Acceptability of single screening and treatment policy for the control of malaria in pregnancy: perceptions of providers and pregnant women from selected health facilities in Lindi region, Tanzania

Kitojo, Chonge; Chacky, Frank; Kigadye, Emmanuel; Mugasa, Joseph P.; Lusasi, Abdallah; Mohamed, Ally; Reaves, Erik J.; Gutman, Julie; Ishengoma, Deus S.

doi:10.1186/s12936-021-03782-3

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Implementation of testing for malaria with an RDT is already underway in all ANC facilities in Tanzania. Because blood for the RDT is obtained at the same time as blood for other routine labs, performing the RDT led to minimal additional workload for the providers, as documented in previous studies [16,[26][27][28]. On the other hand, providers noted that implementation of the questionnaire would add to their workload and cited a need for training as has been found in other studies [28].…”

Section: Discussionmentioning

confidence: 62%

“…Although there are data demonstrating the validity of ANC surveillance for estimating malaria prevalence, there are limited data on the perspectives of providers, as well as pregnant or recently delivered women themselves; further, none of these studies considered aspects other than surveillance for malaria prevalence [16]. As there is consideration of the role that ANC surveillance could play in monitoring malaria burden and coverage of malaria control interventions, it is critical to hear perspectives from those who would perform the work and receive services [17].…”

Section: Introductionmentioning

confidence: 99%

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Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers

Emerson

Ulimboka²,

Lemwayi³

et al. 2023

Malar J

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Background Measurement of malaria prevalence is conventionally estimated through infrequent cross-sectional household surveys that do not provide continuous information regarding malaria parasitaemia. Recent studies have suggested that malaria parasitaemia prevalence among women attending antenatal care (ANC) correlates with prevalence among children under 5 years old and that pregnant women could be a sentinel population for tracking malaria prevalence. In mainland Tanzania, 97% of women are tested for malaria parasitaemia during first ANC visits. However, acceptability among pregnant women and healthcare providers of collecting malaria risk factor data during ANC visits is limited. Methods A tablet-based questionnaire including 15 questions on insecticide-treated net ownership and use and care-seeking for febrile children was introduced at 40 healthcare facilities in Geita Region, Tanzania. Facilities were randomly selected from among those with 15–120 first ANC visits per month. To assess perspectives regarding introduction of the questionnaire, 21 semi-structured interviews were held with providers and facility in-charges at 12 facilities. Thirty pregnant and recently delivered women participated in focus group discussions at seven facilities to assess the acceptability of spending additional time answering questions about malaria risk. Results All pregnant women reported that introduction of ANC surveillance and spending 10 more minutes with providers answering questions about their health would be neutral or beneficial. They perceived being asked about their health as standard of care. Providers and in-charges reported that introduction of ANC surveillance was within their scope of practice. Nine of 21 indicated it could potentially benefit women’s health. Six providers expressed concern about staffing shortages and need for reimbursement for extra time and noted that data management occurs after hours. Conclusions Pregnant women and providers generally perceived ANC surveillance for malaria as acceptable and positive. Pregnant and recently delivered women saw this as a reasonable and even helpful intervention. To be seen as a part of standard practice, efforts are needed to ensure providers perceive a benefit for ANC clients and that staffing concerns are addressed. In addition, staff should receive feedback related to data submissions regarding malaria prevalence and risk factors among women at their facility, with actions to take.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers

Emerson

Ulimboka²,

Lemwayi³

et al. 2023

Malar J

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“…The main challenges to uptake of SP-IPTp were missed ANC contacts, knowledge gaps among pregnant women about the importance of SP-IPTp, drug stock-outs, provider neglect/absenteeism, adverse drug reactions, and change of residence Kitojo [46] 97% had a favorable perception of the screening; 95% satisfied with the service; 99% would recommend continuing with the ministry's strategy; 76% experienced pain and 16% anxiety in taking a blood sample for diagnosis Service providers consider the screening and treatment policy favorable; the main challenge is that nurses cannot prescribe antimalarials. Health workers had a good understanding of the policy.…”

Section: Methodological Quality and Main Topicsmentioning

confidence: 99%

Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention

Cardona‐Arias

2022

TropicalMed

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Malaria in pregnancy (MiP) is a global public health problem; its research is predominantly quantitative. The objective was to analyze the individual, cultural and socioeconomic determinants of the treatment and prevention of MiP with a systematic review of mixed studies (search had no date restriction). Reproducibility and evaluation of the methodological quality were guaranteed. 21 studies were included (20 from Africa). The quantitative component included 7816 pregnant women and 483 health workers. The qualitative component included 800 subjects (pregnant women, health workers, family members and community leaders). The main topics were the use and acceptability of WHO strategies to prevent MiP, individual determinants related with knowledge, perceptions, attitudes and behaviors on MiP, and cultural and socioeconomic barriers for its treatment and prevention. The main determinants of MiP were long distance to the clinic, lack of economic resources, low-coverage antenatal care, few health workers in the communities, drug shortages, cultural rules that prevent women’s participation in health issues, and misconceptions about MiP. MiP has determinants related to economic conditions, the structure and functioning of the health system, symbolic and cultural aspects, as well as knowledge, beliefs, perceptions and behavior of pregnant women, which prevent optimal access and use of preventive strategies. This study evidences the importance of intersectional, intersectoral, and interdisciplinary work to prevent MiP.

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“…This requires minimal explanation because women living in malaria endemic areas are aware of malaria and the risk associated with it and welcome the opportunity to be tested for malaria. 21 Nurses are also well versed in malaria RDT procedures and, in accordance with most case management procedures, will already perform an RDT for any women presenting or reporting malaria symptoms during these visits, and treat anyone testing positive. Therefore, conducting RDTs for all women attending their first ANC visit does not introduce substantial additional time or burden 21 and, at approximately USD $0.35 per RDT, is relatively inexpensive.…”

Section: Challenges Of Anc Surveillancementioning

confidence: 99%

“…21 Nurses are also well versed in malaria RDT procedures and, in accordance with most case management procedures, will already perform an RDT for any women presenting or reporting malaria symptoms during these visits, and treat anyone testing positive. Therefore, conducting RDTs for all women attending their first ANC visit does not introduce substantial additional time or burden 21 and, at approximately USD $0.35 per RDT, is relatively inexpensive. 22 This changes, however, if other malaria programmatic indicators are introduced.…”

Section: Challenges Of Anc Surveillancementioning

confidence: 99%

Routine Healthcare Facility– and Antenatal Care–Based Malaria Surveillance: Challenges and Opportunities

Gutman

Thwing

Mwesigwa³

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Most monitoring and evaluation tools for measuring malaria burden, intervention coverage, and impact of interventions use periodic nationally representative cross-sectional household surveys. These provide advantages in terms of selecting a large, unbiased, population-based sample; however, they are infrequently conducted, are resource-intensive, and do not provide longitudinal data with sufficient granularity. Given the heterogeneity of malaria transmission within most endemic countries, systems with the capacity to provide more granular and frequent data would be more actionable by national malaria control programs and local implementing partners. There is increasing interest in using routine health facility data, usually from outpatient department visits, for monitoring malaria burden. Data from pregnant women attending antenatal care (ANC) could minimize bias related to fever care-seeking among outpatient department visits and provide more granular parasite prevalence data. Most pregnant women attend ANC at least once and are thus highly representative of the overall pregnant population. A growing body of evidence suggests that malaria parasitemia in pregnant women is correlated with parasitemia in children aged < 5 years in moderate to high transmission areas, allowing for monitoring parasitemia in real time. Additional data are needed to assess whether pregnant women are sufficiently representative of the overall population to yield valid malaria prevalence and intervention coverage estimates. Although use of routinely collected ANC data faces many of the same challenges experienced by other routinely collected health facility data, the opportunity to improve parasite prevalence monitoring and the associated health benefits to mothers and infants of early detection of parasitemia make these efforts valuable.

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Acceptability of single screening and treatment policy for the control of malaria in pregnancy: perceptions of providers and pregnant women from selected health facilities in Lindi region, Tanzania

Cited by 5 publications

References 27 publications

Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers

Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers

Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention

Routine Healthcare Facility– and Antenatal Care–Based Malaria Surveillance: Challenges and Opportunities

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