Moving malaria in pregnancy programs from neglect to priority: experience from Malawi, Senegal, and Zambia

Roman, Elaine; Wallon, Michelle; Brieger, William R.; A, Dickerson; Rawlins, Barbara; Agarwal, Koki

doi:10.9745/ghsp-d-13-00136

Cited by 12 publications

(15 citation statements)

References 11 publications

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“…This echoes concerns raised in the literature that failure to create and maintain strong links between disease-specific programmes can lead to fragmented and ineffective service delivery [ 17 ]. In the case of IPTp, this is particularly significant as it cuts across the remit of malaria, maternal health and potentially other stakeholders, such as those focused on HIV or immunization [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…For policies to be implemented effectively, they need to be communicated and interpreted in a consistent manner across the health system [ 18 ]. A review of national-level malaria in pregnancy documents in Uganda carried out in 2013 revealed that guidance with regard to timing and dosage of IPTp was often inconsistent, with some documents specifying the timing of doses in terms of weeks of pregnancy, while others use months and some do not specify timings at all [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

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Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda

Rassi

Graham

Mufubenga

et al. 2016

Malar J

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BackgroundIntermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP), provided as part of routine antenatal care (ANC), is one of three malaria-in-pregnancy prevention and control mechanisms recommended by the World Health Organization (WHO). However, despite high ANC attendance and increased efforts to address known obstacles, IPTp uptake figures have remained low. This study aimed to identify and assess barriers that continue to impede IPTp uptake in Uganda, in particular for women who attend ANC. The paper focuses on supply-side barriers, i.e., challenges relating to the health service provider.MethodsIn-depth interviews were conducted in two regions of Uganda in November 2013 and April/May 2014 with four different target audiences: seven district health officials, 15 health workers, 19 women who had attended ANC, and five opinion leaders. In addition, a document and record review was carried out at four health facilities.ResultsGuidelines with regard to IPTp provision in Uganda have been shown to be inconsistent and, at the time of the research, did not reflect the most recent WHO policy recommendation. There is a lack of training and supervision opportunities for health workers, resulting in poor knowledge of IPTp guidelines and uncertainty about the safety and efficacy of SP. ANC is not consistently offered in health facilities, leading to some women being denied services. While strengthening of the supply chain appears to have reduced the occurrence of stock-outs of SP in public facilities, stock-outs reportedly continue to occur in the private sector. There are also sources of data inaccuracy along the data recording and reporting chain, limiting policy makers’ ability to react adequately to trends and challenges.ConclusionsGiven the high ANC attendance rates in Uganda, supply-side barriers are likely to account for many missed opportunities for the provision of IPTp in Uganda. Improvements will require consistent provision of ANC, implementation of current WHO IPTp policy recommendations, supply of SP to the private sector, availability of clear guidelines, as well as improved training and supervision for health workers. Improving facility and district-level recording and reporting will further strengthen the country’s ability to address uptake of IPTp.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1405-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda

Rassi

Graham

Mufubenga

et al. 2016

Malar J

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“…In 2015, there were 429,000 malaria-associated deaths in the world and most of these deaths (92%) occurred in sub-Saharan Africa [ 1 ]. Pregnant women living in endemic areas are among the most vulnerable to malaria infection [ 2 , 3 ]. Infection with Plasmodium falciparum during pregnancy is responsible for intra-uterine growth retardation which can lead to low birth weight and early infant death [ 3 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the use of malaria prevention strategies by women in Senegal: a cross-sectional study

Mbengue

Bei

Mboup

et al. 2017

Malar J

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BackgroundThe World Health Organization (WHO) recommends the use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) as a cost-effective intervention for the prevention of malaria during pregnancy in endemic areas. This study was conducted to investigate: (1) the extent of use of both IPTp and ITNs, and (2) conduct multinomial regression to identify factors affecting the optimal usage of IPTp and ITNs among women with a recent pregnancy in Senegal.MethodsData was drawn from the 2013–2014 Demographic and Health Survey. A total of 4616 women aged 15–49 years old, who had a recent pregnancy were analyzed. Multinomial logistic regression model was used to assess factors associated with optimal uptake of malaria preventive strategies (both IPTp and ITN use).ResultsAmongst women who had a recent pregnancy, less than half of them used ITNs (46.84%) however, 80.35% reported taking IPTp during their last pregnancy. Overall, 37.51% reported using the optimal malaria preventive strategies. Women aged 35–49 years and living in the richer or middle wealth quintile were more likely to use optimal prevention methods. Pregnant women living in Diourbel, Saint-Louis, Thies, Louga, Fatick and Matam were more likely to use both IPTp-SP and ITNs compared to those living in Dakar. Additionally, women who initiated antenatal care in at least at 6 weeks of pregnancy or who attended four antenatal visits or more were more likely to use optimal malaria preventive methods during pregnancy.ConclusionsThis study has shown important factors that influence the uptake of malaria prevention methods during pregnancy in Senegal. These findings highlight the need for targeted preventive strategies when designing and implementing policies aimed at improving the uptake of these measures during pregnancy in Senegal.

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“…To better understand the features of MIP programs that work well and those that need improvement, Jhpiego, with support from PMI, documented best practices and remaining challenges in MIP programming in three relatively successful countries: Zambia, Malawi, and Senegal. The results of this program assessment have been published elsewhere and are summarized in Box 1 [18].…”

Section: Resultsmentioning

confidence: 99%

“…Engagement with ITN partners can help to increase awareness among pregnant women about the importance of ITN use, and the role of ANC in routine distribution of ITNs among the partners. The eight program areas of MIP are essential health systems components to address when countries are focusing on improving MIP morbidity and mortality rates [18]. As countries consider application of community‐based distribution and/or social mobilization models to augment their existing strategies, it will be essential to document outcomes related to MIP prevention and case management to better understand the feasibility and acceptability of these approaches and guide application.…”

Section: The Way Forwardmentioning

confidence: 99%

Evolution of malaria in pregnancy control: Jhpiego's 10‐year contribution

Roman¹,

Ngindu²,

Orji³

et al. 2015

Intl J Gynecology & Obste

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a b s t r a c t a r t i c l e i n f o Keywords:Focused antenatal care Intermittent preventive treatment Malaria control programs Malaria in pregnancy Sub-Saharan Africa Malaria continues to be a life-threatening illness throughout Sub-Saharan Africa, with pregnant women and children being particularly vulnerable and an estimated 10 000 women and 200 000 newborns dying each year as a result of malaria in pregnancy (MIP). Since 2004, WHO has supported a three-pronged MIP approach: (1) intermittent preventive treatment with sulfadoxine-pyrimethamine; (2) use of insecticide-treated bed nets; and (3) effective case management. The present article identifies benchmarks in Jhpiego's 10-plus years of MIP experience at the regional and national levels that have contributed to its global MIP leadership and aligned programs and policies with global approaches toward malaria elimination. As countries continue to develop and expand MIP programming, support will continue to be essential in the following eight MIP program areas: integration, policy, capacity development, community engagement, quality assurance, commodities, monitoring and evaluation, and financing.

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Moving malaria in pregnancy programs from neglect to priority: experience from Malawi, Senegal, and Zambia

Cited by 12 publications

References 11 publications

Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda

Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda

Factors influencing the use of malaria prevention strategies by women in Senegal: a cross-sectional study

Evolution of malaria in pregnancy control: Jhpiego's 10‐year contribution

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