Assessment of the impact of availability and readiness of malaria services on uptake of intermittent preventive treatment in pregnancy (IPTp) provided during ANC visits in Tanzania

Abstract

Background Intermittent preventive treatment during pregnancy (IPTp) is a highly-recommended intervention to prevent maternal and neonatal complications associated with malaria infection. Despite fairly high antenatal care (ANC) coverage in Tanzania, low IPTp uptake rates represent a gap in efforts to decrease complications attributed to malaria in pregnancy. The objective of this study was to examine if availability, readiness and managing authority are associated with uptake of IPTp during ANC. Methods Data for this analysis come from a cross-sectional survey, the Tanzania Service Provision Assessment conducted between 2014 and 2015. Principal component analysis was used to create scores for availability of malaria services and readiness for the provision of services. Generalized estimating equation models with logit link and the binomial distribution assessed factors that impact the uptake of IPTp by pregnant women attending ANC. Results Higher fraction of women in their third trimester than second (68% versus 49%, OR = 2.6; 95% CI (2.1–3.3)), had received at least one dose of IPTp. There was a wide variation in the availability and readiness of malaria services provision and diagnostic tools by managing authorities. Public facilities were more likely than private to offer malaria rapid diagnostic test, and more providers at public facilities than private diagnosed and/or treated malaria. Women who attended facilities where direct observation therapy was practiced were more likely to have received at least one dose of IPTp (64% versus 46% who received none; p < 0.001). Women who attended ANC at a facility with a high readiness score were more likely to take IPTp than those attending facilities with low readiness scores (OR = 2.1; 95% CI (1.4–3.3)). Reported stock out on the day of interview was negatively associated with IPTp uptake (OR 0.09; 95% CI 0.07–0.1). Conclusion Readiness of health facilities to provide malaria related services, the number of ANC visits and gestational age were associated with uptake of IPTp among women attending ANC. There are disparities in malaria service availability and readiness across geographical location and managing authorities. These findings could be used to assist the malaria programme and policymakers to appropriately decide when planning for malaria service deliveries and interventions. Electronic supplementary material The online version of this article (10.1186/s12936-019-2862-3) contains supplementary material, which is available to authorized users.

Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: further analysis of the data of the 2015–2016 Tanzania demographic and health survey and malaria indicator survey

“…The clinics are responsible for sending the staff for the training. However, private clinics were observed to send a few numbers of staff compared to public clinics for training [ 29 ]. The low proportion of trained staff at the private clinics could affect the provision of SP and hence the uptake of optimal doses of SP among pregnant women.…”

How to Estimate Optimal Malaria Readiness Indicators at Health-District Level: Findings from the Burkina Faso Service Availability and Readiness Assessment (SARA) Data

“…Beyond these descriptive statistics, health facility readiness indicators are also increasingly being used in SSA countries to assess the health system strengthening through the construction of a composite score [33][34][35]. In some studies, either principal component analysis (PCA) [36][37][38][39] or multiple correspondences analysis (MCA) [40,41] was directly applied to readiness indicators, which are usually defined as binary variables [8,16,40].…”

How to Optimally Estimate Malaria Readiness Indicators at the Health district Level? Findings from the Burkina Faso Service Availability and Readiness Assessment (SARA) Cross-Sectional Data

“…Beyond these descriptive statistics, health facility readiness indicators are also increasingly being used in SSA countries to assess the health system strengthening through the construction of a composite score [33][34][35]. In some studies, either principal component analysis (PCA) [36][37][38][39] or multiple correspondences analysis (MCA) [40,41] was directly applied to readiness indicators, which are usually defined as binary variables [8,16,40].…”