| Factors affecting providers' delivery of intermittent preventive treatment for malaria in pregnancy: a five-country analysis of national service provision assessment surveys |
| Authors: |
Maheu-Giroux M, and Castro MC. |
| Source: |
Malaria Journal, 13:440. doi: 10.1186/1475-2875-13-440. |
| Topic(s): |
Antenatal care
Malaria
|
| Country: |
Africa
Kenya
Namibia
Tanzania
Uganda
Rwanda
Multiple African Countries
|
| Published: |
NOV 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. |
| Web: |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247687/ |
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