. There was a median of 19,709 vaccine doses [range: 0-175 thousand] administered annually. Results from the RF model suggest a marked ecological divide separating the broad areas of environmental suitability in northern Ghana from the southern part of the country. Increasing alkaline soil pH was associated with a higher probability of anthrax occurrence. We estimated 2.2 (95% CI: 2.0, 2.5) million livestock and 805 (95% CI: 519, 890) thousand low income rural livestock keepers were located in anthrax risk areas. Based on our estimates, the current anthrax vaccination efforts in Ghana cover a fraction of the livestock potentially at risk, thus control efforts should be focused on improving vaccine coverage among high risk groups.

Large cholera outbreak in Brong Ahafo Region, Ghana.

BACKGROUND: A nationwide outbreak of Vibrio cholerae occurred in Ghana in 2014 with Accra, the nation's capital as the epi-center. The outbreak spread to the Brong Ahafo Region (BAR) which is geographically located in the middle of the country. In this region a review of data collected during the outbreak was carried out and analyzed descriptively to determine the hot spots and make recommendations for effective response to future outbreaks. METHODS: A review of patient records and line lists of cases of cholera reported in all hospitals during the period of the outbreak (July-December 2014) was conducted. Hospitals used IDSR (Integrated Disease Surveillance and Response system) standard case definitions to detect and report cases for management. The GPS coordinates of all districts and health facilities were collected and utilized in the construction of spot maps. We also obtained populations (denominators) from the BAR Health surveillance unit of the Ghana Health Service. All the data thus collected was analyzed descriptively and expressed as frequencies and rates. RESULTS: A total of 1035 cases were reported, 550 (53.4%) were males and the rest females. Their ages ranged from 1 to 95 years; (mean age of 28.2 ± 19.6 years). The most affected (23.5%) was the 20-29 year old age group. On the 30th July, 2014, a 26 year old male (recorded as the index case of the cholera outbreak in the Brong Ahafo region) with a history of travel from Accra reported to the Nkoranza district hospital with a history of symptoms suggestive of cholera. The reporting of cholera cases reached their peak (17.3%) in week 15 of the outbreak (this lasted 25 weeks). An overall attack rate of 71/100,000 population, and a case fatality rate of 2.4% was recorded in the region. Asutifi South district however recorded a case fatality of 9.1%, the highest amongst all the districts which recorded outbreaks. The majority of the cases reported in the region were from Atebubu-Amanten, Sene West, Pru, and Asunafo North districts with 31.1, 26.0, 18.2 and 9.9% respectively. Vibrio cholerae serotype O1 was isolated from rectal swabs/stool samples tested. CONCLUSION: Vibrio cholerae serotype O1 caused the cholera-outbreak in the Brong Ahafo Region and mainly affected young adult-males. The most affected districts were Atebubu-Amanten, Sene west, Pru (located in the eastern part of the region), and Asunafo North districts (located in the south west of the region). Case Fatality Rate was higher (2.4%) than the WHO recommended rate (<1%). Active district level public health education is recommended on prevention and effective response for future outbreaks of cholera.

Evaluation of the enhanced meningitis surveillance system, Yendi municipality, northern Ghana, 2010-2015.

BACKGROUND: Meningitis is the inflammation of the meninges of the brain and or spinal cord. Global mortality rates vary from 2% to 30%. Epidemic meningitis remains a public health concern along the meningitis belt of Africa. Despite the operation of an enhanced meningitis surveillance system in Ghana, institutional mortality rates are estimated to range from 36% to 50%. In 2014, Yendi recorded 83 confirmed cases; with focal epidemics in some sub-municipals. We evaluated the system over a five-year period to find out whether it was achieving its objectives of systematic collection and analyses of data for the prevention or early detection of meningitis epidemics. METHODS: We used cross-sectional design. Both qualitative and quantitative data from Yendi Municipality between January 2010 and December 2015 were collected and analyzed. The updated guidelines for evaluating surveillance systems from Centers for Disease Control and Prevention were used. Content analysis was performed on the responses of key informants. Surveillance data was analyzed using MS-Excel. RESULTS: Fifteen healthcare workers were interviewed. For the period under evaluation, the annual incidence of meningitis ranged from 1.6/100,000 in 2012 to 62.6/100,000 in 2014. The average case fatality rate for the period was 8.3%. The system was sensitive, representative, and acceptable. The predictive value positive was 100% from 2010 to 2014 and 63.3% in 2015. Data quality was good, but timeliness of reporting was poor. CONCLUSIONS: The enhanced meningitis surveillance system in Yendi Municipality is achieving most of its objectives. However, financial constraints and poor personnel motivation pose threats to the sustainability of the system.

Foodborne disease outbreak in a resource-limited setting: a tale of missed opportunities and implications for response.

INTRODUCTION: Foodborne diseases (FBD) have emerged as a major public health problem worldwide. Though the global burden of FBD is currently unknown, foodborne diarrhoeal diseases kill 1.9 million children globally every year. On 25th September 2014, health authorities in Eastern Region of Ghana were alerted of a suspected FBD outbreak involving patrons of a community food joint. We investigated to determine the magnitude, source and implement control and preventive measures. METHODS: A retrospective cohort study was conducted. We reviewed medical records for data on demographics and clinical features. A suspected foodborne disease was any person in the affected community with abdominal pain, vomiting and or diarrhea between 25(th) and 30(th) September 2014 and had eaten from the food joint. We conducted active case search, descriptive data analysis and calculated food specific attack rate ratios (ARR) and their corresponding 95% confidence intervals. RESULTS: Of 43 case-patients, 44.2% (19/43) were males; median age was 19 years (interquartile range: 17-24 years). Overall attack rate was 43.4% (43/99) with no fatality. Case counts rose sharply for four hours to a peak and fell to baseline levels after 12 hours. Compared to those who ate other food items, patrons who ate "waakye" and "shitor" were more likely to develop foodborne disease [ARR = 4.1 (95% CI = 1.09-15.63)]. Food samples and specimens from case-patients were unavailable for testing. Laboratory diagnostic capacity was also weak. CONCLUSION: A point source FBD outbreak linked to probable contaminated "waakye" and or "shitor" occurred. Missed opportunities for definitive diagnosis highlighted the need for strengthening local response capacity.

Training Ghanaian frontline healthcare workers in public health surveillance and disease outbreak investigation and response.

INTRODUCTION: Beyond initial formal academic education, the need for continuous professional development through in-service workforce capacity improvement programs that are aimed at enhancing knowledge and skills of public healthcare workers has assumed immense priority worldwide. This has been heightened by the on-going Ebola Virus Disease outbreak, which is exposing the weak public health systems in West Africa. In response to this need, the Ghana Field Epidemiology and Laboratory Program organized a short-course for frontline health workers in the Greater Accra region of Ghana in order to augment their surveillance and outbreak response capacity. METHODS: Human and veterinary health workers were trained using Field Epidemiology and Laboratory Training Program short course model. A two-week didactic course was conducted with a 10-week field placement. Evaluation of the course was done by assessment of participants' outputs during the training as well as pretest and posttest methods. RESULTS: A total of 32 frontline health workers from both the human and veterinary health services benefited from the two-week initial training of the 12-week course. There was a significant gain in knowledge by the participants after the training course. Participants developed concept papers and implemented their fieldwork projects. Overall assessment of the workshop by the participants was very good. CONCLUSION: Capacity of the health workers has been improved in the area of public health surveillance, outbreak investigation and response. We recommend a scale-up of this training course to other regions.

Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013.

INTRODUCTION: The coverage of adequate (≥2 doses) IPTp-SP in Ghana is below the national target of 80% and that is a threat to reducing the incidence of malaria in pregnancy. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp-SP and suggest approaches for increased uptake. METHODS: A cross sectional study was conducted among ANC clients and staff in Gushegu, questionnaires was administered to 330 conveniently sampled nursing mothers and all ANC staff present. A checklist and observation were used to collect health facility data. Data was analyzed descriptively and associations between the related factors and adequate uptake of IPTp-SP were determined. RESULTS: A total of 91.5% and 8.5% of respondents took adequate (≥2doses) and inadequate (≤1dose) IPTp-SP respectively. 85.4% respondents were early first ANC attendance and 80% were multiple gravidae. Mean ANC visits was 5.0 (standard deviation = 2.2). The key determinants for inadequate uptake of IPTp were Unemployment [OR= 4.9 95% CI (1.9-13.1], single gravidae [OR= 3.4 95% CI (1.5-7.6)] and late first ANC visit [OR= 6.8 95% CI (3.0-15.4)]. DOT practice, good staff attitude and health talk at the facility were observed and confirmed by ANC clients as satisfactory. adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. CONCLUSION: Adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose.