Posts or Comments 04 December 2022

Antenatal Care (ANC) &IPTp Bill Brieger | 31 Oct 2022 02:24 pm

Comparative analysis of facility and community distribution of intermittent preventive treatment of malaria in pregnancy

Charity Anoke, Bright Orji, Emily Bryce, Elizabeth Oliveras, Joseph Enne, Elizabeth Njoku, Lawrence Nwankwo, Emmanuel Ugwa, Bartholomew Odio, Herbert Onuoha, Christina Maly, Emmanuel Otolorin, Elaine Roman, and Oniyire Adetiloye are presenting a poster for the TiPToP project at the American Society of Tropical Medicine and Hygiene’s Annual Meeting in Seattle. Below is the evidence from maternity record booklets in Ohaukwu, Ebonyi State Nigeria.

Nigeria has the highest malaria burden globally, contributing to 31.9% of global malaria deaths, and is one of the two countries with the greatest burden of malaria during pregnancy. According to the 2018 Nigeria Demographic and Health Survey (DHS), even though up to 57% of pregnant women attend ANC four or more times, only 17% received three or more doses of IPTp as recommended by the WHO.

Nigeria supported this demonstration project of CHWs in delivering intermittent preventive treatment of malaria in pregnancy (IPTp) at the community-level, complementing IPTp at antenatal care (ANC) in three districts. Data were extracted from 735 maternity record booklets (MRB) at 25 public health facilities in Ohaukwu for women presenting for ANC between April and September of 2019. The MRB allowed for the longitudinal analysis of client-level data that is not available from routine data sources.

Sixty percent of women received IPTp doses only in the community, while 28% received IPTp only at ANC and 12% received IPTp in both locations. One-way ANOVA and post-hoc Tukey tests were used to examine the difference in mean number of ANC visits and number of IPTp doses between the three groups. The mean number of ANC visits was significantly higher in the group of women receiving IPTp at both locations compared to those only receiving IPTp in the community (0.89 ± 0.18 visits, p<0.01) and those only receiving IPTp during ANC (0.61 ± 0.20 visits, p<0.01).

There was no statistically significant difference in the mean number of ANC visits between the groups receiving IPTp only in one location (0.29 ± 0.13 visits, p=0.077). The difference in number of doses was statistically significant across all groups, whereby women in the facility-only group received the fewest IPTp doses. Receipt of IPTp in both locations was associated with both greater numbers of ANC visits and IPTp doses. Only receiving IPTp in the community was not associated with a decrease in ANC attendance.

These data suggest complementing ANC-based IPTp distribution with community-based distribution is beneficial.

2 Responses to “Comparative analysis of facility and community distribution of intermittent preventive treatment of malaria in pregnancy”

  1. on 31 Oct 2022 at 4:04 pm 1.Musa lawal said …

    A wonderfull presentation

  2. on 28 Nov 2022 at 3:46 am 2.Bright Orji said …

    It is important to note that women received IPTp-SP at home but were not distracted from attending antenatal care. This is good because IPTp-SP is just one of essential interventions given to pregnant women. Therefore, community IPTp should complement comprehensive ANC services and a good way to go if we intend to expand and accelerate access to IPTp intervention.

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