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Quality and Integrated Service Delivery: A Cross-Sectional Study of the Effects of Malaria and Antenatal Service Quality on Malaria Intervention Use in Sub-Saharan Africa. Trop Med Infect Dis 2022; 7:tropicalmed7110363. [DOI: 10.3390/tropicalmed7110363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/14/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Using regionally linked facility and household surveys, we measured the quality of integrated antenatal care and malaria in pregnancy services in Kenya, Namibia, Senegal, and Tanzania. We examined country heterogeneities for the association of integrated antenatal and malaria service quality scores with insecticide-treated bed net (ITN) use in pregnant women and children under-five and intermittent preventive treatment in pregnancy (IPTp-2) uptake. Malaria in pregnancy service quality was low overall. Our findings suggest modest, positive associations between malaria in pregnancy quality and ITN use and IPTp-2 uptake across pooled models and for most studied countries, with evidence of heterogeneity in the strength of associations and relevant confounding factors. Antenatal care quality generally was not associated with the study outcomes, although a positive interaction with malaria in pregnancy quality was present for pooled ITN use models. The improved quality of malaria services delivered during formal antenatal care can help address low coverage and usage rates of preventive malaria interventions in pregnancy and childhood. Study findings may be used to target quality improvement efforts at the sub-national level. Study methods may be adapted to identify low-performing facilities for intervention and adaption to other areas of care, such as HIV/AIDS, child immunizations, and postnatal care.
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Aberese-Ako M, Doegah P, Acquah E, Magnussen P, Ansah E, Ampofo G, Agyei DD, Klu D, Mottey E, Balen J, Doumbo S, Mbacham W, Gaye O, Gyapong M, Owusu-Agyei S, Tagbor H. Motivators and demotivators to accessing malaria in pregnancy interventions in sub-Saharan Africa: a meta-ethnographic review. Malar J 2022; 21:170. [PMID: 35659232 PMCID: PMC9166609 DOI: 10.1186/s12936-022-04205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the introduction of efficacious interventions for malaria control, sub-Saharan Africa continues to bear the highest burden of malaria and its associated effects on vulnerable populations, such as pregnant women and children. This meta-ethnographic review contributes to literature on malaria in pregnancy interventions in sub-Saharan Africa by offering insights into the multiple factors that motivate or demotivate women from accessing MiP interventions. Methods A meta-ethnographic approach was used for the synthesis. Original qualitative research articles published from 2010 to November 2021 in English in sub-Saharan Africa were searched for. Articles focusing on WHO’s recommended interventions such as intermittent preventive treatment with sulfadoxine-pyrimethamine, long-lasting insecticidal nets and testing and treatment of Malaria in Pregnancy (MiP) were included. Selected articles were uploaded into Nvivo 11 for thematic coding and synthesis. Results Twenty-seven original qualitative research articles were included in the analysis. Main factors motivating uptake of MiP interventions were: (1) well organized ANC, positive attitudes of health workers and availability of MiP services; (2) Women’s knowledge of the effects of malaria in pregnancy, previous experience of accessing responsive ANC; (3) financial resources and encouragement from partners, relatives and friends and (4) favourable weather condition and nearness to a health facility. Factors that demotivated women from using MiP services were: (1) stock-outs, ANC charges and health providers failure to provide women with ample education on the need for MiP care; (2) perception of not being at risk and the culture of self-medication; (3) fear of being bewitched if pregnancy was noticed early, women’s lack of decision-making power and dependence on traditional remedies and (4) warm weather, long distances to health facilities and the style of construction of houses making it difficult to hang LLINs. Conclusions Health system gaps need to be strengthened in order to ensure that MiP interventions become accessible to women. Additionally, health managers need to involve communities in planning, designing and implementing malaria interventions for pregnant women. It is important that the health system engage extensively with communities to facilitate pregnant women and communities understanding of MiP interventions and the need to support pregnant women to access them.
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Affiliation(s)
| | - Phidelia Doegah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Acquah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Evelyn Ansah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gifty Ampofo
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | | - Desmond Klu
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Elsie Mottey
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Safiatou Doumbo
- University of Sciences, Techniques and Technologies of Bamako, Malaria Research and Training Center, Bamako, Mali
| | - Wilfred Mbacham
- The Fobang Institutes for Innovations in Science and Technologies & The Biotechnology Center, The Centre for Health Innovations and Translational Research, University of Yaounde I, Yaounde, Cameroon
| | - Ouma Gaye
- Faculty of Medicine, University Cheikh Anta Diop Dakar, Dakar, Senegal
| | - Margaret Gyapong
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Seth Owusu-Agyei
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Mohamoud AM, Yousif MEA, Saeed OK, Allasow MA, Abdulle YA, Ahmed AA, Iye AW, Abdi SM. Knowledge, Attitude and Practice regarding Intermittent Preventive Treatment (IPTs) of Malaria among Pregnant Women Attending for Antenatal Care in Benadir Hospital at Benadir Region, Somalia. Health (London) 2022. [DOI: 10.4236/health.2022.144031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aberese-Ako M, Magnussen P, Gyapong M, Ampofo GD, Tagbor H. Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions. Malar J 2020; 19:347. [PMID: 32977827 PMCID: PMC7519547 DOI: 10.1186/s12936-020-03422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015. METHODS This ethnographic study explored how healthcare managers dealt with existing MiP policy implementation challenges and the consequences on IPTp-SP uptake and access to maternal healthcare. The study collected date using non-participant observations, conversations, in-depth interviews and case studies in eight health facilities and 12 communities for 12 months in two Administrative regions in Ghana. RESULTS Healthcare managers addressed frequent stock-outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing and prescribing drugs for women to buy from private pharmacies. This ensured that facilities had funds to pay creditors, purchase drugs and supplies for health service delivery. However, it affected their ability to enforce DOT and to monitor adherence to treatment. Women who could afford maternal healthcare and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Women who could not maternal healthcare services resorted to visiting other sources of health care, delaying ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended 5 + doses of SP, others did not obtain LLINs early and some did not obtain treatment for MiP. Healthcare providers felt frustrated whenever they could not provide comprehensive care to women who could not afford comprehensive maternal and MiP care. CONCLUSION For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, regular supply of programme drugs and medical supplies to public, faith-based and private health facilities.
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Affiliation(s)
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Margaret Gyapong
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Gifty D Ampofo
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
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Mchwampaka WM, Tarimo D, Chacky F, Mohamed A, Kishimba R, Samwel A. Factors affecting uptake of ≥ 3 doses of Sulfadoxine-Pyrimethamine for malaria prevention in pregnancy in selected health facilities, Arusha region, Tanzania. BMC Pregnancy Childbirth 2019; 19:440. [PMID: 31775686 PMCID: PMC6880562 DOI: 10.1186/s12884-019-2592-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/11/2019] [Indexed: 01/28/2023] Open
Abstract
Background Tanzania adopted the revised World Health Organization policy in 2013 recommending a minimum of ≥3 doses of Intermittent Preventive Treatment during pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) to protect against malaria. A study in Tanzania in 2014 reported low (9%) uptake. We investigated health workers knowledge about IPTp-SP and factors that influenced uptake of > 3 doses of IPTp-SP among pregnant women. Methods We conducted a cross-sectional study in 2017 among post-delivery women and health care workers from nine randomly-selected public health facilities in three Districts of Arusha Region. Probability proportional to size methodology was used to determine number of participants per facility. We used a structured questionnaire to collect socio-demographic and obstetric data, information on doses of SP received, and knowledge of SP for IPTp. Health care workers were interviewed about their knowledge for IPTp- SP and challenges encountered in its uptake and use. Results We interviewed 556 persons (median age 26 years, range 16–42 years) with the response rate of 99.3%. Of these, 484 (87.1%) had > 3 Antenatal Care (ANC) visits. A total of 402 (72.3%) were multigravida with 362 (65.1%) having given birth at least once. Of the 556 participants, 219 (39.4%) made their first ANC booking at < 17 weeks of pregnancy and 269 (48.4%) had received > 3 doses of SP-IPTp. Factors associated with uptake of > 3 doses of IPTp-SP included having secondary or higher education [Adjusted Odds Ratio (AOR) =1.6, 95%CI 1.1–2.4], attending ≥4 ANC visits [AOR = 3.1, 95%CI 2.1–4.6], having first antenatal booking at < 17 weeks [AOR = 1.8, 95%CI 1.4–2.3], and adequate knowledge on IPTp-SP [AOR = 2.7, 95%CI 1.9–3.9]. Among 36 health care workers interviewed, 29(80.6%) had adequate knowledge about IPTp-SP. SP was available in seven (87.5%) of the visited health facilities and was administered under Direct Observed Therapy (DOT) in six (75%) facilities. Health care workers reported that stock outs of SP was a challenge. Conclusions Fewer than half of the women interviewed reported uptake of > 3 doses of IPTp-SP. That is below the Tanzania national target of 80%. Making > 4 ANC visits, having secondary or higher education, making an early first ANC visit and having adequate knowledge on IPTp-SP promoted uptake of > 3 doses. Further qualitative studies are needed to explore factors that might contribute to low uptake of SP.
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Affiliation(s)
| | - Donath Tarimo
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Frank Chacky
- Tanzania National Malaria Control Programme (NMCP), Dar es Salaam, Tanzania
| | - Ahmed Mohamed
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
| | - Rogath Kishimba
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dar es Salaam, Tanzania
| | - Angela Samwel
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
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Nkoka O, Chuang TW, Chen YH. Association between timing and number of antenatal care visits on uptake of intermittent preventive treatment for malaria during pregnancy among Malawian women. Malar J 2018; 17:211. [PMID: 29793482 PMCID: PMC5968590 DOI: 10.1186/s12936-018-2360-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malaria in pregnancy is a critical public health challenge, and intermittent preventive treatment for malaria during pregnancy (IPTp) has proven to be an effective intervention. However, access to and use of malaria interventions, including IPTp, remains a considerable problem among African women. This cross-sectional study investigated factors, including antenatal care (ANC) attendance (both numbers of visits and timing of the first visit) and socio-demographics, associated with the uptake of the recommended IPTp dose among Malawian women. Methods A nationally representative sample of women with a live birth in the 2 years preceding the survey from the Malawi Demographic Health Survey 2015–2016 dataset was analysed. Self-reported data on socio-demographics, ANC attendance and IPTp uptake were collected using a questionnaire and analysed using logistic models. Results Of the 6549 included women, 1981 (30.2%) took the recommended three or more IPTp doses. Despite inadequate ANC visits, early ANC initiation increased the likelihood of these women taking the recommended IPTp dose; women who initiated ANC in the first [adjusted odds ratio (aOR) = 2.24; 95% confidence interval (CI) = 1.44–3.49] and second (aOR = 2.19; 95% CI = 1.56–3.08) trimesters were more likely to take the recommended IPTp dose compared to late initiators. The effect of the number of ANC visits on IPTp uptake was significant in married women (aOR = 1.68, 95% CI = 1.42–1.98), and the timing of first ANC visit was associated with IPTp uptake only among rural women (aOR = 2.13, 95% CI = 1.54–2.95). Conclusion ANC attendance is vital in IPTp uptake. The results highlight the need for health care providers to encourage women, particularly those in high-risk groups, to make frequent ANC visits and receive early ANC initiation to ensure high coverage of the recommended IPTp dose.
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Affiliation(s)
- Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Almond D, Madanitsa M, Mwapasa V, Kalilani-Phiri L, Webster J, Ter Kuile F, Paintain L. Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in Malawi. Malar J 2016; 15:574. [PMID: 27894353 PMCID: PMC5126811 DOI: 10.1186/s12936-016-1627-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Malaria in pregnancy is a major cause of adverse maternal and fetal outcomes. Intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) is one of the control strategies promoted by WHO. In response to mounting resistance to SP, intermittent screening and treatment (ISTp) has been proposed as an alternative. The objective of this study was to explore the acceptability of ISTp for health workers and pregnant women. Methods Semi-structured interviews of ten health workers and five focus group discussions of 38 women enrolled in an ongoing trial comparing IPTp-SP and ISTp with dihydroartemisinin–piperaquine (DP) were conducted at two antenatal clinics in rural Malawi. All transcripts were coded and themes were identified using a content analysis approach. Results Amongst health workers, there were contrasting opinions on the preference of blood sampling methods, and the influence of method on reliability of diagnosis. The perceived greater effectiveness of DP compared to SP was appreciated, however concerns of user compliance with the full dose of DP in non-trial settings were raised. Despite the discomfort of repeated finger pricks, pregnant women were generally accepting of ISTp, particularly the chance for regular blood tests to check for infections and the perceived greater effectiveness with fewer side effects of DP compared to SP. Conclusion In the trial context, pregnant women tended to prefer ISTp-DP over IPTp-SP. Health workers were also accepting of ISTp-DP as an alternative to IPTp-SP in light of increasing SP resistance. However, reliability of stock, adherence to malaria test results and user adherence to the full course of DP may present barriers to successful routine implementation. Effective communication with health workers and between health workers, pregnant women and their communities will be essential for the acceptability of focused antenatal care, including the best malaria control measures available.
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Affiliation(s)
- Deborah Almond
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Mwayi Madanitsa
- College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Feiko Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucy Paintain
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK.
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Rassi C, Graham K, King R, Ssekitooleko J, Mufubenga P, Gudoi SS. Assessing demand-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study in two regions of Uganda. Malar J 2016; 15:530. [PMID: 27809918 PMCID: PMC5096321 DOI: 10.1186/s12936-016-1589-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/28/2016] [Indexed: 11/23/2022] Open
Abstract
Background To prevent malaria infection during pregnancy in endemic areas in Africa, the World Health Organization recommends the administration of intermittent preventive treatment in pregnancy (IPTp) as part of the focused antenatal care package. However, IPTp uptake in most countries remains low despite generally high antenatal care coverage and increased efforts by governments to address known bottlenecks such as drug stock-outs. The study explored factors that continue to impede uptake of IPTp among women who attend antenatal care. This paper focuses on demand-side barriers with regard to accessibility, affordability and acceptability. Methods The research was conducted in 2013/2014 and involved 46 in-depth interviews with four types of respondents: (i) seven district health officials; (ii) 15 health workers; (iii) 19 women who attended antenatal care; (iv) five opinion leaders. Interviews were conducted in Eastern and West Nile regions of Uganda. Data was analysed by thematic analysis. Results District health officials and health workers cited a range of barriers relating to knowledge and attitudes among pregnant women, including lack of awareness of pregnancy-related health risks, a tendency to initiate antenatal care late, reluctance to take medication and concerns about side effects of IPTp. However, women and opinion leaders expressed very positive views of antenatal care and IPTp. They also reported that the burden of travel and cost associated with antenatal care attendance was challenging, but did not keep them from accessing a service they perceived as beneficial. The role of trust in health workers’ expertise was highlighted by all respondents and it was reported that women will typically accept IPTp if encouraged by a health worker. Conclusions Given the positive views of antenatal care and IPTp, high antenatal care coverage and reported low refusal rates for IPTp, supply-side issues are likely to account for the majority of missed opportunities for the provision of IPTp when women attend antenatal care. However, to increase uptake of IPTp on the demand side, health workers should be encouraged to reassure eligible women that IPTp is safe. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1589-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Rassi
- Malaria Consortium, Development House, 56-64 Leonard Street, London, UK.
| | - Kirstie Graham
- Malaria Consortium, Development House, 56-64 Leonard Street, London, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, Leeds Institute of Health SciencesUniversity of Leeds, Leeds, UK
| | - James Ssekitooleko
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, Kampala, Uganda
| | - Patrobas Mufubenga
- Malaria Consortium Uganda and PAMU Consults (U) Ltd, Plot 577, Block 15, Nsambya Road, Kampala, Uganda
| | - Sam Siduda Gudoi
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, Kampala, Uganda
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Doku DT, Zankawah MM, Adu-Gyamfi AB. Factors influencing dropout rate of intermittent preventive treatment of malaria during pregnancy. BMC Res Notes 2016; 9:460. [PMID: 27724980 PMCID: PMC5057376 DOI: 10.1186/s13104-016-2265-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of malaria in terms of morbidity and mortality is huge is Sub-Saharan Africa, particularly among pregnant women. Among the measures to curb down this burden include intermittent preventive treatment (IPT) and effective case management. These strategies were adopted by Ghana and implemented since 2003; however, there is still high dropout rate in IPT coverage. This study sought to investigate factors contributing to high dropout rate between IPT1 and IPT3 in the Tamale Metropolis, one of the health facilities with the highest IPT dropout rates in Ghana. METHODS Survey, in-depth interviews and short ethnographic techniques were conducted among pregnant women, antenatal care (ANC) health workers and heads of health facilities to investigate factors which account for dropout rate of intermittent treatment of malaria. RESULTS Shortage of sulphadoxine pyrimethamine (SP), inadequate supply of portable water for administration of SP, unavailability of IPT during outreach services, lack of knowledge by ANC staff about the dropout rate in their area of jurisdiction and poor attitude of some health workers were identified as barriers to achieving high IPT3 coverage. CONCLUSIONS Late ANC visit, provider and logistical barriers account for the women's missed opportunities to prevent malaria in pregnancy through IPT. Addressing the above barriers will contribute to saving lives and ensuring progress towards the goal of combating malaria as well as reducing maternal, neonatal and child mortalities.
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Affiliation(s)
- David Teye Doku
- Department of Population and Health, Private Mail Bag, University of Cape Coast, Cape Coast, Ghana. .,School of Health Sciences, University of Tampere, Tampere, Finland.
| | | | - Addae Boateng Adu-Gyamfi
- Department of Population and Health, Private Mail Bag, University of Cape Coast, Cape Coast, Ghana
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Protas J, Tarimo D, Moshiro C. Determinants of timely uptake of ITN and SP (IPT) and pregnancy time protected against malaria in Bukoba, Tanzania. BMC Res Notes 2016; 9:318. [PMID: 27328717 PMCID: PMC4915182 DOI: 10.1186/s13104-016-2122-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Insecticides treated nets (ITNs) and intermittent preventive therapy with two doses of sulfadoxine-pyrimethamine (SP IPTp) are the cornerstone for malaria control in pregnancy. Despite the coverage of these interventions being high, it is not known whether they confer optimal protection time against malaria in pregnancy. This study investigated the timing and determinants of timely uptake of SP(IPTp) and ITNs and the pregnancy time protected. METHODS A health facility based cross-sectional study was carried out in Bukoba urban district from 16th April to 29 May 2013. Involving pregnant women and post natal mothers attending Reproductive and Child Health (RCH) clinics. Data on their socio-economic background, pregnancy history and attendance to RCH, receipt of a voucher and acquisition of an ITN as well as SP for IPTp were collected. Their responses were validated from the records of antenatal cards. Data was analysed using SPSS computer program version 20. RESULTS A total of 530 mothers were recruited. The overall uptake of SP IPTp was 96 % and the uptake of two SP (IPTp) doses was 86 %. Timely uptake of 1st dose was predicted by early antenatal booking, [AOR 2.59; 95 % CI 1.51-4.46; P = 0.001], and the availability of SP at the facility [AOR 4.63; 95 % CI 2.51-8.54; P < 0.0001]. Uptake of 2nd dose was independent of any predictor factors. A total of 486 (91.6 %) women received ITNs discount vouchers at different gestational age and of these, less than a quarter (21.4 %) received timely. Timely receipt of discount voucher was highly predicted by early antenatal booking [AOR 200; 95 % CI 80.38-498; P < 0.0001]. CONCLUSION Although there is a high coverage of SP IPTp and discount vouchers for ITNs, timely uptake and therefore optimal protection time depended on early antenatal booking, the availability of (SP IPTp) and discount voucher at the health facility.
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Affiliation(s)
- Joyce Protas
- Department of Community Health Nursing, Hubert Kairuki Memorial University, P.O. Box 65300, Dar Es Salaam, Tanzania.
| | - D Tarimo
- Department of Parasitology, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania
| | - C Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania
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Ndeserua R, Juma A, Mosha D, Chilongola J. Risk factors for placental malaria and associated adverse pregnancy outcomes in Rufiji, Tanzania: a hospital based cross sectional study. Afr Health Sci 2015; 15:810-8. [PMID: 26957969 DOI: 10.4314/ahs.v15i3.15] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prevention and treatment of malaria during pregnancy is crucial for reduction of malaria in pregnancy and its adverse outcomes. The spread of parasite resistance to Sulphadoxine-Pyrimethamine (SP) used for Intermittent Preventive Treatment for malaria in pregnancy (IPTp), particularly in East Africa has raised concerns about the usefulness and the reliability of the IPTp regimen. We aimed to assess the effectiveness of two doses of SP in treating and preventing occurrence of adverse pregnancy outcomes. METHODOLOGY The study was an analytical cross sectional study which enrolled 350 pregnant women from Kibiti Health Centre, South Eastern Tanzania. Structured questionnaires were used to obtain previous obstetrics and medical history of participants and verified by reviewing antenatal clinic cards. Maternal placental blood samples for microscopic examination of malaria parasites were collected after delivery. Data was analyzed for associations between SP dosage, risk for PM and pregnancy outcome. Sample size was estimated based on precision. RESULTS Prevalence of placental maternal (PM) was 8% among pregnant women (95%CI, 4.4-13.1%). Factors associated with increased risk of PM were primigravidity (P<0.001) and history of fever during pregnancy (P= 0.02). Use of at least 2 doses of SP for IPTp during pregnancy was insignificantly associated with reducing the risk PM (P=0.08), low birth weight (P=0.73) and maternal anemia (P=0.71) but associated significantly with reducing the risk of preterm birth (P<0.001). CONCLUSION Two doses of SP for IPTp regime are ineffective in preventing and treating PM and adverse pregnancy outcome. Hence a review to the current IPTp regimen should be considered with possibility of integrating it with other malaria control strategies.
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Affiliation(s)
| | - Adinan Juma
- Kilimanjaro Christian Medical Center, Community Health Department
| | - Dominic Mosha
- Kilimanjaro Christian Medical University College, Community Health Department
| | - Jaffu Chilongola
- Kilimanjaro Christian Medical University College, Biochemistry and Mol Biology
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Kibusi SM, Kimunai E, Hines CS. Predictors for uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Tanzania. BMC Public Health 2015; 15:540. [PMID: 26049737 PMCID: PMC4458339 DOI: 10.1186/s12889-015-1905-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/03/2015] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Tanzania adopted Intermittent-preventive treatment of malaria in pregnancy (IPTp) policy in 2000; the guidelines at the time of the study recommended the timing of the first dose of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) (IPTp-SP) at 20-24 weeks and the timing of the second dose at 28-32 weeks. The aim of this study was to identify factors that are responsible for the uptake of IPTp among pregnant Tanzanian women. Further, this study aims to justify the need for appropriate interventions that would strengthen the Tanzanian IPTp program towards the realization of the Roll Back Malaria (RBM) targets. METHODS Data were analyzed from the 2011-2012 Tanzania HIV and Malaria Indicators Survey (THMIS) of 1,616 women aged 15-49 years who had a live birth in the 2 years prior to the survey and received antenatal care (ANC) services. RESULTS Logistic regression analysis results showed that (1) being in the age groups 30-34 and 35-39 versus other age groups and being married or living with partner versus those who reported as never married or divorced/separated were associated with high uptake of IPTp; (2) women pregnant with their first or second child versus those who already have had two or more children had higher odds of completing the recommended number of IPTp dosage; and (3) being a resident from the Eastern Zone versus Lake Zone as well as having the first antenatal visit in the first or second trimester versus third trimester were associated with higher uptake of IPTp. CONCLUSION Applying these results could contribute to positive social change by helping providers, clinics, and organizations seeking to increase IPTp uptake among ANC attendees and providing health education programs to women, especially those residing in rural areas. This study could also help achieve United Nations Millennium Development Goals (MDG) 6 (combat HIV/AIDS, Malaria and Other Diseases).
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Affiliation(s)
- Stephen M Kibusi
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | - Eunice Kimunai
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | - Courtney S Hines
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
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Toure OA, Kone PL, Coulibaly MAA, Ako BAA, Gbessi EA, Coulibaly B, N' Guessan LT, Koffi D, Beourou S, Soumahoro A, Bassinka I, Nogbou M, Swa T, Gba B, Esmel B, Bokossa EM. Coverage and efficacy of intermittent preventive treatment with sulphadoxine pyrimethamine against malaria in pregnancy in Côte d'Ivoire five years after its implementation. Parasit Vectors 2014; 7:495. [PMID: 25410760 PMCID: PMC4245798 DOI: 10.1186/s13071-014-0495-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) recommends for sub-Saharan Africa a package of prompt and effective case-management combined with the delivery of insecticide-treated nets (ITN) and intermittent preventive treatment during pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) through the national antenatal care (ANC) programs. Implemented in Côte d’Ivoire around 2005, few Data on IPTp coverage and efficacy in the country are available. Methods A multicentre, cross-sectional survey was conducted in Côte d’Ivoire from September 2009 to May 2010 at six urban and rural antenatal clinics. IPTp-sp coverage, Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood as well as placental and cord blood were used to prepare thick and thin blood films. In addition, pieces of placental tissues were used to prepare impression smears and maternal haemoglobin concentration was measured. Regression logistics were used to study factors associated with placental malaria and LBW (<2.500 grams). Results A total of 1317 delivered women were enrolled with a median age of 26 years. A proportion of 43.28% of the women had received at least two doses of IPTsp during the current pregnancy although a high proportion (90.4%) of women received antenatal care and made enough visits (≥2). Variability in the results was observed depending on the type of area (rural/urban). Plasmodium falciparum was detected in the peripheral blood of 97 women (7.3%) and in the placenta of 119 women (9%). LBW infants were born to 18.8% (22/107) of women with placental malaria and 8.5% (103/1097) of women without placental malaria. LBW was associated with placental malaria. Conclusions This study found relative low coverage of IPTp in the study areas which supported findings that high ANC attendance does not guarantee high IPTp coverage. Urgent efforts are required to improve service delivery of this important intervention.
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Affiliation(s)
- Offianan A Toure
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Penali L Kone
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - M'Lanhoro A A Coulibaly
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Berenger A A Ako
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Eric A Gbessi
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Baba Coulibaly
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Landry T N' Guessan
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - David Koffi
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Sylvain Beourou
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Adama Soumahoro
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Issiaka Bassinka
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Messoun Nogbou
- PMI of Yopougon Abidjan, P.O. Box 1351, Abidjan, 23, Côte d'Ivoire.
| | - Tidjane Swa
- PMI of Yopougon Abidjan, P.O. Box 1351, Abidjan, 23, Côte d'Ivoire.
| | - Bernadin Gba
- Maternity Service, Bonoua Hospital, P.O. Box 25, Bonoua, Côte d'Ivoire.
| | - Beugre Esmel
- CHU Cocody, Boulevard de l'Université, P.O. Box v13, Abidjan, Côte d'Ivoire.
| | - Ernestine M Bokossa
- CHU Cocody, Boulevard de l'Université, P.O. Box v13, Abidjan, Côte d'Ivoire.
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Odongo CO, Bisaso RK, Byamugisha J, Obua C. Intermittent use of sulphadoxine-pyrimethamine for malaria prevention: a cross-sectional study of knowledge and practices among Ugandan women attending an urban antenatal clinic. Malar J 2014; 13:399. [PMID: 25306431 PMCID: PMC4210552 DOI: 10.1186/1475-2875-13-399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/07/2014] [Indexed: 12/02/2022] Open
Abstract
Background The WHO recommends supervised administration of sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment for malaria (IPTp) during pregnancy. Logistical constraints have however favoured unsupervised intake of SP-IPTp, casting doubts whether recent guidelines requiring more frequent intake can be effectively implemented. To propose strategies for enhancing compliance under limited supervision, this study sought to identify pregnant women’s knowledge and practices gaps as well as determine predictors of compliance with SP-IPTp, given under limited supervision. Methods A cross-sectional study of 700 women used exit interviews at an urban clinic in Uganda to obtain a descriptive summary of demographic and obstetric characteristics, including knowledge, practice and experiences with SP. Predictors of compliance with SP intake instructions were explored using logistic regression. Results Median age of respondents was 25 (IQR 22–28) and median parity was two (IQR one to three) while median number of antenatal clinic (ANC) visits was 3.0 (IQR three to four). Most women had completed primary (36%) or ordinary secondary education (25.6%) while 16.1% had not completed primary education. Awareness about SP was high (99.4%) although correct knowledge regarding its use in pregnancy was low (57%), with 15.4% thinking it was used to treat malaria and 26.7% lacking any idea about its use. Correct knowledge on SP use during pregnancy significantly predicted compliance with SP-IPTp instructions (OR 1.98, C.I. 1.12-3.55), while age, education level, parity, number of ANC visits, or history of unwanted effects with SP did not. SP was mostly accessed from hospitals (64.4%) followed by private clinics (16.9%) both for preventive and treatment purposes. SP was considered safe by most women, who were willing to take it again in future, without supervision. Conclusion Despite high awareness, knowledge of SP as an intervention for malaria prevention in pregnancy was low. Correct knowledge on use of SP predicted compliance with SP-IPTp intake instructions. Focused malaria-related education during ANC visits may improve compliance with SP intake amidst limited supervision. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-399) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charles O Odongo
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
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Rumisha SF, Zinga MM, Fahey CA, Wei D, Bwana VM, Mlozi MRS, Shayo EH, Malima RC, Mayala BK, Stanley G, Mlacha T, Mboera LEG. Accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania. BMC Health Serv Res 2014; 14:452. [PMID: 25277956 PMCID: PMC4283091 DOI: 10.1186/1472-6963-14-452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Universal access to and utilization of malaria prevention measures is defined as every person at malaria risk sleeping under a quality insecticide-treated mosquito net (ITN) and every pregnant woman at risk receiving at least two doses of sulfadoxine-pyrimethamine (SP). This study aimed to determine factors affecting accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania. Methods Women of reproductive age with children <5 years old or those who had been pregnant during the past 5 years were included in the study. A structured questionnaire was used to seek information on malaria knowledge, accessibility and utilization of malaria interventions during pregnancy. Results A total of 297 women (mean age=29±6.8 years) were involved. Seventy percent of the women had attained primary school education. About a quarter of women had two children of <5 years while over 58% had ≥3 children. Most (71.4%) women had medium general knowledge on malaria while only eight percent of them had good knowledge on malaria in pregnancy. A significant proportion of women were not aware of the reasons for taking SP during pregnancy (35%), timing for SP (18%), and the effect of malaria on pregnancy (45.8%). Timing for first dose of SP for intermittent preventive treatment in pregnancy (IPTp) was 1-3 months (28.4%) and 4-6 months (36.8%). Some 78.1% were provided with SP under supervision of the health provider. Knowledge on malaria in pregnancy had a significant association with levels of education (p=0.024). Ninety-eight percent had an ITN, mostly (87.1%) received free from the government. All women attended the ANC during their last pregnancy. The coverage of IPT1 was 53.5% and IPTp2 was 41.1%. The proportion of women making more ANC visits decreased with increasing parity. Conclusion This study showed that the knowledge of the pregnant women on malaria in pregnancy and IPTp was average and is likely to have an impact on the low IPTp coverage. Campaigns that provide educational massages on the risk of malaria during pregnancy and the usefulness of IPTp need to be emphasised.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Leonard E G Mboera
- National Institute for Medical Research, P,O, Box 9653, Dar es Salaam, Tanzania.
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Graham KJ, Ba-Break MM. Systemic constraints continue to limit coverage of intermittent preventive treatment for malaria in pregnancy in southeast Tanzania. Int Health 2014; 5:126-31. [PMID: 24030112 DOI: 10.1093/inthealth/iht005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Factors limiting coverage of intermittent preventive treatment for malaria in pregnancy (IPTp) in Tanzania were explored from the perspective of health workers, in order to make recommendations to improve service delivery. Recent data estimates coverage of the recommended two doses of IPTp at 26.3%, far short of the national target of 80%. METHODS Semistructured interviews were conducted with 13 health workers and 2 health managers during June 2011 in Ikwiriri, southeast Tanzania. RESULTS Delivery of sulfadoxine-pyrimethamine (SP) was severely constrained by drug shortages and widespread stock-outs, indicative of ongoing difficulties in the wider health system. While SP was well known and attitudes towards IPTp were positive, health workers were often not informed of up-to-date dosing schedules, limiting coverage. Recent literature suggests this could be due to inconsistent and conflicting national guidelines. In addition, it was found that two pills, instead of the recommended three pills, per dose of IPTp were frequently given to pregnant women, a finding previously unreported. CONCLUSION To maximize IPTp coverage, sufficient and consistent supplies of SP to both public and private health facilities are a necessity, combined with effective communication of revised dosing schedules. Further research is warranted to investigate the aberrant administration of two pills per dose, as it may exacerbate drug resistance.
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Affiliation(s)
- Kirstie J Graham
- Ifakara Health Institute, Rufiji Health Demographic Surveillance System, Folk Development College, Ikwiriri, PO Box 40, Tanzania
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Anchang-Kimbi JK, Achidi EA, Apinjoh TO, Mugri RN, Chi HF, Tata RB, Nkegoum B, Mendimi JMN, Sverremark-Ekström E, Troye-Blomberg M. Antenatal care visit attendance, intermittent preventive treatment during pregnancy (IPTp) and malaria parasitaemia at delivery. Malar J 2014; 13:162. [PMID: 24779545 PMCID: PMC4019363 DOI: 10.1186/1475-2875-13-162] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background The determinants and barriers for delivery and uptake of IPTp vary with different regions in sub-Saharan Africa. This study evaluated the determinants of ANC clinic attendance and IPTp-SP uptake among parturient women from Mount Cameroon Area and hypothesized that time of first ANC clinic attendance could influence uptake of IPTp-SP/dosage and consequently malaria parasite infection status at delivery. Methods Two cross sectional surveys were carried out at the Government Medical Centre in the Mutengene Health Area, Mt Cameroon Area from March to October 2007 and June 2008 to April 2009. Consented parturient women were consecutively enrolled in both surveys. In 2007, socio-demographic data, ANC clinic attendance, gestational age, fever history and reported use/dosage of IPTp-SP were documented using a structured questionnaire. In the second survey only IPT-SP usage/dosage was recorded. Malaria parasitaemia at delivery was determined by blood smear microscopy and placental histology. Results and discussion In 2007, among the 287 women interviewed, 2.2%, 59.7%, and 38.1% enrolled in the first, second and third trimester respectively. About 90% of women received at least one dose SP but only 53% received the two doses in 2007 and by 2009 IPTp-two doses coverage increased to 64%. Early clinic attendance was associated (P = 0.016) with fever history while being unmarried (OR = 2.2; 95% CI: 1.3-3.8) was significantly associated with fewer clinic visits (<4visits). Women who received one SP dose (OR = 3.7; 95% CI: 2.0-6.8) were more likely not to have attended ≥ 4visits. A higher proportion (P < 0.001) of women with first visit during the third trimester received only one dose, meanwhile, those who had an early first ANC attendance were more likely (OR = 0.4; 95% CI = 0.2 - 0.7) to receive two or more doses. Microscopic parasitaemia at delivery was frequent (P = 0.007) among women who enrolled in the third trimester and had received only one SP dose than in those with two doses. Conclusion In the study area, late first ANC clinic enrolment and fewer clinic visits may prevent the uptake of two SP doses and education on early and regular ANC clinic visits can increase IPTp coverage.
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Mubyazi GM, Byskov J, Magnussen P, Bygbjerg IC, Ijumba JN, Marero M, Mboera LEG, Molteni F, Bloch P. Health facility-based data on women receiving sulphadoxine-pyrimethamine during pregnancy in Tanzania: lessons to learn from a cross-sectional survey in Mkuranga and Mufindi districts and other national survey reports. Reprod Health 2014; 11:6. [PMID: 24433529 PMCID: PMC3897926 DOI: 10.1186/1742-4755-11-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A study of health facility (HF) data on women receiving sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) was carried out at antenatal care clinics in Mkuranga and Mufindi districts. METHODS A review of health management information system (HMIS) registers, interviews with health-care workers (HWs) and district and national level malaria control program managers corroborated by inter-temporal assessment through observations at HF levels. Statistical data were analyzed in Excel and interpreted in triangulation with qualitative data from interviews and observations. RESULTS Data indicated that IPTp doses administered to women were inadequate and partly inconsistent. HMIS registers lacked space for IPT records, forcing HWs to manipulate their record-keeping. The proportion/number of IPTp recipients in related to the supply of SP for free delivery, to women's attendance behaviours, showed variation by quarter and year of reporting. CONCLUSION It is impossible to achieve rational health service planning when the HMIS is weak. Whilst it is acknowledged that the HMIS is already overloaded, concerted measures are urgently needed to accommodate data on new interventions and other vertical programs if malaria programs are to achieve their goals.
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Affiliation(s)
- Godfrey M Mubyazi
- Department of Health Systems & Policy Research & Centre for Enhancement of Effective Malaria Interventions (CEEMI), National Institute for Medical Research (NIMR) - Headquarters, 2448 Ocean Road, P.O. Box 9653, Dar-Es-Salaam, Tanzania
| | - Jens Byskov
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Institute of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Bleddamsvej 3, DK 2200 Copenhagen N, Denmark
| | - Jasper N Ijumba
- Department of Health Systems & Policy Research & Centre for Enhancement of Effective Malaria Interventions (CEEMI), National Institute for Medical Research (NIMR) - Headquarters, 2448 Ocean Road, P.O. Box 9653, Dar-Es-Salaam, Tanzania
- The Nelson Mandela African Institute of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - Mufungo Marero
- Ministry of Health and Social Welfare, National Malaria Control Programme (NMCP), Dar Es Salaam, P.O. Box 9083, Dar es Salaam, Tanzania
| | - Leonard EG Mboera
- NIMR, Directorate of Information Technology and Communication, National Institute for Medical Research, Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Fabrizio Molteni
- Ministry of Health and Social Welfare, National Malaria Control Programme (NMCP), Dar Es Salaam, P.O. Box 9083, Dar es Salaam, Tanzania
| | - Paul Bloch
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center, Steno Health Promotion Center, Gentofte, Denmark
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Mubyazi GM, Bloch P. 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 Serv Res 2014; 14:15. [PMID: 24410770 PMCID: PMC3897909 DOI: 10.1186/1472-6963-14-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/31/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment of malaria in pregnancy (IPTp) using sulphurdoxine-pyrimethamine (SP) is one of key malaria control strategies in Africa. Yet, IPTp coverage rates across Africa are still low due to several demand and supply constraints. Many countries implement the IPTp-SP strategy at antenatal care (ANC) clinics. This paper reports from a study on the knowledge and experience of health workers (HWs) at ANC clinics regarding psychosocial, behavioural and health system barriers to IPTp-SP delivery and uptake in Tanzania. METHODS Data were collected through questionnaire-based interviews with 78 HWs at 28 ANC clinics supplemented with informal discussions with current and recent ANC users in Mkuranga and Mufindi districts. Qualitative data were analysed using a qualitative content analysis approach. Quantitative data derived from interviews with HWs were analysed using non-parametric statistical analysis. RESULTS The majority of interviewed HWs were aware of the IPTp-SP strategy's existence and of the recommended one month spacing of administration of SP doses. Some HWs were unsure of that it is not recommended to administer IPTp-SP and ferrous/folic acid concurrently. Others were administering three doses of SP per client following instruction from a non-governmental agency while believing that this was in conflict with national guidelines. About half of HWs did not find it appropriate for the government to recommend private ANC providers to provide IPTp-SP free of charge since doing so forces private providers to recover the costs elsewhere. HWs noted that pregnant women often register at clinics late and some do not comply with the regularity of appointments for revisits, hence miss IPTp and other ANC services. HWs also noted some amplified rumours among clients regarding health risks and treatment failures of SP used during pregnancy, and together with clients' disappointment with waiting times and the sharing of cups at ANC clinics for SP, limit the uptake of IPTp-doses. CONCLUSION HWs still question SP's treatment advantages and are confused about policy ambiguity on the recommended number of IPTp-SP doses and other IPTp-SP related guidelines. IPTp-SP uptake is further constrained by pregnant women's perceived health risks of taking SP and of poor service quality.
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Affiliation(s)
- Godfrey M Mubyazi
- National Institute for Medical Research (NIMR), Department of Health Systems and Policy Research, Centre for Enhancement of Effective Malaria Interventions (CEEMI), 2448 Barak Obama Drive (former Luthuli/Ocean Road), P.O Box 9653, Dar es Salaam, Tanzania
| | - Paul Bloch
- Steno Diabetes Center, Steno Health Promotion Center, Gentofte, Denmark
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Mubyazi GM, Magnussen P, Byskov J, Bloch P. Feasibility and coverage of implementing intermittent preventive treatment of malaria in pregnant women contacting private or public clinics in Tanzania: experience-based viewpoints of health managers in Mkuranga and Mufindi districts. BMC Health Serv Res 2013; 13:372. [PMID: 24079911 PMCID: PMC3850681 DOI: 10.1186/1472-6963-13-372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 09/27/2013] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Evidence on healthcare managers' experience on operational feasibility of malaria intermittent preventive treatment for malaria during pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) in Africa is systematically inadequate. This paper elucidates the perspectives of District Council Health Management Team (CHMT)s regarding the feasibility of IPTp with SP strategy, including its acceptability and ability of district health care systems to cope with the contemporary and potential challenges. METHODS The study was conducted in Mkuranga and Mufindi districts. Data were collected between November 2005 and December 2007, involving focus group discussion (FGD) with Mufindi CHMT and in-depth interviews were conducted with few CHMT members in Mkuranga where it was difficult to summon all members for FGD. RESULTS Participants in both districts acknowledged the IPTp strategy, considering the seriousness of malaria in pregnancy problem; government allocation of funds to support healthcare staff training programmes in focused antenatal care (fANC) issues, procuring essential drugs distributed to districts, staff remuneration, distribution of fANC guidelines, and administrative activities performed by CHMTs. The identified weaknesses include late arrival of funds from central level weakening CHMT's performance in health supervision, organising outreach clinics, distributing essential supplies, and delivery of IPTp services. Participants anticipated the public losing confidence in SP for IPTp after government announced artemither-lumefantrine (ALu) as the new first-line drug for uncomplicated malaria replacing SP. Role of private healthcare staff in IPTp services was acknowledged cautiously because CHMTs rarely supplied private clinics with SP for free delivery in fear that clients would be required to pay for the SP contrary to government policy. In Mufindi, the District Council showed a strong political support by supplementing ANC clinics with bottled water; in Mkuranga such support was not experienced. A combination of health facility understaffing, water scarcity and staff non-adherence to directly observed therapy instructions forced healthcare staff to allow clients to take SP at home. Need for investigating in improving adherence to IPTp administration was emphasised. CONCLUSION High acceptability of the IPTp strategy at district level is meaningless unless necessary support is assured in terms of number, skills and motivation of caregivers and availability of essential supplies.
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Affiliation(s)
- Godfrey M Mubyazi
- Department of Health Systems and Policy Research and Centre for Enhancement of Effective Malaria Interventions (CEEMI), National Institute for Medical Research (NIMR), 2448 Ocean Road, P.O Box 9653, Dar es Salaam, Tanzania
- Amani Medical Research Centre, Muheza, P.O Box 81, Tanga, Tanzania
| | - Pascal Magnussen
- DBL - Centre for Health Research and Development, Institute of Veterinary, Pathobiology, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Byskov
- DBL - Centre for Health Research and Development, Institute of Veterinary, Pathobiology, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Bloch
- DBL - Centre for Health Research and Development, Institute of Veterinary, Pathobiology, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center, Steno Health Promotion Center, Gentofte, Denmark
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Esu E, Effa E, Udoh E, Oduwole O, Odey F, Chibuzor M, Oyo-Ita A, Meremikwu M. Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria. Res Rep Trop Med 2013; 4:29-35. [PMID: 30890873 PMCID: PMC6065562 DOI: 10.2147/rrtm.s47677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria. Methods A clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC) visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp) doses was obtained using an audit checklist. Results A total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76%) of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1), 24.2% had two doses of IPTp (IPTp2), while 3.1% had three doses of IPTp (IPTp3). The overall utilization of two doses or more of IPTp (IPTp2+) was 30.7%. Conclusion There was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state.
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Affiliation(s)
- Ekpereonne Esu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Emmanuel Effa
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Ekong Udoh
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Olabisi Oduwole
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Friday Odey
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Moriam Chibuzor
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria,
| | - Angela Oyo-Ita
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Martin Meremikwu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
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Hill J, Hoyt J, van Eijk AM, D'Mello-Guyett L, Ter Kuile FO, Steketee R, Smith H, Webster J. 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 Med 2013; 10:e1001488. [PMID: 23935459 PMCID: PMC3720261 DOI: 10.1371/journal.pmed.1001488] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/13/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Hill J, Dellicour S, Bruce J, Ouma P, Smedley J, Otieno P, Ombock M, Kariuki S, Desai M, Hamel MJ, ter Kuile FO, Webster J. Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Kenya. PLoS One 2013; 8:e64913. [PMID: 23798997 PMCID: PMC3683044 DOI: 10.1371/journal.pone.0064913] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/19/2013] [Indexed: 12/17/2022] Open
Abstract
Background Malaria in pregnancy can have devastating consequences for mother and baby. Coverage with the WHO prevention strategy for sub-Saharan Africa of intermittent-preventive-treatment (IPTp) with two doses of sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) in pregnancy is low. We analysed household survey data to evaluate the effectiveness of antenatal clinics (ANC) to deliver IPTp and ITNs to pregnant women in Nyando district, Kenya. Methods We assessed the systems effectiveness of ANC to deliver IPTp and ITNs to pregnant women and the impact on low birthweight (LBW). Logistic regression was used to identify predictors of receipt of IPTp and ITN use during pregnancy. Results Among 89% of recently pregnant women who attended ANC at least once between 4–9 months gestation, 59% reported receiving one dose of SP and 90% attended ANC again, of whom 57% received a second dose, resulting in a cumulative effectiveness for IPTp of 27%, most of whom used an ITN (96%). Overall ITN use was 89%, and ANC the main source (76%). Women were less likely to receive IPTp if they had low malaria knowledge (0.26, 95% CI 0.08–0.83), had a child who had died (OR 0.36, 95% CI 0.14–0.95), or if they first attended ANC late (OR 0.20, 95% CI 0.06–0.67). Women who experienced side effects to SP (OR 0.18, CI 0.03–0.90) or had low malaria knowledge (OR 0.78, 95% CI 0.11–5.43) were less likely to receive IPTp by directly observed therapy. Ineffective delivery of IPTp reduced its potential impact by 231 LBW cases averted (95% CI 64–359) per 10,000 pregnant women. Conclusion IPTp presents greater challenges to deliver through ANC than ITNs in this setting. The reduction in public health impact on LBW resulting from ineffective delivery of IPTp is estimated to be substantial. Urgent efforts are required to improve service delivery of this important intervention.
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Affiliation(s)
- Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Bouyou-Akotet MK, Mawili-Mboumba DP, Kombila M. Antenatal care visit attendance, intermittent preventive treatment and bed net use during pregnancy in Gabon. BMC Pregnancy Childbirth 2013; 13:52. [PMID: 23442536 PMCID: PMC3599563 DOI: 10.1186/1471-2393-13-52] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 02/12/2013] [Indexed: 11/20/2022] Open
Abstract
Background The World Health Organization (WHO) recommends that intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and insecticide treated bed nets (ITNs) must be provided during antenatal care (ANC) visits for malaria prevention during pregnancy. The aim of this study was to determine the level of ANC attendance and its relationship with IPTp-SP and bed net coverage in Gabonese pregnant women. Methods This was a cross-sectional survey performed in 2011 in sentinel sites for malaria: two ANC units (Melen and Owendo) and one delivery unit (CHL). A validated structured questionnaire was used to collect the following data: age, parity, history of the current pregnancy including gestational age at the interview, number of ANC visits already performed, date of first visit, use of malaria preventive measure and details on IPTp-SP administration. Results During the study, 1030 women were interviewed, 735 at their ANC visit and 295 at the delivery. Their median age was 24[20–29] years and 21.0% were primigravidae. More than 70.0% attended their first ANC visit during the second trimester. Among the 442 women who were at the end of their pregnancy, 71.5% had a correct attendance, at least four ANC visits, most frequently women with no education and older women; IPTp-SP was offered to 84.1% of them and 57.4% received at least two doses. The number of SP doses was correlated to the number of ANC visits. Bed net coverage was 59.0%, not associated with ANC attendance. Among the women with correct ANC attendance, only 49.5% had a complete IPTp-SP course associated with bed net use during pregnancy. In the site where SP administration was supervised, 80% had four ANC visits and 97.4% received a full 2-dose course of IPTp-SP. Conclusions Despite a high level of correct ANC attendance in Gabon, the goal of 80% of women with 2-dose IPTp-SP during pregnancy is not achieved. Evaluations, training of health workers, as well as surveys from other areas of the country are needed to further measure the implementation and the impact of these strategies.
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Affiliation(s)
- Marielle Karine Bouyou-Akotet
- Department of Parasitology-Mycology, Faculty of Medicine, Université des Sciences de la Santé, Libreville, BP 4009, Gabon.
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Namusoke F, Ntale M, Wahlgren M, Kironde F, Mirembe F. Validity of self-reported use of sulphadoxine-pyrimethamine intermittent presumptive treatment during pregnancy (IPTp): a cross-sectional study. Malar J 2012; 11:310. [PMID: 22950456 PMCID: PMC3457910 DOI: 10.1186/1475-2875-11-310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in pregnancy is a major health problem that can cause maternal anaemia, stillbirth, spontaneous abortion, low birth weight and intra-uterine stunting. The WHO recommends use of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) in endemic areas. Towards monitoring and assessing IPTp coverage in the population, the Roll Back Malaria Partnership recommends the use of self-reported data. The aim of this study was to assess the validity of self-reported IPTp by testing for sulphadoxine in maternal blood at delivery. METHODS Two hundred and four pregnant women were consented and enrolled in a cross-sectional study in Mulago National Referral Hospital in Kampala Uganda. - Participants who reported a history of taking sulpha-containing drugs like co-trimoxazole , those who were not sure of dates relating to last menstrual period or who took IPTp within the first 20 weeks of gestation were excluded from the study. Data on demographic characteristics, obstetric history, and delivery outcome were collected. At birth, maternal venous blood was taken off aseptically and used to make thick blood smears for malaria parasites and plasma for determining sulphadoxine using high performance liquid chromatography (HPLC). RESULTS Of 120 participants who self reported to have used IPTp, 35 (29.2%) tested positive for sulphadoxine by HPLC, while 63 (75%) of 84 patients who reported not having used IPTp tested negative for sulphadoxine. Participants possessing post-primary education were more likely to have reported using IPTp. The low agreement (kappa coefficient = 0.037) between self-report and actual presence of the drug in the blood casts doubt on the validity of self-reported data in estimating IPTp coverage. CONCLUSIONS The results of this study question the accuracy of self-reported data in estimating IPTp coverage in the population. More studies on validity of self reported data are recommended. Since the validity of IPTp self reports is vital for guiding policy on malaria control in pregnancy, ways should be sought to improve accuracy of the information from such reports.
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Affiliation(s)
- Fatuma Namusoke
- Department of Biochemistry, Makerere University, Kampala, Uganda
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Amoran OE, Ariba AA, Iyaniwura CA. Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria. Reprod Health 2012; 9:12. [PMID: 22889320 PMCID: PMC3453493 DOI: 10.1186/1742-4755-9-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/14/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Malaria infection in pregnancy is a major risk factor for maternal and child death, and substantially increases the risk of miscarriage, stillbirth and low birthweight. The aim of this study therefore is to assess the prevalence and determinants of Intermittent preventive treatment of Malaria [IPTp] utilization by pregnant women in a rural town in Western Nigeria. METHODS This study is an analytical cross-sectional study. All pregnant women that were due for delivery and were attending the three primary health care center in Sagamu town, Nigeria within a 2 months period were recruited into the study. A semi- structured questionnaire was used to collect relevant information. RESULTS A total of 255 pregnant women were recruited into the study. The mean age of respondents was 28.07 ± 5.12 years. The mean parity and booking age was 2.7 ± 1.67 and 4.42 ± 1.7 months respectively. The prevalence of Malaria attack in the last 3 months was 122(47.8%). Only 107/255 (40.4%) practice IPTp for malaria prevention during the current pregnancy, with only 14.6% of them taking the second dose during pregnancy as recommended. Chloroquine [27.1%] was the most frequently used medication for the treatment of Malaria in Pregnancy. Early booking age [OR = 1.11, C.I = 0.61-2.01], adverse last pregnancy outcome [OR = 1.23, C.I = 0.36-4.22], and parity [OR = 1.87, C.I = 0.25-16.09] were not statistically significantly associated with IPTp utilization. The only predictor of IPTp use was the knowledge of prophylaxis for malaria prevention [OR = 2.47, C.I = 1.06-3.52] using multivariate analysis. CONCLUSION The study concludes that most women who attend ANC in rural areas in Nigeria do not receive IPTp as expected. A major determinant of utilization of IPTp among the study population was the knowledge of prophylaxis for malaria prevention. This study highlights the importance of health education of the pregnant women in increasing IPTp uptake despite the regular drug stock out at the facility level in rural areas in low resource countries.
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Affiliation(s)
- Olorunfemi E Amoran
- Department of Community Medicine and Primary Care, College of Health Sciences Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
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Onwujekwe OC, Soremekun RO, Uzochukwu B, Shu E, Onwujekwe O. Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria. BMC Res Notes 2012; 5:211. [PMID: 22551039 PMCID: PMC3392746 DOI: 10.1186/1756-0500-5-211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/02/2012] [Indexed: 11/16/2022] Open
Abstract
Background Malaria in pregnancy (MIP) is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Information is required on how to improve its prevention and treatment from both the providers’ and consumers’ perspectives. Methods The study sites were two public and two private hospitals in Enugu, southeast Nigeria. Data was collected using a pre-tested structured questionnaire. The respondents were healthcare providers (doctors, pharmacists and nurses) providing ante-natal care (ANC) services. They consisted of 32 respondents from the public facilities and 20 from the private facilities. The questionnaire elicited information on their: knowledge about malaria, attitude, chemotherapy and chemoprophylaxis using pyrimethamine, chloroquine proguanil as well as IPTp with sulphadoxine-pyrimethamine (SP). The data was collected from May to June 2010. Results Not many providers recognized maternal and neonatal deaths as potential consequences of MIP. The public sector providers provided more appropriate treatment for the pregnant women, but the private sector providers found IPTp more acceptable and provided it more rationally than public sector providers (p < 0.05). It was found that 50 % of private sector providers and 25 % of public sector providers prescribed chemoprophylaxis using pyrimethamine, chloroquine and proguanil to pregnant women. Conclusions There is sub-optimal level of knowledge about current best practices for treatment and chemoprophylaxis for MIP especially in the private sector. Also, IPTp was hardly used in the public sector. Interventions are required to improve providers’ knowledge and practices with regards to management of MIP.
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Affiliation(s)
- Ogochukwu C Onwujekwe
- Department of Pharmacy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
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Onoka CA, Hanson K, Onwujekwe OE. Low coverage of intermittent preventive treatment for malaria in pregnancy in Nigeria: demand-side influences. Malar J 2012; 11:82. [PMID: 22443266 PMCID: PMC3364889 DOI: 10.1186/1475-2875-11-82] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/23/2012] [Indexed: 11/29/2022] Open
Abstract
Background Nigeria instituted intermittent preventive treatment for malaria (IPTp) using sulphadoxine-pyrimethamine (SP) for pregnant women in 2001, but coverage remains low. This study examined the influence of demand side factors on IPTp coverage. Methods Data were collected using a household survey from 1307 women who were delivered of a live baby within the one-year period preceding the study and through an exit poll from 146 women attending antenatal clinics (ANC). Data analysis examined coverage based on the national and WHO guidelines for IPTp delivery which differ with regards to use of IPTp in the last month of pregnancy. Focus group discussions (FGDs) were undertaken to further explain demand side constraints to coverage. Results From the household survey, 96.1% of respondents attended ANC, with most having five or more visits. Overall IPTp coverage for the first and second doses was 13.7% and 7.3% respectively. The coverage was higher in the urban areas compared to rural areas (p < 0.01). Amongst women who could have received IPTp based on the timing of their attendance, only 14.1% and 14.3% were offered the first dose based on national and WHO guidelines, while 7.7% and 7.5% were offered the second dose respectively giving significant missed opportunities. Amongst ANC attendees offered first and second doses, 98.9% and 96.9% respectively took the medicine. Only 13.6% and 21.5% of these clients reported taking the drug under direct observation. The low level of coverage was confirmed by exit survey data, which found coverage of 11.6% and 3.0% for the first and second doses. The FGDs revealed that women do not have many concerns about side effects, but they take drugs providers give them because they believe such drugs must be safe. Conclusion This study found low coverage of IPTp and high levels of missed opportunities supporting findings that high ANC attendance does not guarantee high IPTp coverage. Demand side factors such as ANC attendance, appropriate timing of attendance, and perceptions about side effects were not constraining factors to increased coverage, raising the need to examine supply side factors.
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Affiliation(s)
- Chima A Onoka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu campus, Nigeria.
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Mubyazi GM, Bloch P, Byskov J, Magnussen P, Bygbjerg IC, Hansen KS. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts. Malar J 2012; 11:48. [PMID: 22340941 PMCID: PMC3298537 DOI: 10.1186/1475-2875-11-48] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 02/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. METHODS Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. RESULTS In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for clients to use while taking doses under direct observed therapy than their public facility counterparts. Employees in public HFs more acknowledged availability of clinical officers, nurses and midwives than their private facility counterparts. More results are presented and discussed. CONCLUSION The study shows conditions related to staffing levels, health infrastructure and essential supplies being among the key determinants or drivers of frontline HWs' motivation to deliver ANC services in both private and public HFs. Efforts of the government to meet the maternal health related Millennium Development Goals and targets for specific interventions need to address challenges related to HWs' motivation to perform their duties at their work-places.
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Affiliation(s)
- Godfrey M Mubyazi
- National Institute for Medical Research (NIMR), Centre for Enhancement of Effective Malaria Interventions (CEEMI), 2338 Ocean Road, P,O Box 9653, Dar-es-Salaam, Tanzania.
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Smith Paintain L, Antwi GD, Jones C, Amoako E, Adjei RO, Afrah NA, Greenwood B, Chandramohan D, Tagbor H, Webster J. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: provider knowledge and acceptability. PLoS One 2011; 6:e24035. [PMID: 21887367 PMCID: PMC3161113 DOI: 10.1371/journal.pone.0024035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 07/29/2011] [Indexed: 11/24/2022] Open
Abstract
Malaria in pregnancy (MiP) is associated with increased risks of maternal and foetal complications. The WHO recommends a package of interventions including intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), insecticide-treated nets and effective case management. However, with increasing SP resistance, the effectiveness of SP-IPT has been questioned. Intermittent screening and treatment (IST) has recently been shown in Ghana to be as efficacious as SP-IPT. This study investigates two important requirements for effective delivery of IST and SP-IPT: antenatal care (ANC) provider knowledge, and acceptance of the different strategies. Structured interviews with 134 ANC providers at 67 public health facilities in Ashanti Region, Ghana collected information on knowledge of the risks and preventative and curative interventions against MiP. Composite indicators of knowledge of SP-IPT, and case management of MiP were developed. Log binomial regression of predictors of provider knowledge was explored. Qualitative data were collected through in-depth interviews with fourteen ANC providers with some knowledge of IST to gain an indication of the factors influencing acceptance of the IST approach. 88.1% of providers knew all elements of the SP-IPT policy, compared to 20.1% and 41.8% who knew the treatment policy for malaria in the first or second/third trimesters, respectively. Workshop attendance was a univariate predictor of each knowledge indicator. Qualitative findings suggest preference for prevention over cure, and increased workload may be barriers to IST implementation. However, a change in strategy in the face of SP resistance is likely to be supported; health of pregnant women is a strong motivation for ANC provider practice. If IST was to be introduced as part of routine ANC activities, attention would need to be given to improving the knowledge and practices of ANC staff in relation to appropriate treatment of MiP. Health worker support for any MiP intervention delivered through ANC clinics is critical.
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Affiliation(s)
- Lucy Smith Paintain
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Gifty D. Antwi
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caroline Jones
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Esther Amoako
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rose O. Adjei
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana A. Afrah
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Brian Greenwood
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Harry Tagbor
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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The combined effect of determinants on coverage of intermittent preventive treatment of malaria during pregnancy in the Kilombero Valley, Tanzania. Malar J 2011; 10:140. [PMID: 21599999 PMCID: PMC3126755 DOI: 10.1186/1475-2875-10-140] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/21/2011] [Indexed: 11/29/2022] Open
Abstract
Background Intermittent preventive treatment during pregnancy (IPTp) at routine antenatal care (ANC) clinics is an important and efficacious intervention to reduce adverse health outcomes of malaria infections during pregnancy. However, coverage for the recommended two IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage. Methods Data on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Women's timing of ANC visits and health worker's timing of IPTp delivery were analyzed in relation to the different national IPTp schedules and the outcome on IPTp coverage was modelled. Results Among all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. Less than 1% of women started ANC attendance after 32 weeks of gestation. During the second IPTp delivery period health workers delivered IPTp to significantly less women than during the first one (55% vs. 73%) contributing to low second dose coverage. Simplified IPTp guidelines for front-line health workers as recommended by WHO could lead to a 20 percentage point increase in IPTp coverage. Conclusions This study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. To maximize the benefit of the IPTp intervention, revision of existing guidelines is needed. Training on simplified IPTp messages should be consolidated as part of the extended antenatal care training to change health workers' delivery practices and increase IPTp coverage. Pregnant women's knowledge about IPTp and the risks of malaria during pregnancy should be enhanced as well as their ability and power to demand IPTp and other ANC services.
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Vanga-Bosson HA, Coffie PA, Kanhon S, Sloan C, Kouakou F, Eholie SP, Kone M, Dabis F, Menan H, Ekouevi DK. Coverage of intermittent prevention treatment with sulphadoxine-pyrimethamine among pregnant women and congenital malaria in Côte d'Ivoire. Malar J 2011; 10:105. [PMID: 21529344 PMCID: PMC3108318 DOI: 10.1186/1475-2875-10-105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 04/29/2011] [Indexed: 11/26/2022] Open
Abstract
Background The World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa. Data on IPT-SP coverage and factors associated with placental malaria parasitaemia and low birth weight (LBW) are scarce in Côte d'Ivoire. Methods A multicentre, cross-sectional survey was conducted in Côte d'Ivoire from March to September 2008 at six urban and semi-urban antenatal clinics. Standardized forms were used to collect the demographic information and medical histories of women and their offspring. IPT-SP coverage (≥2 doses) as well as placental and congenital malaria prevalence parasitaemia were estimated. Regression logistics were used to study factors associated with placental malaria and LBW (birth weight of alive babies < 2,500 grams). Results Overall, 2,044 women with a median age of 24 years were included in this study. Among them 1017 (49.8%) received ≥2 doses of IPT-SP and 694 (34.0%) received one dose. A total of 99 mothers (4.8%) had placental malaria, and of them, four cases of congenital malaria were diagnosed. Factors that protected from maternal placental malaria parasitaemia were the use of one dose (adjusted odds ratio (aOR), 0.32; 95%CI: 0.19-0.55) or ≥2 doses IPT-SP (aOR: 0.18; 95%CI: 0.10-0.32); the use of ITNs (aOR: 0.47; 95%CI: 0.27-0.82). LBW was associated with primigravidity and placental malaria parasitaemia. Conclusion IPT-SP decreases the rate of placental malaria parasitaemia and has a strong dose effect. Despite relatively successful IPT-SP coverage in Côte d'Ivoire, substantial commitments from national authorities are urgently required for such public health campaigns. Strategies, such as providing IPT-SP free of charge and directly observing treatment, should be implemented to increase the use of IPT-SP as well as other prophylactic methods.
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Sangaré LR, Stergachis A, Brentlinger PE, Richardson BA, Staedke SG, Kiwuwa MS, Weiss NS. Determinants of use of intermittent preventive treatment of malaria in pregnancy: Jinja, Uganda. PLoS One 2010; 5:e15066. [PMID: 21124732 PMCID: PMC2993958 DOI: 10.1371/journal.pone.0015066] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022] Open
Abstract
Background Maternal malaria is associated with serious adverse pregnancy outcomes. One recommended means of preventing malaria during pregnancy is intermittent preventive therapy (IPTp) with sulfadoxine/pyrimethamine (SP). We sought to identify determinants of preventive use of SP during pregnancy among recently pregnant women in Uganda. Additionally, we characterized the timing of and indications for the administration of SP at antenatal care (ANC) visits and missed opportunities for SP administration. Methodology/Principal Findings Utilizing a population-based random sample, we interviewed 500 women living in Jinja, Uganda who had been pregnant in the past year. Thirty-eight percent (192/500) of women received SP for the treatment of malaria and were excluded from the analysis of IPTp-SP. Of the remaining women, 275 (89.3%) reported at least two ANC visits after the first trimester and had an opportunity to receive IPTp-SP according to the Ugandan guidelines, but only 86 (31.3%) of these women received a full two-dose course of IPTp. The remaining 189 (68.7%) women missed one or more doses of IPTp-SP. Among the 168 women that were offered IPTp, 164 (97.6%) of them took the dose of SP. Conclusions/Significance Use of IPTp in Uganda was found to be far below target levels. Our results suggest that women will take SP for IPTp if it is offered during an ANC visit. Missed opportunities to administer IPTp-SP during ANC were common in our study, suggesting provider-level improvements are needed.
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Affiliation(s)
- Laura R Sangaré
- Department of Global Health, University of Washington, Seattle, Washington, USA.
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Webster J, Chandramohan D, Hanson K. Methods for evaluating delivery systems for scaling-up malaria control intervention. BMC Health Serv Res 2010; 10 Suppl 1:S8. [PMID: 20594374 PMCID: PMC2895752 DOI: 10.1186/1472-6963-10-s1-s8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Despite increased resources over the past few years the coverage of malaria control interventions is still inadequate to reach national and international targets and achieve the full potential of the interventions to improve population health. One of the reasons for this inadequate coverage of efficacious interventions is the limited understanding of the optimum delivery systems of the interventions in different contexts. Although there have been debates about how to deliver interventions, the methods for evaluating the effectiveness of different delivery systems have rarely been discussed. Delivery of interventions is relatively complex and a thorough evaluation would need to look holistically at multiple steps in the delivery process and at multiple factors influencing the process. A better understanding of the strength of the evidence on delivery system effectiveness is needed in order to optimise delivery of efficacious interventions. Methods A literature review was conducted of methods used to evaluate delivery systems for insecticide treated nets, intermittent preventive treatment in pregnant women, and treatment for malaria in children. Results The methodology of delivery system evaluations varied. There were inconsistencies between objectives and methods of the evaluations including inappropriate outcome measures and unnecessary controls. There were few examples where the delivery processes were adequately described, or measured. We propose a cross sectional observational study design with attribution of the outcomes to a specific delivery system as an appropriate method for evaluating delivery systems at scale. Conclusions The proposed evaluation framework is adaptable to natural experiments at scale, and can be applied using data from routine surveys such as the Demographic and Health Surveys, modified by the addition of one to two questions for each intervention. This framework has the potential to enable wider application of rigorous evaluations and thereby improve the evidence base on which decisions about delivery systems for malaria control and other public health interventions are taken.
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Affiliation(s)
- Jayne Webster
- Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Ndyomugyenyi R, Katamanywa J. Intermittent preventive treatment of malaria in pregnancy (IPTp): do frequent antenatal care visits ensure access and compliance to IPTp in Ugandan rural communities? Trans R Soc Trop Med Hyg 2010; 104:536-40. [PMID: 20227739 DOI: 10.1016/j.trstmh.2010.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Indexed: 10/19/2022] Open
Abstract
The relationship between antenatal care (ANC) visits and coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), and barriers to IPTp-SP access were examined. Four hundred and fifty-three women who had given birth during the study period were interviewed using a semi-structured questionnaire. Of these, 425 (93.8%) attended ANC at least once, but only 90 (21.2%) made four or more visits. Primigravidae 25 (29.8%) were more likely than multigravidae 65 (17.6%) to make more than four visits (P=0.012). Only 237 (52.3%) women accessed two or more doses of IPT-SP, which increased with the number of ANC visits (X(2) for linear trends, 117.7, P<0.001). However, 131 (28.9%) women made two or more ANC visits, which were sufficient for them to access two or more doses of IPTp-SP, but they did not. The main reasons were: not given SP by the midwife for unknown reasons 36 (27.5%), SP stock-outs 34 (26%) and irregular ANC attendance 18 (13.7%). Frequent ANC visits do not seem to ensure access to IPTp-SP in the presence of other barriers. The Roll Back Malaria target of 80% of women accessing two or more doses of IPTp-SP by 2010 appears unachievable unless alternative channels of delivery are found.
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Akinleye SO, Falade CO, Ajayi IO. Knowledge and utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in primary health care centers in rural southwest, Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2009; 9:28. [PMID: 19589164 PMCID: PMC2719593 DOI: 10.1186/1471-2393-9-28] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 07/09/2009] [Indexed: 11/16/2022] Open
Abstract
Background Intermittent preventive treatment for prevention of malaria in pregnancy (IPTp) is a key component of malaria control strategy in Nigeria and sulfadoxine-pyrimethamine (SP) is the drug of choice. Despite the evidence of the effectiveness of IPTp strategy using SP in reducing the adverse effects of malaria during pregnancy the uptake and coverage in Nigeria is low. This study set out to assess the use of IPTp among pregnant women attending primary health centres in the rural area and determine factors that influence the uptake. Methods A cross-sectional study was carried out between July and August 2007 among 209 pregnant women selected by systematic random sampling from antenatal care attendees at primary health care in a rural Local Government Area of Ekiti State, Nigeria. Information on knowledge of IPT, delivery, adherence and acceptability was obtained using an interviewer administered questionnaire. Descriptive statistics such as means, range, proportions were used. Chi-square test was used to examine association between categorical variables. All analyses were performed at 5% level of significance. Results One hundred and nine of 209 (52.2%) respondents have heard about IPTp but only 26 (23.9%) were able to define it. Fifty seven (27.3%) reported to have received at least one dose of IPTp during the index pregnancy and all were among those who have heard of IPTp (52.3%). Twenty one of the 57 (36.8%) took the SP in the clinic. Only three of the twenty-one (14.3%) were supervised by a health worker. Twenty two of the 36 women (61.1%) who did not take their drugs in the clinic would have liked to do so if allowed to bring their own drinking cups. Almost half (43.9%) of those who had used IPTp during the index pregnancy expressed concern about possible adverse effect of SP on their pregnancies. Periodic shortages of SP in the clinics were also reported. Conclusion In this study, IPTp use among pregnant women was very low and there was poor adherence to the Directly Observed Therapy (DOT) scheme. Concerted effort should be made to increase awareness of IPTp among the public especially women of child bearing age. Health workers should also be trained and monitored to ensure adherence.
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Affiliation(s)
- Stella O Akinleye
- Department of Epidemiology, Medical Statistics and Environmental Health, College of Medicine, University of Ibadan, Nigeria.
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Marchant T, Nathan R, Jones C, Mponda H, Bruce J, Sedekia Y, Schellenberg J, Mshinda H, Hanson K. Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania. Malar J 2008; 7:260. [PMID: 19094198 PMCID: PMC2630326 DOI: 10.1186/1475-2875-7-260] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 12/18/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. However, different settings have reported coverage levels well below the target 80%. Antenatal implementation guidelines in Tanzania recommend IPTp first dose to be given at the second antenatal visit, and second dose at the third visit. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. METHODS Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 210 clusters sampled using two-stage cluster sampling from 21 randomly selected districts. Female residents who reported a livebirth in the previous year were asked questions about malaria prevention during that pregnancy and individual characteristics including education, pregnancy history, and marital status. The RCH facility serving each cluster was also surveyed, and information collected about drug stocks, health education delivery, and the timing of antenatal care delivery by clinic users. RESULTS The national IPTp coverage had declined over the survey period being 71% for first dose in 2005 falling to 65% in 2007 (chi2 2.9, p = 0.05), and 38% for second dose in 2005 but 30% in 2007 (chi2 4.4, p = 0.01). There was no evidence of any individual factors being associated with second dose coverage beyond living in an urban area. Availability of sulphadoxine-pyrimethamine at RCH had decreased year on year from 85% of clinics in stock in 2005 to 60% in 2007 (chi2 20.6, p < 0.001). This reduction was evident in rural but not urban clinics. If safety recommendations and national antenatal care guidelines for IPTp delivery were followed, in 2007 only 76% of pregnant women could have received IPTp first dose and only 46% could have received second dose. CONCLUSION There is scope to improve IPTp first and second dose coverage at national scale within existing systems by improving stock at RCH, and by revising the existing guidelines to recommend delivery of IPTp after quickening, rather than at a pre-defined antenatal visit.
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Affiliation(s)
- Tanya Marchant
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Rose Nathan
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Caroline Jones
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Hadji Mponda
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Jane Bruce
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Yovitha Sedekia
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Joanna Schellenberg
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Hassan Mshinda
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Kara Hanson
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Mubyazi GM, Bygbjerg IC, Magnussen P, Olsen O, Byskov J, Hansen KS, Bloch P. Prospects, achievements, challenges and opportunities for scaling-up malaria chemoprevention in pregnancy in Tanzania: the perspective of national level officers. Malar J 2008; 7:135. [PMID: 18647404 PMCID: PMC2500039 DOI: 10.1186/1475-2875-7-135] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 07/22/2008] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To describe the prospects, achievements, challenges and opportunities for implementing intermittent preventive treatment for malaria in pregnancy (IPTp) in Tanzania in light of national antenatal care (ANC) guidelines and ability of service providers to comply with them. METHODS In-depth interviews were made with national level malaria control officers in 2006 and 2007. Data was analysed manually using a qualitative content analysis approach. RESULTS IPTp has been under implementation countrywide since 2001 and the 2005 evaluation report showed increased coverage of women taking two doses of IPTp from 29% to 65% between 2001 and 2007. This achievement was acknowledged, however, several challenges were noted including (i) the national antenatal care (ANC) guidelines emphasizing two IPTp doses during a woman's pregnancy, while other agencies operating at district level were recommending three doses, this confuses frontline health workers (HWs); (ii) focused ANC guidelines have been revised, but printing and distribution to districts has often been delayed; (iii) reports from district management teams demonstrate constraints related to women's late booking, understaffing, inadequate skills of most HWs and their poor motivation. Other problems were unreliable supply of free SP at private clinics, clean and safe water shortage at many government ANC clinics limiting direct observation treatment and occasionally pregnant women asked to pay for ANC services. Finally, supervision of peripheral health facilities has been inadequate and national guidelines on district budgeting for health services have been inflexible. IPTp coverage is generally low partly because IPTp is not systematically enforced like programmes on immunization, tuberculosis, leprosy and other infectious diseases. Necessary concerted efforts towards fostering uptake and coverage of two IPTp doses were emphasized by the national level officers, who called for further action including operational health systems research to understand challenges and suggest ways forward for effective implementation and high coverage of IPTp. CONCLUSION The benefit of IPTp is appreciated by national level officers who are encouraged by trends in the coverage of IPTp doses. However, their appeal for concerted efforts towards IPTp scaling-up through rectifying the systemic constraints and operational research is important and supported by suggestions by other authors.
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Mubyazi GM, Magnussen P, Goodman C, Bygbjerg IC, Kitua AY, Olsen ØE, Byskov J, Hansen KS, Bloch P. Implementing Intermittent Preventive Treatment for Malaria in Pregnancy: Review of Prospects, Achievements, Challenges and Agenda for Research. THE OPEN TROPICAL MEDICINE JOURNAL 2008; 1:92-100. [PMID: 19946608 PMCID: PMC2782184 DOI: 10.2174/1874315300801010092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Implementing Intermittent Preventive Treatment for malaria in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) through antenatal care (ANC) clinics is recommended for malaria endemic countries. Vast biomedical literature on malaria prevention focuses more on the epidemiological and cost-effectiveness analyses of the randomised controlled trials carried out in selected geographical settings. Such studies fail to elucidate the economic, psychosocial, managerial, organization and other contextual systemic factors influencing the operational effectiveness, compliance and coverage of the recommended interventions. OBJECTIVE: To review literature on policy advances, achievements, constraints and challenges to malaria IPTp implementation, emphasising on its operational feasibility in the context of health-care financing, provision and uptake, resource constraints and psychosocial factors in Africa. RESULTS: The importance of IPTp in preventing unnecessary anaemia, morbidity and mortality in pregnancy and improving childbirth outcomes is highly acknowledged, although the following factors appear to be the main constraints to IPTp service delivery and uptake: cost of accessing ANC; myths and other discriminatory socio-cultural values on pregnancy; target users, perceptions and attitudes towards SP, malaria, and quality of ANC; supply and cost of SP at health facilities; understaffing and demoralised staff; ambiguity and impracticability of user-fee exemption policy guidelines on essential ANC services; implementing IPTp, bednets, HIV and syphilis screening programmes in the same clinic settings; and reports on increasing parasite resistant to SP. However, the noted increase in the coverage of the delivery of IPTp doses in several countries justify that IPTp implementation is possible and better than not. CONCLUSION: IPTp for malaria is implemented in constrained conditions in Africa. This is a challenge for higher coverage of at least two doses and attainment of the Abuja targets. Yet, there are opportunities for addressing the existing challenges, and one of the useful options is the evaluation of the acceptability and viability of the existing intervention guidelines.
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Affiliation(s)
- Godfrey Martin Mubyazi
- National Institute for Medical Research, P.O Box 9653 Dar es Salaam, Tanzania
- Amani Medical Research Centre, P.O Box 81 Muheza, Tanzania
| | - Pascal Magnussen
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Denmark
| | | | - Ib Christian Bygbjerg
- Institute of International Health, Immunology and Microbiology, Faculty of Life Sciences, University of Copenhagen, Denmark
| | - Andrew Yona Kitua
- National Institute for Medical Research, P.O Box 9653 Dar es Salaam, Tanzania
| | - Øystein Evjen Olsen
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Denmark
| | - Jens Byskov
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Denmark
| | - Kristian Schultz Hansen
- Department of Health Services Research, Institute of Public Health, University of Aarhus, Aarhus, Denmark
| | - Paul Bloch
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Denmark
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