Evaluation of the national policy of single screening and treatment for the prevention of malaria in pregnancy in two districts in Eastern Indonesia: health provider perceptions

Abstract

BackgroundMalaria in pregnancy has devastating consequences for both the expectant mother and baby. Annually, 88.2 (70%) of the 125.2 million pregnancies in malaria endemic regions occur in the Asia–Pacific region. The control of malaria in pregnancy in most of Asia relies on passive case detection and prevention with long-lasting insecticide-treated nets. Indonesia was the first country in the region to introduce, in 2012, malaria screening at pregnant women’s first antenatal care visit to reduce the burden of malaria in pregnancy. The study assessed health providers’ acceptability and perceptions on the feasibility of implementing the single screening and treatment (SST) strategy in the context of the national programme in two endemic provinces of Indonesia.MethodsQualitative data were collected through in-depth interviews with 86 health providers working in provision of antenatal care (midwives, doctors, laboratory staff, pharmacists, and heads of drug stores), heads of health facilities and District Health Office staff in West Sumba and Mimika districts in East Nusa Tenggara and Papua provinces, respectively.ResultsHealth providers of all cadres were accepting of SST as a preventive strategy, showing a strong preference for microscopy over rapid diagnostic tests (RDTs) as the method of screening. Implementation of the policy was inconsistent in both sites, with least extensive implementation reported in West Sumba compared to Mimika. SST was predominantly implemented at health centre level using microscopy, whereas implementation at community health posts was said to occur in less than half the selected health facilities. Lack of availability of RDTs was cited as the major factor that prevented provision of SST at health posts, however as village midwives cannot prescribe medicines women who test positive are referred to health centres for anti-malarials. Few midwives had received formal training on SST or related topics.ConclusionsThe study findings indicate that SST was an acceptable strategy among health providers, however implementation was inconsistent with variation across different localities within the same district, across levels of facility, and across different cadres within the same health facility. Implementation should be re-invigorated through reorientation and training of health providers, stable supplies of more sensitive RDTs, and improved data capture and reporting.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2426-y) contains supplementary material, which is available to authorized users.

Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

“…Other studies had shown the advantages of RDTs including their cost-effectiveness [12,16,41]. A qualitative study had shown that formal providers like nurses had greater trust in microscopy and some doubted whether RDTs gave correct results [42]. The current study did not indicate such issues in context of CHWs carrying out large-scale screening using RDTs.…”

“…The fear of needle prick in IST was not found to be a big barrier. IST was found to be acceptable to pregnant women and providers in Indonesia [42,47]. The acceptability of IST was found to be high where the providers enjoyed trust of community, especially women [27].…”

“…A recurring theme in literature on 'MiP', from both Africa and Asia, has been of the perceived apprehensions associated with taking anti-malarial drugs during pregnancy [42,[45][46][47][48]. Such fears had posed challenges for IPT but to a lesser extent for IST.…”

Intermittent screening and treatment or intermittent preventive treatment compared to current policy of single screening and treatment for the prevention of malaria in pregnancy in Eastern Indonesia: acceptability among health providers and pregnant women

“…Health providers in western Kenya described microscopy as the gold standard, while RDTs were considered useful in settings without laboratories or electricity but had limited sensitivity and specificity [ 14 ]. Lack of trust in negative RDT results prompted some providers to advise re-checking RDT results using microscopy, as found in an evaluation of the SSTp strategy in West Sumba and Mimika [ 21 ]. Provider mistrust was also reported in Uganda, where only 49% of health workers believed a negative result to be true [ 22 ].…”

Devising a strategy for prevention of malaria in pregnant women in the Asia Pacific

“…6 In 2012, Indonesia was the first country in the region to implement a strategy of screening and treating malaria at the first antenatal visit, with passive case management provided thereafter. 7 In The Lancet Infectious Diseases, Rukhsana Ahmed and colleagues 8 report the results of the first IPT study in the WHO South-East Asia region, a three-arm, open-label, cluster-randomised controlled trial in HIV-negative women from Sumba island (site of low malaria transmission) and southern Papua (site of moderate, year-round, malaria transmission), eastern Indonesia. Participants (of any gravidae between 16 and 30 weeks' gestation) received either single screening with a rapid diagnostic test and treatment with dihydroartemisinin-piperaquine if parasitaemic or passive case detection to delivery, intermittent screening with a rapid diagnostic test at each antenatal visit and treatment with dihydroartemisinin-piperaquine if parasitaemic, or IPT with dihydroartemisininpiperaquine at monthly visits without screening.…”