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Open Access 01-12-2014 | Research

Factors affecting providers’ delivery of intermittent preventive treatment for malaria in pregnancy: a five-country analysis of national service provision assessment surveys

Authors: Mathieu Maheu-Giroux, Marcia C Castro

Published in: Malaria Journal | Issue 1/2014

Abstract

Background

Intermittent preventive treatment in pregnancy (IPTp) delivered during antenatal care (ANC) visits has been shown to be a highly efficacious and cost-effective intervention. Given the high rates of ANC attendance in sub-Saharan Africa, the current low IPTp coverage represents considerable missed opportunities. The objective of this study was to explore factors affecting provider’s delivery of IPTp during ANC consultations.

Methods

Data from five nationally representative service provision assessment surveys informed the statistical analyses (Kenya, Namibia, Rwanda, Tanzania, and Uganda; 2006-2010). Poisson regression models with robust/clustered standard errors were used to estimate the effect of different determinants on IPTp delivery from 4,971 observed ANC consultations.

Results

The five major modifiable determinants of IPTp delivery were: 1) user-fees for ANC medicines (relative risk (RR) = 0.76; 95% confidence intervals (95% CI): 0.62-0.93); 2) facilities having IPTp guidelines (RR = 1.12; 95% CI: 1.01-1.24); 3) facilities having implemented IPTp as part of their routine ANC services offering (RR = 4.18; 95% CI: 1.75-10.01); 4) stock-outs of sulphadoxine-pyrimethamine (RR = 0.40; 95% CI: 0.27-0.60); and, 5) providers having received IPTp training (RR = 1.21; 95% CI: 1.09-1.35). Using the population-attributable fraction, it was estimated that addressing these barriers jointly could lead to a 31% increase in delivery of this intervention during ANC consultations. Of these four potentially modifiable determinants, training of providers for IPTp had the largest potential impact.

Conclusions

If proved to be cost-effective, dispensing IPTp training to ANC providers should be prioritized. Multifaceted approaches targeted in areas of low coverage and/or type of facilities least likely to provide this intervention should be implemented if the Roll Back Malaria target of 100% IPTp coverage by 2015 is to be attained.

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Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, Newman RD: Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007, 7: 93-104. 10.1016/S1473-3099(07)70021-X.CrossRefPubMed

Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO: Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med. 2010, 7: e1000221-10.1371/journal.pmed.1000221.PubMedCentralCrossRefPubMed

WHO: WHO Policy Brief for the Implementation of Intermittent Preventive Treatment of Malaria in Pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP). 2013, Geneva, Switzerland: World Health Organization (WHO) Global Malaria Programme, WHO Department of Reproductive Health and Research, and WHO Department of Maternal, Newborn, Child and Adolescent Health, 12-

Garner P, Gülmezoglu AM: Drugs for preventing malaria in pregnant women. Cochrane Database Syst Rev. 2006, 18: CD000169-

Eisele TP, Larsen DA, Anglewicz PA, Keating J, Yukich J, Bennett A, Hutchinson P, Steketee RW: Malaria prevention in pregnancy, birthweight, and neonatal mortality: a meta-analysis of 32 national cross-sectional datasets in Africa. Lancet Infect Dis. 2012, 12: 942-949. 10.1016/S1473-3099(12)70222-0.CrossRefPubMed

Menéndez C, Bardají A, Sigauque B, Sanz S, Aponte JJ, Mabunda S, Alonso PL: Malaria prevention with IPTp during pregnancy reduces neonatal mortality. PLoS One. 2010, 5: e9438-10.1371/journal.pone.0009438.PubMedCentralCrossRefPubMed

Eisele TP, Larsen D, Steketee RW: Protective efficacy of interventions for preventing malaria mortality in children in Plasmodium falciparum endemic areas. Int J Epidemiol. 2010, 39 (Suppl 1): i88-i101.PubMedCentralCrossRefPubMed

ter Kuile FO, van Eijk AM, Filler SJ: Effect of sulfadoxine-pyrimethamine resistance on the efficacy of intermittent preventive therapy for malaria control during pregnancy: a systematic review. JAMA. 2007, 297: 2603-2616. 10.1001/jama.297.23.2603.CrossRefPubMed

Sicuri E, Bardají A, Nhampossa T, Maixenchs M, Nhacolo A, Nhalungo D, Alonso PL, Menéndez C: Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in southern Mozambique. PLoS One. 2010, 5: e13407-10.1371/journal.pone.0013407.PubMedCentralCrossRefPubMed

10.

van Eijk AM, Hill J, Alegana VA, Kirui V, Gething PW, ter Kuile FO, Snow RW: Coverage of malaria protection in pregnant women in sub-Saharan Africa: a synthesis and analysis of national survey data. Lancet Infect Dis. 2011, 11: 190-207. 10.1016/S1473-3099(10)70295-4.PubMedCentralCrossRefPubMed

11.

van Eijk AM, Hill J, Larsen DA, Webster J, Steketee RW, Eisele TP, Ter Kuile FO: Coverage of intermittent preventive treatment and insecticide-treated nets for the control of malaria during pregnancy in sub-Saharan Africa: a synthesis and meta-analysis of national survey data, 2009-11. Lancet Infect Dis. 2013, 13: 1029-1042. 10.1016/S1473-3099(13)70199-3.CrossRefPubMed

12.

Hill J, Hoyt J, van Eijk AM, D'Mello-Guyett L, Ter Kuile FO, Steketee R, Smith H, Webster J: Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2013, 10: e1001488-10.1371/journal.pmed.1001488.PubMedCentralCrossRefPubMed

13.

RBM: Refined/Updated Global Malaria Action Plan Objectives, Targets, Milestones and Priorities Beyond 2011. 2011, Geneva, Switzerland: Roll Back Malaria Partnership, 6-

14.

PMI: The President's Malaria Initiative - Seventh Annual Report to Congress. 2013, Washington, DC: United States Agency for International Development, Centers for Disease Control and Prevention, Department of Health & Human Services, 53-

15.

Crawley J, Hill J, Yartey J, Robalo M, Serufilira A, Ba-Nguz A, Roman E, Palmer A, Asamoa K, Steketee R: From evidence to action? Challenges to policy change and programme delivery for malaria in pregnancy. Lancet Infect Dis. 2007, 7: 145-155. 10.1016/S1473-3099(07)70026-9.CrossRefPubMed

16.

WHO: Updated WHO Policy Recommendation - Intermittent Preventive Treatment of Malaria in Pregnancy using Sulfadoxine-Pyrimethaine (IPTp-SP). 2012, Geneva, Switzerland: World Health Organization, Global Malaria Programme, 2-

17.

Okeibunor JC, Orji BC, Brieger W, Ishola G, Otolorin E, Rawlins B, Ndekhedehe EU, Onyeneho N, Fink G: Preventing malaria in pregnancy through community-directed interventions: evidence from Akwa Ibom State. Nigeria Malar J. 2011, 10: 227-10.1186/1475-2875-10-227.CrossRefPubMed

18.

Ndyomugyenyi R, Tukesiga E, Katamanywa J: Intermittent preventive treatment of malaria in pregnancy (IPTp): participation of community-directed distributors of ivermectin for onchocerciasis improves IPTp access in Ugandan rural communities. Trans R Soc Trop Med Hyg. 2009, 103: 1221-1228. 10.1016/j.trstmh.2009.03.006.CrossRefPubMed

19.

Msyamboza KP, Savage EJ, Kazembe PN, Gies S, Kalanda G, D'Alessandro U, Brabin BJ: Community-based distribution of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy improved coverage but reduced antenatal attendance in southern Malawi. Trop Med Int Health. 2009, 14: 183-189. 10.1111/j.1365-3156.2008.02197.x.CrossRefPubMed

20.

Mbonye AK, Bygbjerg IC, Magnussen P: A community-based delivery system of intermittent preventive treatment of malaria in pregnancy and its effect on use of essential maternity care at health units in Uganda. Trans R Soc Trop Med Hyg. 2007, 101: 1088-1095. 10.1016/j.trstmh.2007.06.017.CrossRefPubMed

21.

Mbonye AK, Yanow S, Birungi J, Magnussen P: A new strategy and its effect on adherence to intermittent preventive treatment of malaria in pregnancy in Uganda. BMC Pregnancy Childbirth. 2013, 13: 178-10.1186/1471-2393-13-178.PubMedCentralCrossRefPubMed

22.

Gies S, Coulibaly SO, Ky C, Ouattara FT, Brabin BJ, D'Alessandro U: Community-based promotional campaign to improve uptake of intermittent preventive antimalarial treatment in pregnancy in Burkina Faso. Am J Trop Med Hyg. 2009, 80: 460-469.PubMed

23.

Ouma PO, Van Eijk AM, Hamel MJ, Sikuku E, Odhiambo F, Munguti K, Ayisi JG, Kager PA, Slutsker L: The effect of health care worker training on the use of intermittent preventive treatment for malaria in pregnancy in rural western Kenya. Trop Med Int Health. 2007, 12: 953-961. 10.1111/j.1365-3156.2007.01876.x.CrossRefPubMed

24.

NCAPD, MOMS, MOPHS, KNBS, ICF Macro: Kenya Service Provision Assessment Survey 2010. 2011, Nairobi, Kenya: National Coordinating Agency for Population and Development, Ministry of Medical Services, Ministry of Public Health and Sanitation, Kenya National Bureau of Statistic, and ICF Macro, 660-

25.

MoHSS, ICF Macro: Namibia Health Facility Census 2009. 2010, Windhoek, Namibia: Ministry of Health and Social Services and ICF Macro, 600-

26.

NIS, MoH, Macro International Inc: Rwanda Service Provision Assessment Survey 2007. 2008, Claverton, MD: National Institute of Statistics, Ministry of Health, and Macro International Inc, 685-

27.

NBS, Inc. MI: Tanzania Service Provision Assessment Survey 2006. 2007, Dar es Salaam, Tanzania: National Bureau of Statistics and Macro International Inc, 691-

28.

MoH, Macro International Inc: Uganda Service Provision Asssessment Survey 2007. 2008, Kampala, Uganda: Ministry of Health and Macro International Inc, 710-

29.

NCAPD, MoH, CBS, ORC Macro: Kenya Service Provision Assessment Survey 2004. 2005, Nairobi, Kenya: National Coordinating Agency for Population and Development, Ministry of Health, Central Bureau of Statistics, and ORC Macro, 490-

30.

Zou G: A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004, 159: 702-706. 10.1093/aje/kwh090.CrossRefPubMed

31.

Zou GY, Donner A: Extension of the modified Poisson regression model to prospective studies with correlated binary data. Stat Methods Med Res. 2013, 22: 661-670. 10.1177/0962280211427759.CrossRefPubMed

32.

Yelland LN, Salter AB, Ryan P: Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol. 2011, 174: 984-992. 10.1093/aje/kwr183.CrossRefPubMed

33.

Betensky RA, Talcott JA, Weeks JC: Binary data with two, non-nested sources of clustering: an analysis of physician recommendations for early prostate cancer treatment. Biostatistics. 2000, 1: 219-230. 10.1093/biostatistics/1.2.219.CrossRefPubMed

34.

Solon G, Haider S, Wooldridge J: What are we weighting for?. NBER Working Paper Series. 2013, Cambridge, MA: National Bureau of Economic Research, 29-

35.

Miettinen OS: Theoretical Epidemiology : Principles of Occurrence Research in Medicine. 1985, New York: Wiley

36.

R Development Core Team: R: A Language and Environment for Statistical Computing. 2013, Vienna, Austria: R Foundation for Statistical Computing

37.

Højsgaard S, Halekoh U, Yan J: The R package geepack for generalized estimating equations. J Stat Softw. 2006, 15: 1-11.

38.

Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJ, Ezzati M: The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States. PLoS Med. 2010, 7: e1000248-10.1371/journal.pmed.1000248.PubMedCentralCrossRefPubMed

39.

Lincetto O, Mothebesoanne-Anoh S, Gomez P, Munjanja S: Antenatal Care. Opportunities for Africa's Newborns - Practical Data, Policy and Programmatic Support for Newborn Care in Africa. Edited by: Lord D, Wake R, Elder L, Grear K, Antayhua A. 2006, Cape Town, South Africa: The Partnership for Maternal, Newborn & Child Health, 51-62.

40.

KNBS, ICF Macro: Kenya Demographic and Health Survey 2008-09. 2010, Calverton, MD: Kenya National Bureau of Statistics and ICF Macro, 430-

41.

MoHSS, Inc. MI: Namibia Demographic and Health Survey 2006-07. 2008, Windhoek, Namibia and Calverton, MD: Ministry of Health and Social Services and Macro International Inc, 428-

42.

MoH, NISR, ICF Macro: Rwanda Interim Demographic and Health Survey 2007-08. 2009, Calverton, MD: Ministry of Health, National Institute of Statistics of Rwanda, and ICF Macro, 190-

43.

NBS, ICF Macro: Tanzania Demographic and Health Survey 2010. 2011, Dar es Salaam, Tanzania: National Bureau of Statistics (NBS) [Tanzania] and ICF Macro, 451-

44.

UBOS, ICF International Inc: Uganda Demographic and Health Survey 2011. 2012, Kampala, Uganda: Uganda Bureau of Statistics and ICF International Inc, 315-

45.

Mubyazi GM, Bloch P, Byskov J, Magnussen P, Bygbjerg IC, Hansen KS: Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts. Malar J. 2012, 11: 48-10.1186/1475-2875-11-48.PubMedCentralCrossRefPubMed

46.

Mubyazi GM, Bloch P: Psychosocial, behavioural and health system barriers to delivery and uptake of intermittent preventive treatment of malaria in pregnancy in Tanzania - viewpoints of service providers in Mkuranga and Mufindi districts. BMC Health Serv Res. 2014, 14: 15-10.1186/1472-6963-14-15.PubMedCentralCrossRefPubMed

47.

Brentlinger PE, Dgedge M, Correia MA, Rojas AJ, Saúte F, Gimbel-Sherr KH, Stubbs BA, Mercer MA, Gloyd S: Intermittent preventive treatment of malaria during pregnancy in central Mozambique. Bull World Health Organ. 2007, 85: 873-879.PubMedCentralPubMed

48.

Thiam S, Kimotho V, Gatonga P: Why are IPTp coverage targets so elusive in sub-Saharan Africa? a systematic review of health system barriers. Malar J. 2013, 12: 353-10.1186/1475-2875-12-353.PubMedCentralCrossRefPubMed

49.

Mubyazi G, Bloch P, Kamugisha M, Kitua A, Ijumba J: Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe District, North-Eastern Tanzania. Malar J. 2005, 4: 31-10.1186/1475-2875-4-31.PubMedCentralCrossRefPubMed

50.

Smith LA, Jones C, Adjei RO, Antwi GD, Afrah NA, Greenwood B, Chandramohan D, Tagbor H, Webster J: Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability. Malar J. 2010, 9: 18-10.1186/1475-2875-9-18.PubMedCentralCrossRefPubMed

51.

Hill J, Dellicour S, Bruce J, Ouma P, Smedley J, Otieno P, Ombock M, Kariuki S, Desai M, Hamel MJ, ter Kuile FO, Webster J: Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Kenya. PLoS One. 2013, 8: e64913-10.1371/journal.pone.0064913.PubMedCentralCrossRefPubMed

52.

Pell C, Meñaca A, Afrah NA, Manda-Taylor L, Chatio S, Were F, Hodgson A, Hamel MJ, Kalilani L, Tagbor H, Pool R: Prevention and management of malaria during pregnancy: findings from a comparative qualitative study in Ghana, Kenya and Malawi. Malar J. 2013, 12: 427-10.1186/1475-2875-12-427.PubMedCentralCrossRefPubMed

53.

Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu BS: Sub-optimal delivery of intermittent preventive treatment for malaria in pregnancy in Nigeria: influence of provider factors. Malar J. 2012, 11: 317-10.1186/1475-2875-11-317.PubMedCentralCrossRefPubMed

54.

Mubyazi GM, Magnussen P, Byskov J, Bloch P: Feasibility and coverage of implementing intermittent preventive treatment of malaria in pregnant women contacting private or public clinics in Tanzania: experience-based viewpoints of health managers in Mkuranga and Mufindi districts. BMC Health Serv Res. 2013, 13: 372-10.1186/1472-6963-13-372.PubMedCentralCrossRefPubMed

55.

Gross K, Alba S, Schellenberg J, Kessy F, Mayumana I, Obrist B: The combined effect of determinants on coverage of intermittent preventive treatment of malaria during pregnancy in the Kilombero Valley, Tanzania. Malar J. 2011, 10: 140-10.1186/1475-2875-10-140.PubMedCentralCrossRefPubMed

56.

MoHSS: National Malaria Policy. 2005, Windhoek, Namibia: Ministry of Health and Social Services, 40-

57.

MoHSW: National Guidelines for Diagnosis and Treatment of Malaria. Malaria Control Series 11. 2006, Dar es Salaam, Tanzania: National Malaria Control Programme, Ministry of Health and Social Welfare, 105-

58.

Kenya MoH: National Guidelines for Diagnosis, Treatment and Prevention of Malaria for Health Workers in Kenya. 2006, Nairobi, Kenya: Division of Malaria Control, Ministry of Health, 43-

59.

WHO: WHO Expert Consultation on Cotrimoxazole Prophylaxis in HIV Infection. WHO Technical Report Series WHO/HIV/200601. 2006, Geneva, Switzerland: World Health Organization, 35-

60.

Landsberger HA: Hawthorne Revisited. : Management and the Worker: Its Critics, and Developments in Human Relations in Industry. 1958, Ithaca, N.Y.: Cornell University

61.

Namusoke F, Ntale M, Wahlgren M, Kironde F, Mirembe F: Validity of self-reported use of sulphadoxine-pyrimethamine intermittent presumptive treatment during pregnancy (IPTp): a cross-sectional study. Malar J. 2012, 11: 310-10.1186/1475-2875-11-310.PubMedCentralCrossRefPubMed

62.

Bank W: World Bank Policy Note: Enhancing Public Supply Chain Management in Zambia. 2012, Washington, DC: World Bank

63.

Mikkelsen-Lopez I, Shango W, Barrington J, Ziegler R, Smith T, de Savigny D: The challenge to avoid anti-malarial medicine stock-outs in an era of funding partners: the case of Tanzania. Malar J. 2014, 13: 181-10.1186/1475-2875-13-181.PubMedCentralCrossRefPubMed

Title: Factors affecting providers’ delivery of intermittent preventive treatment for malaria in pregnancy: a five-country analysis of national service provision assessment surveys
Authors: Mathieu Maheu-Giroux
Marcia C Castro
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Malaria Journal / Issue 1/2014
Electronic ISSN: 1475-2875
DOI: https://doi.org/10.1186/1475-2875-13-440

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