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Kabeya TK, Kasongo JCM, Matumba NB, Tshibangu DI, Garcia-Morzon LA, Burgueño E. Impact of mass distribution of long-lasting insecticide nets on the incidence of malaria in Lomami, Democratic Republic of Congo: a study based on electronic health record data (2018 - 2019). Pan Afr Med J 2023; 45:89. [PMID: 37663637 PMCID: PMC10474805 DOI: 10.11604/pamj.2023.45.89.33099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/16/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction holoendemic, malaria remains one of the major public health problems in Lomami Province in the Democratic Republic of Congo (DRC). To fight against it, a free mass distribution of long-lasting insecticide nets (LLINs) was organized in July 2019 throughout the province. The present study aimed to assess the incidence of malaria and its impact on anaemia of children from 0 to 59 months in this region before and after this intervention. Methods we had conducted a retrospective observational study from June to December 2018 and June to December 2019. The data were collected on District Health Information System version two (DHIS2) and analyzed with T-tests to compare the incidence rates before (second semester 2018) and after the distribution of LLINs (second semester 2019). Results the evolution of malaria cases immediately dropped after the distribution campaign. The incidence rates per 1,000 inhabitants in 2018 and 2019 were 106 and 107 respectively in the general population; 302 versus 305 in children aged 0 to 59 months and 219 versus 209 in pregnant women. The differences in incidence were not statistically significant with p values 0.497, 0.4602, and 0.3097 respectively. However, it was observed that the decrease in malaria cases led to a decrease in anaemia cases in general. Conclusion the LLIN distribution campaign did not decrease the incidence of malaria. The synergy of preventive interventions to reduce the incidence of malaria remains key.
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Affiliation(s)
- Theddy Kazadi Kabeya
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Health Regional Division, Kabinda, Lomami, Democratic Republic of Congo
| | - Jean Claude Musasa Kasongo
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Mwene-Ditu Health Zone, Lomami, Democratic Republic of Congo
| | | | | | | | - Eduardo Burgueño
- Centre Médical Vésale, Ngaliema, Kinshasa, Democratic Republic of Congo
- School of Medicine, Official University of Mbujimayi, Kasai-Oriental, Democratic Republic of Congo
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Rubenstein BL, Chinkhumba J, Chilima E, Kwizombe C, Malpass A, Cash S, Wright K, Troell P, Nsona H, Kachale F, Ali D, Kaunda E, Lankhulani S, Kayange M, Mathanga DP, Munthali J, Gutman JR. A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi. Malar J 2022; 21:195. [PMID: 35729612 PMCID: PMC9210049 DOI: 10.1186/s12936-022-04216-4] [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: 10/15/2021] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria in pregnancy doubles the risk of low birthweight; up to 11% of all neonatal deaths in sub-Saharan Africa are associated with malaria in pregnancy. To prevent these and other adverse health consequences, the World Health Organization recommends administering intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine for all pregnant women at each antenatal care (ANC) visit, starting as early as possible in the second trimester. The target is for countries to administer a minimum of three doses (IPTp3+) to at least 85% of pregnant women. Methods A cluster randomized, controlled trial was conducted to assess the effect of delivery of IPTp by community health workers on the coverage of IPTp3 + and ANC visits in Malawi. Community delivery of IPTp was implemented within two districts in Malawi over a 21-month period, from November 2018 to July 2020. In control sites, IPTp was delivered at health facilities. Representative samples of women who delivered in the prior 12 months were surveyed at baseline (n = 370, December 2017) and endline (n = 687, August 2020). A difference in differences analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results Overall IPTp coverage increased over the study period. At baseline, women received a mean of 2.3 IPTp doses (range 0–5 doses) across both arms, and at endline, women received a mean of 2.8 doses (range 0–9 doses). Despite overall increases, the change in IPTp3 + coverage was not significantly different between intervention and control groups (6.9%, 95% CI: -5.9%, 19.6%). ANC4 + coverage increased significantly in the intervention group compared with the control group, with a difference-in-differences of 25.3% points (95% CI: 1.3%, 49.3%). Conclusions In order to reduce the burden of malaria in pregnancy, new strategies are needed to improve uptake of effective interventions such as IPTp. While community health workers’ delivery of IPTp did not increase uptake in this study, they may be effective in other settings or circumstances. Further research can help identify the health systems characteristics that are conducive to community delivery of IPTp and the operational requirements for effective implementation. Trial registration: ClinicalTrials.gov Identifier: NCT03376217. Registered December 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03376217.
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Affiliation(s)
- Beth L Rubenstein
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | - Jobiba Chinkhumba
- University of Malawi College of Medicine, Malaria Alert Centre, Blantyre, Malawi
| | - Ethel Chilima
- Management Sciences for Health (MSH), Lilongwe, Malawi
| | - Collins Kwizombe
- U.S. President's Malaria Initiative, United States Agency for International Development (USAID), Lilongwe, Malawi
| | - Ashley Malpass
- U.S. President's Malaria Initiative, United States Agency for International Development (USAID), Washington, D.C, USA
| | - Shelby Cash
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Peter Troell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | | | | | | | | | | | - Don P Mathanga
- University of Malawi College of Medicine, Malaria Alert Centre, Blantyre, Malawi
| | - John Munthali
- Management Sciences for Health (MSH), Lilongwe, Malawi
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA, 30329, USA.
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Malaria and Helminthic Co-Infection during Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095444. [PMID: 35564842 PMCID: PMC9101176 DOI: 10.3390/ijerph19095444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/22/2022]
Abstract
Malaria and helminthic co-infection during pregnancy causes fetomaternal haemorrhage and foetal growth retardation. This study determined the pooled burden of pregnancy malaria and helminthic co-infection in sub-Saharan Africa. CINAHL, EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were used to retrieve data from the literature, without restricting language and publication year. The Joanna Briggs Institute’s critical appraisal tool for prevalence studies was used for quality assessment. STATA Version 14.0 was used to conduct the meta-analysis. The I2 statistics and Egger’s test were used to test heterogeneity and publication bias. The random-effects model was used to estimate the pooled prevalence at a 95% confidence interval (CI). The review protocol has been registered in PROSPERO, with the number CRD42019144812. In total, 24 studies (n = 14,087 participants) were identified in this study. The pooled analysis revealed that 20% of pregnant women were co-infected by malaria and helminths in sub-Saharan Africa. The pooled prevalence of malaria and helminths were 33% and 35%, respectively. The most prevalent helminths were Hookworm (48%), Ascaris lumbricoides (37%), and Trichuris trichiura (15%). Significantly higher malaria and helminthic co-infection during pregnancy were observed. Health systems in sub-Saharan Africa must implement home-grown innovative solutions to underpin context-specific policies for the early initiation of effective intermittent preventive therapy.
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Walsh CM, Mwase T, De Allegri M. How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II. Int J Health Plann Manage 2020; 35:1571-1592. [PMID: 33030271 DOI: 10.1002/hpm.3055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022] Open
Abstract
Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.
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Affiliation(s)
- Caitlin M Walsh
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Takondwa Mwase
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Manuela De Allegri
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
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Azizi SC. Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015-2016. BMC Public Health 2020; 20:335. [PMID: 32178658 PMCID: PMC7077170 DOI: 10.1186/s12889-020-08471-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background Malawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp with SP among pregnant women in Malawi after the adoption and operationalisation of updated WHO IPTp-SP policy. Methods The 2015–16 Malawi Demographic and Health Survey dataset was analysed. Of 1219 women aged 15–49 years who had live births and the children were born after the date of July 2015, 1069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account a complex survey sample design. Results Of the 1069 women, 447 (42, 95% CI: 38.1–45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR = 0.71, 95% CI 0.49–1.02) and (AOR = 0.12, 95% CI 0.06–0.21) respectively. Conclusions To achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. Moreover, there is limited effectiveness of an increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp with SP doses during pregnancy.
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Affiliation(s)
- Steven Chifundo Azizi
- Malawi Defence Force, Malawi Military Health Services, Kamuzu Barracks, Lilongwe, Malawi.
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Mwendera CA, de Jager C, Longwe H, Kumwenda S, Hongoro C, Phiri K, Mutero CM. Challenges to the implementation of malaria policies in Malawi. BMC Health Serv Res 2019; 19:194. [PMID: 30917823 PMCID: PMC6437884 DOI: 10.1186/s12913-019-4032-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite malaria prevention initiatives, malaria remains a major health problem in Malawi, especially for pregnant mothers and children under the age of five. To reduce the malaria burden, Malawi established its first National Malaria Control Programme in 1984. Implementation of evidence-based policies contributed to malaria prevalence dropping from 43% in 2010 to 22% in 2017. In this study, we explored challenges to implementing malaria policies in Malawi from the perspective of key stakeholders in the country. METHODS In this qualitative study, we conducted in-depth interviews with 27 key informants from April to July 2015. We stopped sampling new participants when themes became saturated. Purposive and snowballing sampling techniques were used to identify key informants including malaria researchers that were policy advisors, policy makers, programme managers, and other key stakeholders. Interviews were conducted in English, recorded and transcribed, and imported into QSR Nvivo 11 for coding and analysis. Data were analysed using the qualitative content analysis approach. RESULTS Participants identified three main categories of challenges to the implementation of malaria policies. First structural challenges include inadequate resources, unavailability of trained staff, poor supervision and mentorship of staff, and personnel turnover in government. The second challenge is unilateral implementation of policies. The third category is the inadequately informed policy development and includes lack of platforms to engage with communities, top-down approach in policy formulation and lack of understanding of socio-cultural factors affecting policy uptake by communities. CONCLUSIONS Policy makers should recognize that inadequate support of policy objectives leads to an implementation gap. Therefore, policy development and implementation should not be viewed as distinct, but rather as interactive processes shaping each other. Support for health policy and systems research should be mobilized to strengthen the health system. Detailed assessment of implementation challenges to specific malaria policies should also be conducted to address these challenges and support the shift from the paradigm of malaria prevention and control to elimination in Malawi.
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Affiliation(s)
- Chikondi A. Mwendera
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
| | - Christiaan de Jager
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
| | - Herbert Longwe
- ICAP at Columbia University, Mailman School of Public Health, Pretoria, South Africa
| | - Save Kumwenda
- Department of Environmental Health, the Polytechnic, University of Malawi, private bag 303, Blantyre, Malawi
| | - Charles Hongoro
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
- Population Health, Health Systems and Innovation, Human Sciences Research Council (HSRC), Pretoria, South Africa
| | - Kamija Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Clifford M. Mutero
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
- International Centre of Insect Physiology and Ecology (ICIPE), P.O. Box 30772, Nairobi, Kenya
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Henry M, Florey L, Youll S, Gutman JR. An analysis of country adoption and implementation of the 2012 WHO recommendations for intermittent preventive treatment for pregnant women in sub-Saharan Africa. Malar J 2018; 17:364. [PMID: 30326904 PMCID: PMC6192297 DOI: 10.1186/s12936-018-2512-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022] Open
Abstract
Background An estimated 30 million women give birth annually in malaria endemic areas of sub-Saharan Africa. Malaria in pregnancy is associated with an increased risk of adverse maternal and infant outcomes. To combat the adverse effects of MiP, the World Health Organization (WHO) recommends the provision of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp–SP) in areas of moderate to high malaria transmission. In 2012, the WHO updated its policy with respect to IPTp administration to recommend administration at each antenatal care visit in the second and third trimesters, with a minimum of three, rather than two, doses. While rapid improvements in coverage were expected, gains have occurred more slowly than anticipated. Methods The President’s Malaria Initiative (PMI) assessed IPTp uptake before and after countries implemented the new WHO policy, and assessed how long it took for implementation to occur, using a combination of data from household surveys, routine health management information systems, and programmatic data provided to PMI. Results It took an average of 2 years for countries to complete the process of revising their IPTp policies, and it was not until 2015 that all 17 PMI countries had updated their policies. Policy dissemination and training had not been completed in several countries as of early 2018, and only seven countries had fully implemented the new policy including updating their antenatal care registers to collect information on IPTp3+ coverage. The coverage of IPTp1+, 2+, and 3+ has increased by 19, 16, and 13 percentage points since the revised IPTp policy adoption. Discussion Overall, coverage of both IPTp2+ and IPTp3+ has improved in recent years. The change in policy from a minimum of two to a minimum of three doses has likely contributed to these improvements. Progress has been slow, likely related to the complicated process of policy adoption exacerbated by the lag in measurement through national household surveys. The impact of future policy changes may be more readily seen if the policy change and implementation process were more streamlined and coordinated between key stakeholders (National Malaria Control Programmes and Reproductive Health Programmes), with more real-time data reporting. Electronic supplementary material The online version of this article (10.1186/s12936-018-2512-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marianne Henry
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Lia Florey
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Susan Youll
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Julie R Gutman
- Malaria Branch, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop A06, Atlanta, GA, 30322, USA.
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Azizi SC, Chongwe G, Chipukuma H, Jacobs C, Zgambo J, Michelo C. Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: a cross-sectional study. BMC Pregnancy Childbirth 2018; 18:108. [PMID: 29678150 PMCID: PMC5910602 DOI: 10.1186/s12884-018-1744-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/12/2018] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Malaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Zomba district IPTp uptake falls far below the national average. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district after adoption of new IPTp-SP policy in 2014. METHODS This was a cross-sectional survey. Two public health facilities (HFs) were randomly selected from urban and rural areas in Zomba district. Study participants were postpartum women selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire. Bivariate and multiple logistic regression was used in data analysis. RESULTS Out of all the enrolled participants (n = 463), 92% women had complete information for analysis. Of these, (n = 426) women, 127 (29.8%, 95% CI: 25.6%-34.3%) received three or more doses of SP, 299 (70.2%, 95% CI: 65.7%-74.4%) received two or less doses. Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR = 0.31, 95% CI 0.13-0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR = 0.29, 95% CI 0.18-0.48); not taking SP under direct observation therapy (DOT) (AOR = 0.18, 95% CI (0.05-0.63). CONCLUSIONS There is low utilisation of at least three doses of SP in this population and this seems to be associated with the number of ANC visits and use of DOTs. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.
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Affiliation(s)
- Steven Chifundo Azizi
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Post Box 50110, Lusaka, Zambia. .,Malawi Defence Force, Malawi Military Health Services, Kamuzu Barracks, Private Bag 43, Lilongwe, Malawi.
| | - Gershom Chongwe
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Post Box 50110, Lusaka, Zambia
| | - Helen Chipukuma
- Department of Health Policy and Management, School of Public Health, University of Zambia, Post Box 50110, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Post Box 50110, Lusaka, Zambia
| | - Jessy Zgambo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Post Box 50110, Lusaka, Zambia
| | - Charles Michelo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Post Box 50110, Lusaka, Zambia
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Odjidja EN, Duric P. Evaluation of demand and supply predictors of uptake of intermittent preventive treatment for malaria in pregnancy in Malawi. MALARIAWORLD JOURNAL 2017; 8:20. [PMID: 34532243 PMCID: PMC8415061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The intermittent preventive treatment (IPTp) policy of Malawi (2002) stipulates that IPTp is administered during antenatal care as a direct observation therapy (DOT). The policy further recommends that IPT should be administered monthly after 16 weeks of pregnancy until delivery. This study assessed both the demand and supply factors contributing to higher dropout of IPT after the first dose. Optimal number of doses was pegged at a minimum of three in accordance with WHO recommendation. MATERIALS AND METHODS Data were analysed from the Malawi multiple indicator cluster survey (2015) and the service provision assessment (2014) of 6637 women (aged 15- 49 yrs), 763 facilities and 2105 health workers. The sample was made up of pregnant women, health facilities and workers involved in routine antenatal services across all regions of Malawi. A composite indicator was constructed to report integration of IPTp with ANC services and administration of IPTp-SP as DOT. Multivariate and logistic regression were conducted to determine associations. RESULTS Regression analysis found that: 1. Age of women (women 35-49 yrs, AOR 1.98; 95% CI 1.42 - 2.13, number of children as well as the number of ANC visits were associated with optimal uptake of IPTp. 2. Administering IPT as DOT was higher in facilities in rural areas (AOR 1.86; 95% CI 1.54 - 1.92) than in urban areas. 3. Administration of IPTp as DOT was relatively lower in across all facilities with highest being facilities managed by CHAM (72.8%, AOR 1.40; 95% CI 1.22 - 1.54). CONCLUSION Health system bottlenecks were found to present the main cause of low coverage with optimal doses of IPTp. Incorporating these results into strategic policy IPTp formulation could help improve coverage to desired levels. This study could serve as plausible evidence for government and donors when planning malaria in pregnancy interventions, especially in remote parts of Malawi.
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Affiliation(s)
- Emmanuel N. Odjidja
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom,*
| | - Predrag Duric
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
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Development of a framework to improve the utilisation of malaria research for policy development in Malawi. Health Res Policy Syst 2017; 15:97. [PMID: 29157288 PMCID: PMC5697395 DOI: 10.1186/s12961-017-0264-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhance knowledge translation. These efforts aim at maximising health research utilisation in policy and practice to address the world's disease burdens, including malaria. This study aimed at developing a contextual framework to improve the utilisation of malaria research for policy development in Malawi. METHODS The study used two approaches including: two case studies of policy analysis exploring the policy-making process in Malawi, utilisation of local malaria research, and the role of key stakeholders in policy formulation process; and the assessment of facilitating factors and barriers to malaria research utilisation for policy-making in Malawi. RESULTS From the case studies' lessons and elements identified during the assessment of facilitating factors and barriers, a framework is developed to promote an integrated approach to knowledge translation. In this framework the Ministry of Health is considered as the main user of knowledge from research through the demand created by the research directorate and the National Malaria Control Programme. Key documents identified as being particularly relevant to the Ministry of Health for purposes of knowledge translation include the National Health Research Agenda, Guidelines for Policy Development and Analysis, and Guidelines for Evidence Use in Policy-making. Institutions conducting academic and policy-relevant malaria research in Malawi are identified and a consolidation of their linkages with the users of research is established through the Knowledge Translation Unit, the Evidence Informed decision-making Centre, and the African Institute for Development Policy. Equally, key players in this framework are the funding partners for both research and programmes that need to see accountability and impact of their support. Independent advisors, partners, and consultants also have their vital role in the process. CONCLUSION The framework offers a practical basis for the factors identified and their linkages to promote a co-ordinated approach to malaria research utilisation in policy-making. Its applicability and success hinges on its wider dissemination and ownership by the government through the National Malaria Control Programme.
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