The Provider's Checklist to Improve Pregnant Women Coverage by Intermittent Preventive Malaria Treatment in Mali. A Pilot Implementation Study

Abstract

Background: Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) is a comprehensive treatment protocol of antimalarial drugs administered to pregnant women to prevent Malaria, started at the fourth pregnancy month, with at least three doses of Sulfadoxine-pyrimethamine (SP), taken as directly observed treatment (DOT) every 30 days as interval until childbirth, in combination with other preventive measures. This paper introduces feasibility and adoption concepts as implementation research outcomes (IRO), allowing, after a defined intervention, to assess the coverage improvement by intermittent preventive malaria treatment for pregnant women attending a reference District hospital in Mali. Specifically, the purpose is to evaluate the feasibility of a reminder tool (provider checklist) to enhance pregnant women's adoption of information about IPTp-SP as immediate and sustained women practices.Methods: The implementation strategy was based on using a reminder checklist about malaria knowledge and the recommended preventive tools. Then, the checklist feasibility was assessed during routine practices with the adoption-level about pregnant women' knowledge. Quantitative data were collected through a questionnaire distributed to a non-probability purposive sampling targeting 200 pregnant women divided into two groups before and after the checklist intervention. In contrast, the qualitative data were based on in-depth face to face gynaecologists interviews. Results: Both the implementation research outcomes (feasibility and adoption) were satisfactory. The gynaecologists agreed of the easy use of this checklist during the routine practice with a recommendation to generalise it to other health providers. After the gynaecologist visit, a significant increase of the adoption-level about the prior knowledge and preventive tools was noticed. A total of 83% of participants were not knowledgeable about malaria disease before checklist use vs 15% after. Similarly, women's coverage to SP DOT increased from 0% to 59% after introducing the checklist and the SP intake after the visit time was highly significative in the second group. The latter reached 95% of the pregnant woman with four and eight months as gestational age, who were the most respectful of all SP future visits as theoretically scheduled.Conclusions: We recommend generalising such a checklist reminder to improve women's knowledge about malaria prevention.