Effectiveness of Antenatal Clinics to Deliver Intermittent Preventive Treatment and Insecticide Treated Nets for the Control of Malaria in Pregnancy in Kenya

Abstract

BackgroundMalaria in pregnancy can have devastating consequences for mother and baby. Coverage with the WHO prevention strategy for sub-Saharan Africa of intermittent-preventive-treatment (IPTp) with two doses of sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) in pregnancy is low. We analysed household survey data to evaluate the effectiveness of antenatal clinics (ANC) to deliver IPTp and ITNs to pregnant women in Nyando district, Kenya.MethodsWe assessed the systems effectiveness of ANC to deliver IPTp and ITNs to pregnant women and the impact on low birthweight (LBW). Logistic regression was used to identify predictors of receipt of IPTp and ITN use during pregnancy.ResultsAmong 89% of recently pregnant women who attended ANC at least once between 4–9 months gestation, 59% reported receiving one dose of SP and 90% attended ANC again, of whom 57% received a second dose, resulting in a cumulative effectiveness for IPTp of 27%, most of whom used an ITN (96%). Overall ITN use was 89%, and ANC the main source (76%). Women were less likely to receive IPTp if they had low malaria knowledge (0.26, 95% CI 0.08–0.83), had a child who had died (OR 0.36, 95% CI 0.14–0.95), or if they first attended ANC late (OR 0.20, 95% CI 0.06–0.67). Women who experienced side effects to SP (OR 0.18, CI 0.03–0.90) or had low malaria knowledge (OR 0.78, 95% CI 0.11–5.43) were less likely to receive IPTp by directly observed therapy. Ineffective delivery of IPTp reduced its potential impact by 231 LBW cases averted (95% CI 64–359) per 10,000 pregnant women.ConclusionIPTp presents greater challenges to deliver through ANC than ITNs in this setting. The reduction in public health impact on LBW resulting from ineffective delivery of IPTp is estimated to be substantial. Urgent efforts are required to improve service delivery of this important intervention.

Coverage and efficacy of intermittent preventive treatment with sulphadoxine pyrimethamine against malaria in pregnancy in Côte d¿Ivoire five years after its implementation

“…Consistent with other studies, our findings suggest that health provider practices rather than women's ANC attendance are primarily responsible for the ineffectiveness of the IPTp strategy in this setting [18,[21][22][23][24].…”

“…Higher IPTp coverage has been reported even in settings with lower ANC attendance rates [18,19]. High attendance to ANC does not translate to high IPTp coverage [19,20].…”

“…Additional factors can also contribute to low SP coverage including poor accessibility to health facilities and poor quality of antenatal service provided [14,[16][17][18].…”

Determinants of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnant Women (IPTp-SP) in Mali, a household survey.

“…Several studies have explored the determinants of the use and completeness of IPTp-SP (9,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Nonattendance and/or completeness of ANC is considered a key determinant of IPTp-SP coverage (15,16,21,24). A qualitative study conducted in Mali in 2013 identi ed the following factors in uencing the completeness of the 2 doses of IPTp-SP: late use or non-use of ANC services, perception of malaria during pregnancy, poor acceptability of SP, stock-outs of SP, and insu cient information on the policy of providing SP free of cost to pregnant women (16).…”

Managing Malaria in Pregnancy Policy Interventions in A Challenging Environment: an Ethnographic Study of two Ghanaian Administrative Regions

“…Despite such interventions Ghana like other sub Saharan African countries did not achieve the reset Abuja targets of achieving 100% of pregnant women having access to IPTp and 100% use of LLINs by 2015 (13) i . Challenges and gaps in the implementation of MiP interventions have been reported in the sub region (13)(14)(15)(16)(17)(18). Health facility factors such as poor organization of health delivery, leading to poor quality of care, confusion over the timing of each IPTp dose, stock outs, user fees and negative health worker attitudes contributed to women delaying in accessing health care in the prevention and treatment of MiP (19)(20)(21)(22)(23)(24)(25)(26).…”