Posts or Comments 20 April 2021

Equity &Gender &Health Systems &Migration &Nomadic People &poverty Bill Brieger | 05 Mar 2021

Nomads in Mali Face Barriers to Health Care

We are sharing the abstract of a just published article by Moussa Sangare and colleagues entitled, “Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali,” that appears in BMC Public Health. As COVID-19 has been disrupting health services generally, we need greater awareness of the serious barriers faced by more vulnerable populations even in better times.

Background: In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions.

Methods: To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings.

Results: We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38?years old with extremes ranging from 18 to 86?years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94?km and 23.19?km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender.

Conclusion: This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods.

Agriculture &Case Management &CHW &Essential Medicines Bill Brieger | 17 Feb 2021

Frederick Olori Oshiname (1954-2021): Malaria and Tropical Health Researcher

Fred Oshiname has been my student, colleague and friend for 35 years. I was fortunate to supervise his MPH dissertation and PhD thesis when I was at the University of Ibadan. He has been a major partner in many tropical disease and malaria research projects over the years. His untimely passing deprives us of more fruitful years of malaria research in Nigeria.

Below is a brief summary of some of the malaria research projects/teams for which Fred was a partner. At his memorial service friends and colleagues commented on the valuable role he played in any team in helping the group focus, plan and produce quality work. The articles mentioned below are examples of such work.

One of Fred’s first contributions was designing and implementing training for patent medicine vendors, a major, though informal source of primary care for malaria and other diseases in Nigeria. This training demonstrated that medicine shops could become a reliable part of malaria treatment programs.

Subsequently, he was part of a team that helped develop a community-based essential medicine revolving fund for community health workers. CHWs were found to be another important component of malaria control.

Continuing on the theme of medicines for malaria, Fred was part of a team that examined how perceptions of medicine efficacy and appropriateness were influenced by the color of the drugs. This study aimed at determining perceptions of both consumers and sellers of medicines at the community level to learn about color likes and dislikes that might influence acceptance of new color-coded child prepacks of antimalarial drugs

As part of another team, Fred examined malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria. The team learned of the urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favor mosquito breeding.

He also participated in a multi country team that studied the Feasibility of Malaria Diagnosis and Management at the community level in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study. An important lesson learned by the group was that provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases.

That team went on to conduct Training Community Health Workers to Manage Uncomplicated and Severe Malaria: Experience From 3 Rural Malaria-Endemic Areas in Sub-Saharan Africa. The training and related supervision resulted in improved diagnosis and treatment of uncomplicated and severe malaria. Furthermore, this training was connected with greater acceptability of community health workers by the communities where they worked.

We trust that these endeavors have made a major contribution to knowledge and the field of malaria control.

Education &Health Education &Learning/Training &Mentoring &Nigeria Bill Brieger | 29 Dec 2020

Prof Adetokunbo O Lucas, 1931-2020, Public Health and Tropical Disease Pioneer

Forty-five years ago, this week I arrived in Ibadan Nigeria to visit my MPH classmate, Joshua Adeniyi, and meet the faculty of the newly established African Regional Health Education Centre (ARHEC). A highlight of those meetings was seeing Prof Ade Lucas who as head of the Department of Preventive and Social Medicine (PSM), which housed ARHEC), had supported the partnership of the University of Ibadan, Federal Ministry of Health, and the World Health Organization that created ARHEC as the first Africa-based professional postgraduate training program in public health education. Prof Lucas had created a multidisciplinary environment where Public Health Education could thrive.

I was convinced to join the faculty of OSM and ARHEC, and by the time I returned in October 1976, Prof Lucas had taken up the directorship of The Special Program of Research and Training in Tropical Diseases (TDR), which was initially sponsored by WHO, the World Bank and UNDP. Fortunately, Prof Lucas continued to mentor the ARHEC faculty and by encouraging us to apply for TDR grants ensured that I was well on my way in building a career around social and behavioral interventions to control tropical diseases.

Unfortunately, Prof Lucas left us finally on 25 December 2020. Below are the postings of colleagues to commemorate his life. Idowu Olayinka of the Nigerian Academy of Science outlined some of the many accomplishments of Prof Lucas as follows:

  • He was an outstanding medical scientist.
  • Former Professor and Head Department of Preventive and Social Medicine at the University of Ibadan.
  • Founding Director, WHO Special Programme for Research and Training in Tropical Diseases.
  • Former Programme Chair, Carnegie Foundation.
  • Former Professor of International Health, Harvard University.
  • He was the first person ever to receive, in 1995, the highest academic honour of the University of Ibadan, Honorary Fellowship of UI, FUI.

The Provost of the College of Medicine, University of Ibadan, Prof Olayinka Omigbodun adds more to the list. “His achievements and accomplishments are too numerous to list here. These have been documented very well in many books, reports, and newspapers. He was the author of numerous books and articles in refereed public health journals. He was an author of many books including “A Short Textbook of Preventive Medicine for the Tropics”. Books have been written about him including his own autobiography (It Was the Best of Times: From Local to Global Health (2010,” and a biography “The Man: Adetokunbo Lucas” (2011).”

“A recipient of many honorary degrees from Emory University, Tulane University, and University of Ibadan he was also a recipient of academic honors from Harvard where he was a professor of Public health, he was bestowed with numerous awards including Prince Mahidol Award (1999), the Centenary Medal for Life-Time Achievements in Tropical Medicine (2007) and from the National Foundation for Infectious Diseases (NFID) (5 March 2013), to name a few.”

“There can be no question about Prof Lucas being a distinguished teacher of many students was who have become distinguished in their own rights. He was a global leader in Medical Research that has impacted many populations, especially in Africa. The footprints are notable and impactful.”

“When my children and grandchildren ask me who my best teachers while in the Medical School (or thereafter) were, I always list some top 10 teachers to those who imparted knowledge, affected my ambition to be “like them”, impressed me with statements and instructions that continued to ring in my ears till today, or demonstrated acts of exemplary kindness and character, indicated personal interest in my progress and success in life, and showed loving friendship to someone who was once their student or junior colleague. Professor Lucas was one of them.” The Provost refers people to a memorial website that has been created to share tributes, photographs and other memories.

Colleagues who worked with Professor Lucas in TDR or knew him because of TDR have shared their reflections. Jamie Guth said, “Prof Lucas was an amazing man. I felt privileged to have known him and experience the impact of what he started with TDR at WHO – now several generations of top scientists across Africa and many other countries finding solutions to infectious diseases.”

Jane Kayondo Frances Kengeya reacted with, “A giant has fallen. His legacy will live on through those he taught, mentored, influenced, supported and loved. Let’s celebrate his life and thank God that we had a chance to know him. May his soul Rest In eternal peace. May his family and close friends receive the grace to endure the loss.”

Mohamnadou Jabur Cham, observed that, “His contributions to the RCS within TDR were not only impressively significant but indeed phenomenal. An envious legacy especially for young scientists from disadvantaged countries. Adieu Prof. till we meet again.”

We trust that the legacy of Professor Ade Lucas will live on in the many people he has taught and mentored and the many careers he has helped launch in public health, preventive medicine and tropical disease control.

Malaria in Pregnancy &Mentoring &mHealth Bill Brieger | 18 Nov 2020

Mentorship to Strengthen Quality of Malaria Case Management & Malaria in Pregnancy, Zimbabwe

Gilson Mandigo et al. examine how mentoring can be achieved from a distance in Zimbabwe. Their presentation at the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene of “Mentorship to Strengthen Quality of Malaria Case Management And Malaria in Pregnancy (MIP) in Zimbabwe: Lessons Learned From One Year of Implementation” is shared below.

Despite significant investment in training and supervision of facility-based health workers in Zimbabwe, persistent malaria case management and MIP gaps remain. National Malaria Control Program and US President’s Malaria Initiative developed and implemented a mentorship intervention in five high burden malaria districts to motivate provider performance and improve quality services.

From June 2018 – June 2019, 25 health workers proficient in malaria service delivery were selected and trained in clinical mentorship. These individuals mentored 98 providers at 25 facilities, covering clinical case reviews, bedside coaching, simulations, and records review. USAID’s Zimbabwe Assistance Project in Malaria subsequently assessed the mentorship program through review of patient records, feedback from mentors and mentees, and engagement of stakeholders.

Record review compared practices before and after implementation, using a checklist that noted completeness and appropriateness of case management across multiple parameters, including physical examination, diagnosis, classification and treatment. Mentored facilities documented improvements in recommended practices across registers: 58% to 63% for outpatient clinical settings, 53% to 64% for integrated management of neonatal and childhood illnesses, and 72% to 76% for antenatal care.

A phone-based e-survey of 49 mentees and 21 mentors elicited positive feedback on the mentorship approach: 62% of mentors were “very satisfied” with the program, 67% reported quality improvement and 86% benefited from learning new skills. Among mentees:

  • 60% were “very satisfied”,
  • 67% said that the program has improved service quality and
  • 97% benefited from learning new skills

Common challenges included mentor transportation, mentee availability, and commodity availability. Through a review meeting, stakeholders recommended the intervention continue, as it was acceptable, feasible and achieved promising results. Recommendations include prioritizing high-volume facilities, integrating management of mentorship into District Health Executive functions and use of low-cost communication platforms to aid virtual mentorship.

Authors and Affiliations

Gilson Mandigo(1), Anthony Chisada(1), Noe Rakotondrajaona(2), Paul Matsvimbo(3), Christie Billingsley(4), Chantelle Allen(5), Katherine Wolf(5), Patience Dhliwayo(3). 1.ZAPIM/Jhpiego, Harare, Zimbabwe, 2.ZAPIM/Abt, Harare, Zimbabwe, 3.MOHCC, Harare, Zimbabwe, 4.PMI, Harare, Zimbabwe, 5.Jhpiego HQ, Baltimore, MD, United States

Antenatal Care (ANC) &Malaria in Pregnancy Bill Brieger | 18 Nov 2020

Group Antenatal Care to Improve Malaria in Pregnancy & ANC in Geita, Tanzania

Jasmine Chadewa and colleagues are sharing their work on Group Antenatal Care (GANC): A Baseline Initiative to Improve Malaria in Pregnancy & ANC Indicators. A Case from Geita Tanzania at the virtual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene. See their findings below.

Malaria in pregnancy (MiP) is a major public health concern contributing to poor maternal and newborn health outcomes. Early and frequent Antenatal Care attendance (ANC) could address this problem. Early ANC booking is still low in Tanzania. USAID Boresha Afya and Tanzania Ministry of Health introduced a Group Antenatal Care (GANC) initiative in Geita region where malaria prevalence is high. This model brings 8-15 pregnant women of similar gestational age together for ANC. Group contacts last 1.5-2 hours, and include clinical care, information sharing, and peer support to improve quality of care and women’s engagement, leading to better retention in care.

Prior to implementation, a baseline cross-sectional household survey was conducted in December 2019 in 40 communities across Geita region. The survey was intended to identify gaps and targets in MiP services delivery which could be addressed through GANC. Women who had delivered a live born infant in the preceding 12 months were included. We interviewed 1111 women; mean age was 27 years. One-third had no education and only 9% had secondary education.

Nearly all 95% of women lived in a house with an Insecticide Treated Net (ITN); 87% reported receiving an ITN during their last pregnancy and 90% reported ITN use on the night before the survey. Nearly all 98% attended ANC at least once, with 17% attending in first trimester. Only 45% attended ?4 visits; 6% of women were stopped by their husbands from attending ANC.

Median total time spent away from the home for each ANC was 4 hours. 88% received Intermittent Preventive Treatment of malaria in pregnancy (IPTp), with 53% receiving the recommended 3 or more doses. Among those who did not receive IPTp, 42% reported that the provider did not offer it and 25% reported it was not available at the facility. Receipt of other interventions varied: 64% reported that their blood pressure was checked, 95% and 57% had blood and urine samples collected, 74% had received adequate doses of tetanus vaccination, and 94% received iron/folate supplements.

We will assess whether GANC improves MiP services as well as quality of ANC care, to promote positive pregnancy outcomes.

Authors and Affiliations

Jasmine Chadewa1, Mary Drake1, Chonge Kitojo2, Ryan Lash3, Stephanie Suhowatsky4, Abdalah Lusasi5, Japhet Simeo6, Goodluck Tesha7, Ruth Lemwayi1, Issa Garimo5, Agnes Kosia1, Alice Christensen1, Rita Noronha1, Zahra Mkomwa7, Naomi Serbantez2, Melkior Assenga1, Erik Reaves8, Samwel Lazaro5, Miriam Kombe9, Alen Kinyina1, Alen Kinyina1, Ally Mohamed5, Gladys Tetteh4, Bill Brieger10, Edward Kenyi4, Annette Almeida1, Julie Gutman3
1USAID Boresha Afya Project -Jhpiego Tanzania, Dar es Salaam, Tanzania, United Republic of, 2President’s Malaria Initiative/United States Agency for International Development, Tanzania, Dar es Salaam, Tanzania, United Republic of, 3Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania, United Republic of, 4Jhpiego Headquarter U.S.A, Baltimore, MD, United States, 5National Malaria Control Program-Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania, United Republic of, 6Regional Health Management Team, Dar es Salaam, Tanzania, United Republic of, 7USAID Boresha Afya Project –Path Tanzania, Dar es Salaam, Tanzania, United Republic of, 8President’s Malaria Initiative, Centers for Disease Control and Prevention Tanzania, Dar es Salaam, Tanzania, United Republic of, 9USAID, Dares Salaam, Dar es Salaam, Tanzania, United Republic of, 10Jhpiego Headquarter U.S.A, Dar es Salaam, Tanzania, United Republic of

Uncategorized Bill Brieger | 17 Nov 2020

Advantages of Virtual Technical and Skills Training Courses on Malaria During COVID-19 in Myanmar

Aung K. Zaw et al. share in a poster their experiences with malaria and COVID-19 in Myanmar through the Defeat Malaria USAID/PMI Project. This can be found at the website of the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene Which is virtual. Their presentation is see below.

The President’s Malaria Initiative-supported Defeat Malaria Project aims to enhance the technical and operational capacity of the NMCP and health care providers in four States/Regions of Myanmar between 2016-2021. The project designed a capacity development strategy for staff and the NMCP using cascade training.

Master mentors (MM) from new Regions of the project were trained November/December 2019 who will train a cadre of general trainers (GT) at district and township level. Then GT will conduct onsite courses for integrated community malaria volunteers (ICMV).

However, due to the current COVID-19 situation travel and movement restrictions are in place. The project shifted from classroom-based to virtual training via Zoom for a 5-day training of GT and to develop 11 GT on malaria and other ICMV-managed diseases and training skills.

Participatory classroom training methodology was used for virtual training, including knowledge update and skills and attitudes development. Pre and post-training knowledge assessments and skills assessments were carried out to measure knowledge improvement. Daily and end course evaluations were done to gauge participants’ perception of virtual training. 64% of participants passed (score ?80%) the pre-training knowledge assessment, and 100% achieved ?80% on the post-training assessment.

Training skills (facilitation and demonstration of skills) were assessed using checklists during practice with RDTs and all participants passed. Coaching skills could not be assessed in this virtual training. Daily evaluation results showed that participants’ expectations and objectives were met. 75% stated that they felt more confident in planning and conducting a training course.

According to the final evaluation, 83% of participants felt positive about the virtual training methodology. On the other hand, 17% noted occasional difficulty hearing due to unstable internet connections. From a logistics and cost standpoint, it is feasible to continue the use of the virtual training platform for technical and training skills courses at the township level.

Authors and Affiliations

Aung K. Zaw(1), May Khin(1), Thiha Soe(1), Khin Zin(1), Ni Ni Aye(1), May Aung Lin(2), Thin Chit(2), Naung Naung(2), Paing Lin(2), Soe Tun(2), Wai Paing(2), Arkar Thant(2) – 1.Jhpiego, Myanmar/PMI Defeat Malaria, Yangon, Myanmar, 2.University Research Co., Myanmar/PMI Defeat Malaria, Yangon, Myanmar

Communication &Community &IPTp &Malaria in Pregnancy Bill Brieger | 17 Nov 2020

What could hinder IPTp uptake?

Cristina Enguita-Fernàndez and colleagues share findings on from a qualitative study on the acceptability of a community-based approach to IPTp delivery in 4 sub-Saharan countries in the UNITAID TiPTop project. Their poster is available at the vitrual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene.

Increasing uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is key to improving maternal health indicators in malaria endemic countries, yet current coverage rates remain low. This qualitative study is part of a project evaluating the acceptability of a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in 4 countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria.

Between March 2018 and February 2020 a total of 435 in-depth interviews and 181 focus group discussions were carried out in the four country sites with pregnant women, relatives, women of reproductive age, community leaders, CHWs, and health providers. These were combined with direct observations of both community and facility based IPTp delivery.

Grounded theory guided the study design and data collection, and data were analysed following a combination of content and thematic analysis to identify barriers to IPTp uptake. Although the novel C-IPTp intervention overcomes some access barriers (such as distance from health care providers, and travel costs), the study identified important barriers, some of which cut across delivery mechanisms and others that are specific to the C-IPTp approach.

Cross-cutting barriers consisted of perceived attributes of SP that explain treatment refusal. These consisted of sensorial characteristics, including the drug’s perceived foul smell, taste and large size; experiences with adverse drug effects, such as nausea and weakness; fears of adverse pregnancy outcomes, such as miscarriages or oversized babies leading to C-sections.

Attributes originated either in individual experiences of SP intake or were socially transmitted. Barriers specific to C-IPTp were centered around concerns over trust in CHWs as adequate providers of maternal healthcare and their competence in delivering IPTp. Despite sensitization activities, misinformation could still be determining these barriers. Ensuring an improved awareness of SP effects and its use, as well as a better understanding of the intervention should lead to enhanced C-IPTp adherence

Authors and Affiliations

Cristina Enguita-Fernàndez1, Yara Alonso1, Wade Lusengi2, Alain Mayembe2, Aimée M. Rasoamananjaranahary3, Estêvão Mucavele4, Ogonna Nwankwo5, Elaine Roman6, Franco Pagnoni1, Clara Menéndez1, Khátia Munguambe4 – 1ISGlobal – Barcelona Institute for Global Health, Barcelona, Spain, 2Bureau d’Étude et de Gestion de l’Information Statistique, Kinshasa, Congo, Democratic Republic of the, 3Malagasy Associates for Numerical Information and Statistical Analysis, Antananarivo, Madagascar, 4Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique, 5University of Calabar, Calabar, Nigeria, 6Jhpiego, affiliate of Johns Hopkins University, Baltimore, MD, United States

coronavirus &COVID-19 &Mentoring Bill Brieger | 16 Nov 2020

Remote mentoring to ensure continuity of malaria service delivery during the COVID-19 pandemic in Zimbabwe, Cote d’Ivoire, and Cameroon

Katherine Wolf and colleagues address the need for mentoring in malaria programs across three countries when COVID-19 restricts travel and in-person work. They presented at the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene and share the information below on e-mentoring.

After the COVID-19 pandemic emerged in March 2020, global health experts warned that significant disruptions to malaria programs could lead to a doubling of malaria deaths in 2020, with a major spike overwhelming fragile health systems. To ensure the continuity and safety of malaria service delivery during the pandemic and associated lockdowns, Zimbabwe, Cote d’Ivoire (CI), and Cameroon transitioned from in-person, facility-based mentorship for health care providers to phone-based e-mentorship.

Working with the 3 National Malaria Control Programs, an e-mentoring package was developed and provided to mentors including technical guidance on malaria service delivery during COVID-19, a sample call guide, and a call tracker. Mentorship calls focused on continuity of malaria service delivery and applying WHO and PMI COVID-related guidance on triaging of patients and infection control measures.

From April to June, Zimbabwe reached 134 providers in 24 of 25 health facilities that previously received in-person mentorship. CI reached 41 providers in 33 facilities, where mentors already worked with staff in-person. Cameroon reached 179 providers in 116 lower performing facilities. In Zimbabwe, e-mentorship identified malaria commodity shortfalls and over-stocking, and facilitated re-distribution. Mentors advocated successfully for provision of PPE.

E-mentorship identified a facility that had incorrectly stopped providing routine services; mentors were able to clarify COVID-related guidance from central authorities and assist in re-establishing routine services. In CI, the most frequently discussed topics were malaria commodities and case management. In Cameroon, frequent stockouts reported were better understood, and national stakeholders contacted for better solutions, including redeployment of medicines and commodities from overstocked sites to stocked-out areas.

All 3 countries demonstrated that e-mentorship successfully offers health care providers support and guidance to deliver quality malaria services during a crisis. Lessons learned can be applied in the context of natural disasters, political instability, and other potential disruptions to malaria programs.

Authors and Affiliations

Katherine Wolf1, Chantelle Allen2, Gilson Mandigo3, Leocadia Mangwanya3, Cyprien Noble1, Eric Tchinda4, Mathurin Dodo5, Arthur Konan1, Jacques Kouakou6, Lolade Oseni1
1Jhpiego/Impact Malaria, Baltimore, MD, United States, 2Jhpiego, Baltimore, MD, United States, 3ZAPIM/Jhpiego, Harare, Zimbabwe, 4Jhpiego/Impact Malaria, Kribi, Cameroon, 5Jhpiego/Impact Malaria, Ouagadougou, Burkina Faso, 6Jhpiego/Impact Malaria, Abidjan, Côte D’Ivoire

Antenatal Care (ANC) &CHW &IPTp Bill Brieger | 16 Nov 2020

Increasing Access to Malaria in Pregnancy Services through Community Health Units and Enhanced Supportive Supervision of Community Health Volunteers

Donald Apat and colleagues address the importance of community health workers and appropriate supervision in their study from Kenya. This was presented today at the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene which is virtual. See their findings below.

According to the 2018 Kenya malaria program review, the uptake of malaria in pregnancy interventions by rural communities in Kenya remains low due to late first presentation to antenatal care (ANC), leading to sub-optimal intermittent preventive treatment in pregnancy (IPTp) coverage. Poor healthcare provider-client communication and low investment in advocacy, communication, and social mobilization contribute to late ANC presentation.

Kenya is using community health volunteers (CHVs) supervised by community health assistants (CHAs) in community health units (CHUs) to increase demand for ANC services and uptake of IPTp but tracking of progress is hampered by a lack of accurate data on the number of estimated pregnancies at the sub-national level and poor household coverage by CHVs at the community level.

In July 2019, Impact Malaria supported malaria-endemic Teso South sub-county of Busia county with the reorientation of 354 CHVs (92%) and 14 CHAs (100%), to identify and track pregnant women at the household level within the government established CHUs, provide social and behavior change communication messages, and enhance monthly supervision and reporting by CHAs.

CHVs identified and tracked 917 pregnant women from 32,758 (89.6%) households and identified and referred 273 ANC defaulters. We compared the uptake of IPTp before intervention (January to June 2019) and during the intervention (July to December 2019) using programmatic and Kenya health information system (KHIS) data.

At pre-intervention, 32,898 (90%) households were visited, with 2,160 new ANC visits and 5,342 ANC revisits. During the intervention period, 35,910 (98.3%) households were visited with 1,934 new ANC visits and 5,904 ANC revisits. Uptake of IPTp1 increased from 83.6% to 92.6%; IPTp2 from 73.5% to 87%; and IPTp3 from 51.9% to 75.4%.

Enhanced supervision of CHVs by CHAs to conduct and improve household visits enabled identification and referral of ANC defaulters and contributed to increased IPTp uptake. Supportive supervision and optimal CHU coverage in tracking pregnant women if conducted routinely may provide accurate denominators to track IPTp coverage and inform targeted interventions.

Authors and Affiliations

Donald Apat1, Willis Akhwale1, Moses Kidi1, Edwin Onyango2, James Andati1, Hellen Gatakaa1, Augustine Ngindu1, Lolade Oseni3, Gladys Tetteh3, Daniel Wacira4
1PMI-Impact Malaria, Nairobi, Kenya, 2Department of Health, Busia County, Kenya, 3Jhpiego, Baltimore, MD, United States, 4PMI, Nairobi, Kenya

CHW &Community &IPTp &Malaria in Pregnancy Bill Brieger | 16 Nov 2020

Community health workers’ sex and variation in uptake of malaria in pregnancy services in Ebonyi State, Nigeria

Ebonyi members of Integrated Health Data Management Team (IHDTM) providing mentorship to HCWs during RDQA visit to Akpaka

Bartholomew Odio et al. work with CHWs who promote community delivery of intermittent preventive treatment for pregnant women in Ebonyi State, Nigeria for the UNITAID/Jhpiego TiPToP Project. They shared below some of their findings from the virtual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene this week. (Photos are from Bright Orji)

In Nigeria, malaria remains a high burden disease and pregnant women are among the most vulnerable. According to the 2019, World Malaria Report only 31% of pregnant women received the World Health

CHWs at data validation meeting during COVID 19 pandemic social distancing

Organization recommended minimum of three doses of IPTp with Sulfadoxine-Pyrimethamine (SP) compared to 17% in Nigeria (DHS, 2018). In order to expand the coverage of this life-saving intervention, the Transforming Intermittent Preventive Treatment for Optimal Pregnancy project engaged community health workers (CHWs) to introduce the delivery of community IPTp (C-IPTp) to eligible pregnant women, in addition to women being able to access IPTp at antenatal care in Ohaukwu district of Ebonyi State, Nigeria.

Community meeting in Bosso

As findings from studies in Nepal and Uganda showed that the sex of CHWs were correlated with uptake of iCCM services, we examined routine project data to determine if the sex of the CHWs was correlated with uptake of IPTp. Of the 462 CHWs selected, 49% were male and 51% were female and were deployed at a ratio of one CHW to 27 pregnant women. All CHWs were trained on early identification of pregnant women, referral to antenatal care and provision of C-IPTp using SP.

A trained data analyst extracted routine data from the national community health management information system for 13,733 pregnant women who received IPTp from CHWs between June and November 2019. Data abstracted included CHW sex and number of PW that received IPTp. Findings showed that female CHWs distributed 60% of IPTp1, 65% IPTp2, and 61% IPTp3 (p-value=0.00 for all comparisons). The data suggest that trained female CHWs may reach more pregnant women than their male counterparts in community directed IPTp interventions.

Authors and Affiliations

Bartholomew Odio(1), Onyinye Udenze(1), Chinyere Nwani(1), Herbert Onuoha(1), Elizabeth Njoku(1), Lawrence Nwankwo(2), Oniyire Adetiloye(1), Bright Orji(1) 1.Jhpiego, Nigeria, Abuja, Nigeria, 2.State Ministry of Health, Nigeria, Abuja, Nigeria. This is part of the TiPToP Project funded by UNITAID.

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