Community‐based distribution of sulfadoxine‐pyrimethamine for intermittent preventive treatment of malaria during pregnancy improved coverage but reduced antenatal attendance in southern Malawi

Abstract

Summaryobjective To evaluate the impact of a 2-year programme for community-based delivery of sulfadoxine-pyremethamine (SP) on intermittent preventive treatment during pregnancy coverage, antenatal clinic attendance and pregnancy outcome.methods Fourteen intervention and 12 control villages in the catchment areas of Chikwawa and Ngabu Government Hospitals, southern Malawi, were selected. Village-based community health workers were trained in information, education and counselling on malaria control in pregnancy and the importance of attending antenatal clinics and promoted these messages to pregnant women. In the intervention group community health workers also distributed SP to pregnant women.results In the control area, coverage of intermittent preventive treatment during pregnancy (>2 doses) was low before (44.1%) and during the intervention (46.1%). In the intervention area, coverage increased from 41.5% to 82.9% (P < 0.01). Antenatal clinic attendance (>2 visits) was maintained in control villages at above 90%, but fell in intervention villages from 87.3% to 51.5% (P < 0.01). Postnatal malaria parasitaemia prevalence fell in women from both study areas during the intervention phase (P < 0.05). Increasing the coverage of intermittent preventive treatment during pregnancy to >40% did not significantly improve maternal haemoglobin or reduce low birthweight prevalence.conclusions Better coverage of community-based intermittent preventive treatment during pregnancy can lower attendance at antenatal clinics; thus its effect on pregnancy outcome and antenatal attendance need to be monitored.

The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

“…These included community case management or home management of malaria with or without the use of rapid diagnostic tests [54], distribution of intermittent preventive treatment (IPT) to pregnant women and children [55–57] and the promotion of insecticide-impregnated bed nets [58]. …”

Maternal nutrition: how is Eastern and Southern Africa faring and what needs to be done?

“…Multiple micronutrient supplementation (MMN) among pregnant and lactating women significantly improved hemoglobin, serum ferritin, birth weight, small-for-gestational age (SGA), anemia in children with non-significant impact on serum retinol levels and preterm birth [52][53][54][55][56][57][58][59][60][61] . Malaria prevention in pregnancy showed that the use of ITNs in pregnancy sig- nificantly reduced the risk of peripheral parasitemia [62][63][64][65][66][67] . These findings should be interpreted with caution as limited number of studies were pooled for each intervention due to restricted region and population for inclusion.…”

Impact of community-based interventions for the prevention and control of malaria on intervention coverage and health outcomes for the prevention and control of malaria

“…All the studies were conducted in African countries except for three studies, one each from China, India, and Thailand. Interventions were non-integrated in 23 [10,12-14,16-18,20-22,28-33,37,39-42,45,47] of the studies, while in 17 [8,9,19,23-27,34-36,43,44,46,48-50] studies intervention was integrated with routine community-based antenatal care (ANC), primary healthcare (PHC), child health days or measles, and polio campaigns. The primary comparison was between the community-based delivery strategy versus routine or facility-based care.…”

“…The integration of CBIs for malaria with existing ANC and immunization campaigns is reportedly more feasible and acceptable, and has reported improved coverage of IPTp to pregnant women [36]. The integration of malaria control programs with such promotional campaigns has resulted in a major increase in treatment coverage and ITNs distribution at a very low cost [23,24,36,43].…”

“…The integration of malaria control programs with such promotional campaigns has resulted in a major increase in treatment coverage and ITNs distribution at a very low cost [23,24,36,43]. Several features of ITNs distribution and mass measles vaccination campaigns favor the sustainability of an integrated approach.…”