Tropical Health Matters

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 69^th 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 Gutman^3
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

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