Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys

Abstract

Background Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, baseline information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.

Effect of referral by community health workers on uptake of intermittent preventive treatment of malaria in pregnancy in Ohaukwu, Ebonyi State Nigeria: An analysis of individual level data from the maternity record booklet.

“…This is of high importance in sub-Saharan Africa, where health systems face both human resource and nancial constraints. However, the low uptake of IPTp3 reported in this study, which is similar to that reported in some sub-Saharan African subregions, (20,27,28) indicates that more improvements in coverage must be made in order to reach the Sustainable Development Goal Target 3.3, to end the malaria epidemic (in addition to the AIDS and tuberculosis epidemics). Future research should explore barriers and facilitators of CHWs interventions to best inform scale-up of these programs.…”

Factors associated with the uptake of Intermittent Preventive Treatment (IPTp-SP) for malaria in pregnancy: further analysis of the 2018 Nigeria Demographic and Health Survey

“…and how many times did you receive SP/Fansidar during this pregnancy?” For statistical analysis, the uptake of at least one dose of IPTp-SP was categorised and coded into 0 = no dose of IPTp-SP and 1 = at least one dose of IPTp-SP (≥1 dose). The uptake of optimal doses of IPTp-SP was categorised and coded into 0 = two or fewer doses (≤ 2 doses) and 1 = at least three doses of IPTp-SP (≥ 3 doses) (10, 21)…”

“…Studies have reported that pregnant women’s attitudes and motivation to receive IPTp-SP was related to their levels of knowledge of malaria-related factors such as morbidities caused by malaria (8, 9). Similarly, region, religion, age, and marital status influenced the number IPTp-SP doses received during pregnancy (8,10,11). Socioeconomic considerations including education level, spouse’s education level, employment status, health insurance coverage and household wealth index influenced IPTp-SP uptake (12, 13).…”

“…Increased uptake during pregnancy was associated with higher education (14, 15), and some studies found a strong association between being employed and IPTp-SP uptake (16). Also, several studies established that IPTp-SP uptake was pro-rich, such that women in the “middle” to “richest” household wealth index had higher IPTp-SP uptake compared to those in the “poorest” to “poorer” wealth categories, including uptake of at least three IPTp-SP doses during pregnancy (10,11,17,18).…”

It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures

“…The WHO recommends a minimum of three doses of IPTp (IPTp3+) with universal coverage of at least 80% of pregnant women [ 1 ]. However, in DRC, IPTp3+ implementation is less than the universal coverage and the majority of women attending at least four antenatal care visits receive less than three doses of IPTp [ 1 , 98 ]. Despite the increase in SP falciparum resistance in DRC [ 99 , 100 , 101 , 102 , 103 , 104 ], IPTp is still used for malaria prevention during pregnancy and protection against maternal anemia and low birthweight; especially when it is given in three or more doses [ 101 ], as shown in other countries [ 105 , 106 , 107 , 108 , 109 ].…”