Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

Abstract

Background Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. Methods This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20. Results During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%). Conclusion Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

Community Malaria Knowledge, Experiences, Perceived Roles, and Acceptability of Community-Directed Distribution of Intermittent Preventive Therapy for Pregnancy in Rural Southeast Nigeria

“…Reduced queues in the health facilities was cited as the main reason for this disposition [ 18 ]. The high levels of acceptability closely match with the postintervention satisfaction levels with the community-directed distribution of IPTp intervention [ 19 ].…”

“…Community involvement and ownership is critical to the success of community-level projects [ 12 ]. The successful implementation of the community-directed distribution of sulfadoxine-pyrimethamine project in the study community was mostly hinged on the positive attitude and cooperation shown by the community members who were actively involved in the project [ 19 ].…”

“…Ebiriogu community located in Okuzzu-Ukwau political ward was the intervention community for the community-directed IPTp distribution project. More details about the intervention have been published elsewhere [ 19 ]. The community has three settlements and one primary health center (PHC) which is the major source of orthodox health care services in the community.…”

“…Such community-level programs include community-directed distribution of preventive malaria commodities such as IPTp-SP by trained community distributors, community sensitization, and community case management of malaria by community health workers [ 14 , 17 , 18 ]. Although such community-level interventions have been shown to be contextually relevant and effective in resource-constrained settings [ 14 , 19 , 20 ], very few studies have assessed their acceptability by community members as acceptability can be an important precursor of sustainability. The aim of this study was to assess community malaria experiences, knowledge, perceived roles in prevention of malaria in pregnancy, and acceptability of community-directed distribution of intermittent preventive therapy for malaria in pregnancy in rural Southeast Nigeria.…”

“…The aim of this study was to assess community malaria experiences, knowledge, perceived roles in prevention of malaria in pregnancy, and acceptability of community-directed distribution of intermittent preventive therapy for malaria in pregnancy in rural Southeast Nigeria. The findings are part of the baseline findings of an intervention study to implement community-directed distribution of intermittent preventive therapy for the prevention of malaria in pregnancy [ 19 ].…”