The combined effect of determinants on coverage of intermittent preventive treatment of malaria during pregnancy in the Kilombero Valley, Tanzania

Abstract

BackgroundIntermittent preventive treatment during pregnancy (IPTp) at routine antenatal care (ANC) clinics is an important and efficacious intervention to reduce adverse health outcomes of malaria infections during pregnancy. However, coverage for the recommended two IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage.MethodsData on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Women's timing of ANC visits and health worker's timing of IPTp delivery were analyzed in relation to the different national IPTp schedules and the outcome on IPTp coverage was modelled.ResultsAmong all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. Less than 1% of women started ANC attendance after 32 weeks of gestation. During the second IPTp delivery period health workers delivered IPTp to significantly less women than during the first one (55% vs. 73%) contributing to low second dose coverage. Simplified IPTp guidelines for front-line health workers as recommended by WHO could lead to a 20 percentage point increase in IPTp coverage.ConclusionsThis study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. To maximize the benefit of the IPTp intervention, revision of existing guidelines is needed. Training on simplified IPTp messages should be consolidated as part of the extended antenatal care training to change health workers' delivery practices and increase IPTp coverage. Pregnant women's knowledge about IPTp and the risks of malaria during pregnancy should be enhanced as well as their ability and power to demand IPTp and other ANC services.

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].…”

“…Stock outs of SP, absence of cups and clean drinking water for taking SP by DOT [17], unclear guidelines [21] or confusion among health workers regarding the guidelines [24] and other related health facility factors [15,25] are factors which hamper delivery of IPTp.…”

Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment

“…Further, if many health professional students have to be present during service provision, a different culture for how to approach the women could be encouraged. In other settings, it has been suggested that improved quality of care can be achieved by in-service training and improved supportive structures at managing levels [10, 41, 47, 52]. …”

‘My wife, you are supposed to have a rest now’: an analysis of norms influencing men's role in prenatal care in south-eastern Tanzania

“…Interest in this topic was triggered by data from qualitative and quantitative studies on women's access to antenatal care (ANC) and malaria prophylaxis in rural south-eastern Tanzania (Gross et al 2011(Gross et al , 2012 and critical reflections of the second author who has grown up in the Kilombero Valley and now lives there as a young father and an anthropologist. Based on this interest, eight focus group discussions (FGDs) were organised in April 2009.…”