Availability and utilization of malaria prevention strategies in pregnancy in eastern India

Abstract

BackgroundMalaria in pregnancy in India, as elsewhere, is responsible for maternal anemia and adverse pregnancy outcomes such as low birth weight and preterm birth.It is not known whether prevention and treatment strategies for malaria in pregnancy (case management, insecticide-treated bednets, intermittent preventive therapy) are widely utilized in India.MethodsThis cross-sectional study was conducted during 2006-2008 in two states of India, Jharkhand and Chhattisgarh, at 7 facilities representing a range of rural and urban populations and areas of more versus less stable malaria transmission. 280 antenatal visits (40/site) were observed by study personnel coupled with exit interviews of pregnant women to assess emphasis upon, availability and utilization of malaria prevention practices by health workers and pregnant women. The facilities were assessed for the availability of antimalarials, lab supplies and bednets.ResultsAll participating facilities were equipped to perform malaria blood smears; none used rapid diagnostic tests. Chloroquine, endorsed for chemoprophylaxis during pregnancy by the government at the time of the study, was stocked regularly at all facilities although the quantity stocked varied. Availability of alternative antimalarials for use in pregnancy was less consistent. In Jharkhand, no health worker recommended bednet use during the antenatal visit yet over 90% of pregnant women had bednets in their household. In Chhattisgarh, bednets were available at all facilities but only 14.4% of health workers recommended their use. 40% of the pregnant women interviewed had bednets in their household. Only 1.4% of all households owned an insecticide-treated bednet; yet 40% of all women reported their households had been sprayed with insecticide. Antimalarial chemoprophylaxis with chloroquine was prescribed in only 2 (0.7%) and intermittent preventive therapy prescribed in only one (0.4%) of the 280 observed visits.ConclusionsA disconnect remains between routine antenatal practices in India and known strategies to prevent and treat malaria in pregnancy. Prevention strategies, in particular the use of insecticide-treated bednets, are underutilized. Gaps highlighted by this study combined with recent estimates of the prevalence of malaria during pregnancy in these areas should be used to revise governmental policy and target increased educational efforts among health care workers and pregnant women.

Attitudes, Knowledge, and Practices Regarding Malaria Prevention and Treatment among Pregnant Women in Eastern India

“…The difference in perceptions of availability and affordability of bed nets and coils reinforces evidence indicating uneven implementation of India's malaria control policy. 13,14,23 Given the relative isolation and lower levels of income of Konbir, it was not surprising that respondents there reported greater difficulty obtaining prevention items.…”

“…Pregnant women often used untreated nets whereas chemoprophylaxis was rarely used. 23 To our knowledge, this is the first report that uses qualitative methods to examine these issues among pregnant women in India.…”

“…12,22 Surveys of pregnant women in eastern India showed that bed nets were widely available and used, although other prevention measures, such as chemoprophylaxis and ITNs, were underused. 14,23 In central India, sociocultural barriers to acceptance of malaria chemoprophylaxis among pregnant women were found to include fear of mixing medications, concerns about medications not prescribed by antenatal clinics, and infertility conspiracies. 24 Given the mixed record on implementation of malaria prevention and treatment measures, and the need for greater understanding of barriers to implementation among pregnant women, we conducted a qualitative study among pregnant women in the state of Jharkhand, India, as one component of a large cross-sectional study of the burden of MIP.…”

Malaria in pregnancy in the Asia-Pacific region

“…126,127 Recommendations about regimens to use in treatment of malaria during pregnancy are notably absent in many settings. 128 A major disconnect has been identifi ed between routine antenatal practices and known strategies to prevent and treat malaria in pregnancy. 128 13 (62%) of 21 studies into antimalarial pharmacokinetics in pregnancy worldwide have been done in the Asia-Pacifi c region.…”

Intrauterine deaths: challenges faced in developing countries

“…Most common reason for hyperthermia was malaria. 20,21 Malaria is known to cause intrauterine growth retardation by depleting placental transport of nutrients and cause placental changes in the trophoblast. Malaria further causes maternal anaemia, and hence can leads to intrauterine growth restriction.…”