Posts or Comments 04 December 2021

Archive for "Antenatal Care (ANC)"



Antenatal Care (ANC) &Behavior Change &Communication &ITNs Bill Brieger | 20 Nov 2021

Factors affecting adoption of malaria-preventive behaviors among populations at high risk of malaria in Cote d’Ivoire

Save the Children designs programs to protect children and families from malaria. An important aspect of the design process is learning about the factors that influence community members’ behaviors related to the prevention of the disease. Here we learn about behavioral factors that must be considered to design effective programs. This information is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting. See Author List below.

Understanding the drivers of malaria-related behavior helps national malaria control programs and implementing partners to plan national malaria strategies and to tailor interventions accordingly. This study examined the factors affecting adoption of malaria behaviors and those that drive or inhibit them among populations at high risk of malaria in Cote d’Ivoire.

This study was a multi-method, qualitative study with an exploratory approach using focus group discussions (FGDs), in-depth interviews (IDIs) and life stories. The study was conducted in 12 health districts across 10 health regions of Cote d’Ivoire in both urban and rural areas. FGDs and life stories were conducted with pregnant women and mothers of children under 5 and men (heads of household). IDIs were conducted with a number of stakeholders including: departmental district directors; midwives, nurses, community health workers, leaders of women’s groups, community leaders, and the local media.

The findings from this study show that incorrect knowledge about LLINs, LLIN dislike and discomfort, housing structure and size, sleeping arrangements for children under 5, and lack of LLIN recycling strategies were among the root causes for incorrect, non-use and/or inconsistent use of LLINs. In terms of ANC attendance, the main reported barriers were influence of their beliefs and norms, cost, perceived poor services provided, bad experiences from gynecological examinations, and the distance of health facilities in rural areas. Additionally, the lack of information on the benefits of SP for prevention of malaria in pregnancy and the use of traditional medicine were the main barriers for SP in pregnancy. Cost, poor services by health care providers and stock outs were the main barriers to diagnosis and treatment for children U5.  The main factor that influenced the adoption of preventive measures was free LLIN distribution through ANC viists and mass distribution campaigns.

Findings from this study are useful to inform the revision of the Social Behavior Change Communication Strategy in Cote d’Ivoire. Additionally, they can inform key messaging and the design of interventions in a context where malaria is the main cause of morbidity and mortality and children under 5 and pregnant women are the most affected.

AUTHOR LIST:

Jacob Y. Agniman1, Manasse N. Kassi1, Yssouf Ouattara1, Edouard C. Balogoun1, Serge B. Assi2, Philomène A. Beda1, Michel N’da-Ezoa3, Aristide E. Kouadio1, Joel Koffi1, Apollinaire N. Kouadio1, Paul Bouey4, Sara Canavati4, Eric Swedberg4 — 1Save the Children, Abidjan, Côte D’Ivoire, 2Le Programme Nationale de Lutte contre le Paludisme (PNLP), Abidjan, Côte D’Ivoire, 3Socio-Anthropologue de la Santé, Abidjan, Côte D’Ivoire, 4Save the Children, Washington, DC, United States

Antenatal Care (ANC) &Communication &Health Systems &ITNs Bill Brieger | 20 Nov 2021

Education and knowledge help fighting malaria, but health systems strengthening in Cote d’Ivoire

Save the Children recognizes the importance of strong health systems to deliver malaria interventions. Here they arsharing a wealth of information on these efforts at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting. Here is an abstract from one of their malaria efforts. See Author List below.

Since 2010, Cote d’Ivoire has made significant progress in the fight against malaria; however, since 2016 progress has stagnated and malaria incidence is steadily increasing. The aims of this study were to assess knowledge, attitudes and practices among heads of households, pregnant women and caretakers of children under 5 years of age (U5) and IPTp-SP compliance.

A mixed-methods study was conducted in rural and urban areas in 20 health districts of Cote d’Ivoire. A total of 1,812 households composed of 8,813 members were surveyed using a structured questionnaire. Qualitative data were gathered through twenty focus group discussions. Data triangulation was used during analysis.

Fever was the main malaria symptom reported by heads of households (38.5%) followed by headache (25.5%). Additionally, many FGD participants also reported sadness as a symptom of malaria. The primary cause of malaria was mosquito bites, followed by fatigue, the sun, and salty water, 70.7%, 15.1% and 10.9%, 3.3% respectively. The main prevention methods reported were sleeping under an ITN (60.4%), spraying the house (25.9%), taking medication (5.8%), and using a fan (7.9%). In FGDs, additional means of prevention were discussed including sanitation of the environment, personal hygiene, and stopping alcohol consumption.

The majority of women with at least one child reported having attended at least three ANC visits in their last pregnancy (85.1%). The cost of ANC was a main factor affecting attendance.  Overall, 78.2% of them received SP and of these women, 98.1% said they received it during their ANC visits. However, only 55.4% received 3 doses or more of SP and 76.79% received SP free of charge. The reasons for not taking SP were stock outs, side effects, bitter taste, and preference for injections.

Our study revealed that knowledge of prevention measures (ITNs) and causes of malaria (mosquito bites) were high and in line with the targets of the National BCC Strategy 2021-2025. However, even though the majority of pregnant women would like to take SP, they were blocked by the health system unable to provide them with the drugs and others had to pay for them. These problems within the health system are likely to contribute to the high malaria incidence in Cote d’Ivoire.

AUTHOR LIST

Edouard C. Balogoun1, Manasse Kassi1, Philomène A. Beda1, Jacob Y. Agniman1, Serge B. Assi2, Florence Kadjo-Kouadio3, Michel N’da-Ezoa4, Aristide E. Kouadio1, Joel Koffi1, Apollinaire N. Kouadio1, Paul Bouey5, Sara Canavati5, Eric Swedberg5 — 1Save the Children, Abidjan, Côte D’Ivoire, 2Le Programme Nationale de Lutte contre le Paludisme (PNLP), Abidjan, Côte D’Ivoire, 3Médecin Spécialiste de Santé, Abidjan, Côte D’Ivoire, 4Socio-Anthropologue de la Santé, Abidjan, Côte D’Ivoire, 5Save the Children, Washington, DC, United States

Antenatal Care (ANC) &CHW &IPTp Bill Brieger | 19 Nov 2021

Changes in ANC Attendance and IPTp Uptake after Introduction of Complimentary Community Interventions

The TiPToP malaria in pregnancy project of Jhpiego and Unitaid has been aiming to increase coverage of Intermittent Preventive Treatment of malaria in pregnancy. The abstract below shares experiences from Nigeria, one of 4 TiPToP countries, is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting. Described are Changes in antenatal care (ANC) attendance and uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) after introduction of community-based distribution of IPTp in three local government areas (LGA) in Nigeria. See Author List below.

In Nigeria, community health workers (CHWs) from three LGAs were engaged to introduce community delivery of IPTp (C-IPTp) with quality-assured sulfadoxine-pyrimethamine to prevent malaria. This approach, which complements IPTp delivery during ANC visits, was carried out in Ohaukwu, Akure South, and Bosso LGAs. C-IPTp was introduced in September 2018 in Ohaukwu and in December 2019 in Akure South and Bosso.

A total of 1,062 CHWs were trained on early identification of pregnant women, referral to ANC, IPTp administration, and use of mobile phones to capture and report data. CHWs conduct household visits, provide malaria health education, refer and encourage pregnant women to attend ANC, and provide IPTp.

Routine facility data from 2017 before introduction of C-IPTp were compared with 2020 facility and CHW data to understand the effect of C-IPTp across the LGAs. Before C-IPTp, 43% of the estimated number of pregnant women in these areas attended at least one ANC visit as compared to 57% in 2020 (p<.05).

Attending at least four ANC (ANC4) visits increased in Ohaukwu by ten percentage points to 29% in 2020 (p<.05). In Akure South, ANC4 remained steady Bosso pre-C-IPTp data on ANC4 visits were of too poor quality to conduct a meaningful analysis. Though this project focused on C-IPTp, it also resulted in statistically significant increases in IPTp distribution during ANC visits.

From 2017 to 2020, coverage of IPTp doses 1, 2, and 3 all saw increases across the three sites: IPTp1 increased from 54%?to 57%; IPTp2 from 36% to 42%; and IPTp3 increased 20 percentage points from 5% to 25%. Of pregnant women receiving all doses of IPTp, 39% did so through ANC with 61% receiving IPTp from CHWs.

These data suggest that in addition to contributing to overall increases in IPTp coverage, C-IPTp may also contribute to increases IPTp delivery in ANC and ANC attendance.

AUTHORS LIST:

Herbert Enyeribe Onuoha1, Bartholomew Odio1, Christina Maly2, Lawrence Nwankwo3, Folayan Waheed Adewale4, Elizabeth Njoku1, Oniyire Adetiloye1, Orji Bright1, Emmanuel Dipo Otolorin1, Elaine Roman2 — 1Jhpiego, Abakaliki, Nigeria, 2Jhpiego, Baltimore, MD, United States, 3Ebonyi State Ministry of Health, Abakaliki, Nigeria, 4Ondo State Ministry of Health, Alagbaka, Akure, Nigeria

Antenatal Care (ANC) &Case Management &CHW Bill Brieger | 19 Nov 2021

The role of community health workers in malaria control in in Cote d’Ivoire

Save the Children is sharing a wealth of information on programs at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting. Here is an abstract from one of their malaria efforts. See Author List below.

Since the Alma Ata Declaration in 1978, international efforts to improve access to primary health care have shifted towards the deployment of various types of community health workers (CHWs). This study aimed to assess the contribution of CHWs and identify challenges faced, which may impede malaria control efforts in Cote d’Ivoire.

A mixed-methods assessment was conducted in 16 health districts. A total of 1,922 community members were surveyed using a structured questionnaire. Qualitative data was gathered through 48 focus group discussions with pregnant women and mothers of children under 5, women’s groups and men and 132 in-depth interviews with government and implementation stakeholders, community members, caregivers and community leaders. Thematic content analysis around the key themes of the project implementation was used.

Over 50% of participants knew the CHW. The reported services provided by the CHW were diagnosis and treatment (47.4%), referrals to the health center (17.3%), education (14.1%), other medicines (12.2 %), and support at the health center (6.4%).  The benefits to children U5 reported by the participants were home-based treatment (22.9%), children get less sick (20.4%) and are in good health (14.7%), children suffer less from malaria (14%), and families spend less money on treatment (12.8%).

Additionally, up to 53% of pregnant women who had stopped attending ANC started to go again after being sensitized by the CHW. The main challenges reported by community members in accessing CHW services were non-coverage of all households by CHWs (13.6%), stock-outs of ACTs (10.9%), treatment provided is mostly for children U5 (10.4%). Distances between the CHW and the households were a major barrier to malaria treatment by CHWs.

CHWs were well perceived by the communities they serve. Expanding CHW coverage as well as CHW’s role to diagnose and treat adults is necessary for malaria control. Additionally, the lack of consistent supplies necessary for day-to-day activities, like ACTs and RDTs, must be addressed at the system level. Supply chain strengthening in Cote d’Ivoire, including forecasting and monitoring, is vital for CHWs to be effective.

AUTHOR LIST

Edouard C. Balogoun1, Manasse N. Kassi1, Philomène A. Beda1, Serge B. Assi2, Jacob Y. Agniman1, Théodore D. Doudou3, Rodolphe H. Yao4, Adama Z. Ouattara5, Joel Koffi1, Aristide E. Kouadio1, Apollinaire N. Kouadio1, Paul Bouey6, Sara Canavati6, Eric Swedberg6 — 1Save the Children, Abidjan, Côte D’Ivoire, 2Le Programme Nationale de Lutte contre le Paludisme (PNLP), Abidjan, Côte D’Ivoire, 3Sociologue de la Santé CRD/UAO, Abidjan, Côte D’Ivoire, 4National Statistical Institute (INS), Abidjan, Côte D’Ivoire, 5Socio-Anthropologue de la Santé (CRD/UAO), Abidjan, Côte D’Ivoire, 6Save the Children, Washington, DC, United States

Antenatal Care (ANC) &COVID-19 Bill Brieger | 18 Nov 2021

Factors related to changes in health facility attendance among pregnant women during COVID-19

As mentioned previously, the TiPToP malaria in pregnancy project of Jhpiego and Unitaid has been adjusting to the COVID-19 pandemic by training health workers to be more conscious of infection prevention skills. The abstract below is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting outlines what is happening with clinic attendance. See Author List below.

COVID-19 disrupted public health interventions and weakened global and national health systems. We used a mixed-methods study to explore factors related to changes in health facility attendance during the COVID-19 pandemic in three local government areas (LGAs) in Nigeria: Ohaukwu, Akure South and Bosso.

Three hundred fifteen pregnant women seen for antenatal care (ANC) in November 2020 participated in a survey about their attendance before and during the pandemic; 198 women participated in focus group discussions (FGDs). One quarter of women surveyed reported that they reduced the frequency of their visits or did not visit during the pandemic.

The biggest reported changes in visits were for immunization (47% visited before the pandemic versus 30% during the pandemic, p<0.001) and other outpatient services (66% to 57%, p=0.027), with small but statistically significant declines in ANC (99% to 94%, p=0.002) and family planning (11% to 5%, p=0.002). Both LGA and religion were significantly correlated with reduced/no visits during the pandemic; other socio-demographic characteristics were not. Whereas 33% of Christian women reported reduced/no care seeking, only 7% of Muslim women did (p<0.001).

Women in Ohaukwu were most likely to report reduced/no visits (39%), followed by those in Akure South (26%), and Bosso (7%) (p=0.012). During FGDs transport issues, proximity to health facilities, and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons mentioned for not seeking care during the pandemic.

Differences by LGA are likely related to differences in both levels of transmission and the State-level response to the pandemic. Ebonyi state, where Ohaukwu is located, had the longest lockdown and most restricted movement; better understanding of differences in the pandemic and state response could inform future actions.

The FGDs findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care.

AUTHOR LIST

Bright Orji 1, Elizabeth Oliveras 2, Emmanuel Ugwa 3, Aishatu Bintu Gubio 4, Edima Akpan 5, Bartholomew Odio 1, Herbert Onuoha 1, Ibrahim Idris 6, Emmanuel Dipo Otolorin 1, Elaine Roman 2 1Jhpiego, Abuja, Nigeria, 2Jhpiego, Baltimore, MD, United States, 3Federal Medical Center, Birnin kudu, Jigawa state, Nigeria, 4National Malaria Elimination Program, Federal Ministry of Health, Abuja, Nigeria, 5Reproductive Health Division, Federal Ministry of Health, Abuja, Nigeria, 6Niger State Ministry of Health, Minna, Nigeria

Antenatal Care (ANC) &Communication &Community &COVID-19 &IPTp &Malaria in Pregnancy &mHealth Bill Brieger | 18 Nov 2021

SMS to support health worker knowledge retention of maternal health and malaria interventions

The TiPToP malaria in pregnancy project of Jhpiego and Unitaid has been adjusting to the COVID-19 pandemic. Their abstract below is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting and explains the use of bulk SMS to support health worker knowledge retention on antenatal care and the use of intermittent preventive treatment of malaria in pregnancy during COVID-19 in Bosso local government area of Niger State, Nigeria. See Author List below.

In light of COVID-19 travel restrictions, bulk SMS were used to support knowledge retention of health workers following an in-person training held before the pandemic. In December 2019, 72 facility health workers and 260 community health workers (CHWs) in Bosso local government area of Niger State, Nigeria participated in a 12-day training about benefits of early antenatal care (ANC) attendance, CHW referrals to ANC, and use of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine to prevent malaria.

In-person supervision visits were conducted 3 months following training, although three months later in-person supervision was no longer possible due to COVID-19 related travel restrictions. Post-training support transitioned to use of bulk SMS which were sent twice a week to each cadre for two 3-month rounds of messaging.

Knowledge tests comprised of 10 multiple choice questions linked to key ANC and IPTp guidelines were administered at 5 time points: 1) baseline; 2) post-training; 3) at in-person supervision visit 3 months after training; 4) after first round of bulk SMS (6 months post-training); and 5) after second round of bulk SMS (9 months post-training).

Average test scores for each cadre were calculated at each time point and T-tests were used to assess differences in scores. The results show that facility health workers scored an average of 53% on the pre-test followed by scores of 76%, 74%, 86%, and ending at 80% 9 months following training. CHWs started with an average score of 49% which increased to 67% post-training; subsequent average scores were 83%, 74%, and 94%.

Results were compelling with facility health worker knowledge improving from 76% immediately post-training to 80% 9 months later (p-value<0.05) and for CHWs the improvement was from 67% to 94% (p-value<0.05). These findings suggest that use of SMS can support knowledge retention of key ANC and IPTp guidelines following an in-person training. Program managers, trainers and supervisors may consider using this approach to support health workers where resources and/or movement are restricted.

AUTHOR INFORMATION:

Charity Anoke 1, Orji Bright 1, Joseph Enne 1, Bartholomew Odio 1, Christina Maly 2, Amina Zimro 3, Ibrahim Idris 3, Elizabeth Njoku 1, Oniyire Adetiloye 1, Emmanuel Dipo Otolorin 1, Elaine Roman 2  — 1Jhpiego, Abuja, Nigeria, 2Jhpiego, Baltimore, MD, United States, 3Niger State Ministry of Health, Minna, Nigeria

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

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

Antenatal Care (ANC) &IPTp &Malaria in Pregnancy Bill Brieger | 16 Nov 2020

Achieving antenatal care attendance and intermittent preventive treatment in pregnancy in Geita, Tanzania

Ryan Lash and colleagues examined factors associated with achieving antenatal care (ANC) attendance and intermittent preventive treatment in pregnancy (IPTp) and made recommendations in Geita Region, Tanzania, 2019. There findings are being presented at the virtual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene.

Malaria in pregnancy results in an estimated 10,000 maternal and 100,000 infant deaths globally each year. To reduce this burden, the World Health Organization (WHO) recommends pregnant women in high to moderate malaria transmission areas receive at least 3 doses of intermittent preventive treatment in pregnancy (IPTp3) with sulfadoxine-pyrimethamine (SP) starting in the second trimester as part of routine antenatal care (ANC). Tanzania has national coverage goals of 80% coverage for women receiving IPTp3 and at least four ANC visits (ANC4).

We surveyed women 15-49 years who had given birth in the last 12 months from randomly selected households across 40 communities in Geita Region, Tanzania. ANC attendance and IPTp uptake was recorded from respondent ANC cards if available, or self-reported. Predictors of ANC4 and IPT3 uptake were identified using logistic regression modeling, accounting for clustering and controlling for gravidity.

Of 1,111 women surveyed, 505 (51.9%) received IPTp3 and 472 (43.4%) achieved ANC4. Among women who achieved ANC4, 295 (62.5%) received IPTp3. IPTp3 was associated with basic knowledge about ANC and IPTp (aOR 2.4, CI 1.9 -3.1), initiating ANC <20 weeks (aOR 1.7, CI 1.3-2.3), waiting at the facility for <120 minutes (aOR 1.4, CI 1.1-1.9), and receiving advice from a health worker about SP (aOR 1.7, CI 1.3-2.2).

ANC4 was associated with better access to care (aOR 1.9, CI 1.3-2.8, for travelling <3.75 km to ANC and aOR 1.9, CI 1.1-2.2, for waiting <90 minutes for the provider), initiating ANC at <20 weeks gestation (aOR 10.7, CI 8.2-14.1), and basic knowledge about ANC and IPTp (aOR 1.4, CI 1.0-1.9). Poor access to care and late initiation of ANC reduced the likelihood that women will attend 4 ANC visits. Knowledge was a predictor of both ANC attendance and IPTp uptake; increasing women’s health literacy may overcome some of the barriers associated with retention in ANC.

New approaches to delivering ANC that focus on improving knowledge and the experience of care among ANC clients could help close coverage gaps for ANC4 and IPTp3 in Tanzania

Authors and Affiliations

R. Ryan Lash(1), Ruth Lemwayi(2), Melkior Assenga(2), Alen Kinyina(2), Annette Almeida(2), Samwel L. Nhiga(3), Lia Florey(4), Chonge Kitojo(5), Erik Reaves(6), Miriam Kombe(5), Ally Mohamed(3), Japhet Simeo(7), Stephanie Suhowatsky(8), Mary Drake(2), Julie Gutman(1) 1.US Centers for Disease Control and Prevention, Atlanta, GA, United States, 2.Jhpiego Tanzania, Dar es Salaam, Tanzania, United Republic of, 3.National Malaria Control Program, Tanzania, Dar es Salaam, Tanzania, United Republic of, 4.US Agency for International Development, Washington, DC, United States, 5.US President’s Malaria Initiative / US Agency for International Development Tanzania, Dar es Salaam, Tanzania, United Republic of, 6.US Centers for Disease Control and Prevention / US President’s Malaria Initiative Tanzania, Atlanta, GA, United States, 7.Regional Medical Office, Geita, Geita, Tanzania, United Republic of, 8.Jhpiego, Baltimore, MD, United States