Assessment of coverage of preventive treatment and insecticide-treated mosquito nets in pregnant women attending antenatal care services in 11 districts in Mozambique in 2011: the critical role of supply chain

Abstract

BackgroundMalaria during pregnancy is associated with poor maternal and pregnancy outcome and the World Health Organization recommends the administration of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) and distribution of insecticide-treated mosquito nets (ITNs) to all pregnant women attending antenatal care (ANC) services. This study was conducted with the aim to assess the uptake of IPTp and ITNs in pregnant women attending ANC services and correlate with ANC attendance and frequency of stock-outs in 22 health facilities Mozambique.MethodsA cross-sectional study was conducted between July and December 2011 in 22 health units in 11 districts situated in 11 provinces in Mozambique. Two health facilities were selected per district (one urban and one rural). Data were collected by reviewing logbooks of antenatal consultations as well as from monthly district reports.ResultsDuring the period under investigation, a total of 23,524 pregnant women attended their 1st antenatal care visits, of which 12,775 (54.3%) and 7581 (32.2%) received one and two doses of IPTp, respectively. In regard to ITNs, a total of 16,436 (69.9%) pregnant women received ITNs. Uptake of IPTp and ITNs by pregnant women at ANC services was higher in southern Mozambique and lower in districts situated in the northern part of the country. Stock-outs of SP and ITNs were reported in 50.0% (11/22) and 54.5% (12/22) of the health facilities, respectively. Coverage of IPTp and ITN in health facilities with stock-outs of SP and ITNs was much lower as compared to health facilities with no stock-outs.ConclusionsAltogether, data from this study shows that coverage of the 2nd dose of IPTp, as well as ITNs, was low in pregnant women attending ANC services in Mozambique. In addition, this data also shows that stock-outs of SP and ITNs were frequent and led to lower coverage of IPTp and ITN, representing a serious barrier for the accomplishment of targets. In conclusion, this study recommends that efforts should be made to improve the supply chains of SP and ITNs.

Use of Intermittent Preventive Treatment among Pregnant Women in Sub-Saharan Africa: Evidence from Malaria Indicator Surveys

“…Malaria is historically recognised as a significant public health concern for healthcare systems in sub-Saharan Africa (SSA), and to date remains a major contributor to maternal and infant morbidity and mortality in the continent [ 1 , 2 , 3 ]. Led by strong political commitments and programmatic efforts by national and international agencies, most countries in SSA have achieved noteworthy progress in increasing the coverage of insecticide-treated nets (ITNs) and antimalarial intermittent preventive therapy in pregnancy (IPTp) that has brought about a subsequent reduction in the prevalence of malaria in the population [ 4 , 5 , 6 ]. There is a growing body of evidence that in the endemic regions malaria in pregnancy (MiP) remains a prominent preventable cause of maternal and infant morbidity and mortality [ 7 ], accounting for about 75,000–200,000 infant deaths in the region [ 8 , 9 ].…”

Uptake of intermittent preventive treatment and pregnancy outcomes: health facilities and community surveys in Chókwè district, southern Mozambique

“…In 2015, only 50% of women in 36 reporting countries in the African region received two SP doses, while only 31% received ≥ 3 doses [ 2 ]. The major factors that have been associated with low IPTp-SP uptake include the number and timing of ANC visits, the lack of knowledge of MiP adverse consequences [ 11 ], systemic factors such as lack of clear policies and guidelines, as well as insufficient training, supervision, and quality assurance at the health facility level [ 10 , 12 – 14 ] and drug stock-outs [ 15 ]. In addition, women that have non-institutional deliveries (deliveries at home) may be more likely to benefit less from health care including prenatal consultations and hence, receive less IPTp-SP doses [ 16 , 17 ].…”

“…In 2014, the national guidelines were updated and implemented countrywide to adjust to the current ≥ 3 SP-dose WHO recommendation [ 21 ]. Although the collection of robust data on IPTp coverage is essential to monitor, evaluate and further improve the currently implemented MiP interventions, in Mozambique IPTp coverage available data is based mainly on routine annual reports from health centres (often lacking completeness and accuracy) [ 21 ], household surveys (HH) of HIV and malaria indicators at the province level [ 22 ] and retrospective studies (which do not reflect the current situation) [ 15 ].…”

Intermittent preventive treatment of malaria in pregnancy: a cross-sectional survey to assess uptake of the new sulfadoxine–pyrimethamine five dose policy in Ghana

“…There are still issues of stock-out and non-adherence to protocols by health care providers [ 8 ]. Several other service related and community factors such as unavailability of skilled attendants at ANC [ 9 ], poor attitudes of staffs and travel distance to health facilities still hinder the implementation of IPTp-SP [ 10 ]. In some cases, the women are given the drug and yet they do not swallow it as it is not always given as directly observed therapy [ 8 ].…”