BackgroundMalaria 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.MethodsThis 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.ResultsOut 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).ConclusionsThere 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.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1744-y) contains supplementary material, which is available to authorized users.

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.

Background: Community Health Workers (CHWs) are an important human resource in improving community malaria intervention coverages and success in reducing malaria incidence has been attributed to them. However, despite this attribution, malaria resurgence cases have been reported in various countries including Zambia. This study aims to evaluate the implementation fidelity of CHW roles in malaria prevention and control programs in Livingstone through performance and service quality assessment. Methods: A mixed method concurrent cross-sectional study based on quantitative and qualitative approaches was used to evaluate performance and service quality of the CHW roles for selected catchments areas in Livingstone district. For the quantitative approach, (34) CHWs were interviewed and a community survey was also done with 464 community participants. For qualitative approach, two focused group discussions with CHWs and three key informant interviews from the CHW supervisors were done. Results: Overall implementation fidelity to the CHW roles was low with only 5(14.7%) of the CHWs having good performance and least good quality service while 29 (85.3%) performed poorly with substandard service. About 30% of households reported having experienced malaria cases but CHWs had low coverage in testing with RDT (27%) for malaria index case service response with treatment at 14% coverage and provision of health education at 23%. For other households without malaria cases, only 27% had received malaria health education and 15% were screened for malaria. However, ITN distribution, sensitization for IRS were among other CHW services received by the community but were not documented in CHW registers for evaluation. Factors that shaped fidelity were being married, record for reports, supervision, and work experience as significant factors associated with performance. Lack of supplies, insufficient remuneration and lack of ownership by the supervising district were reported to hinder ideal implementation of the CHW strategy.

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 1,219 women aged 15-49 years who had live births and the children were born after the date of July 2015, 1,069 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 1,069 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.