Scoping Review of the Key Determinants and Indicators of Malaria in Pregnancy, Madagascar (2010-2019)

This year the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene is virtual.  Catherine Dentinger and colleagues (see authors below) gathered information to guide partner planning to combat malaria in pregnancy in Madagascar. Here are their findings.

Malaria in pregnancy (MIP) increases the risk of poor maternal and infant outcomes; to prevent this, the World Health Organization (WHO) recommends insecticide-treated net (ITN) use, intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), and prompt case management. In Madagascar, IPTp uptake remains low; 10% of targeted women receive 3 doses.

To determine if additional data are needed to improve MIP activities, we conducted a scoping review to identify barriers to antenatal care (ANC) and IPTp uptake. We searched PubMed, Google Scholar and USAID’s files (Development Experience Catalog) using the terms “Madagascar” and “pregnancy” and “malaria” and collected materials from stakeholders. We included English and French documents from 2010 to 2019 with quantitative or qualitative data regarding malaria during pregnancy.

Documents were reviewed and categorized as MIP background information, care seeking, and facility readiness. Of 69 project reports, surveys and published articles, 15 (22%) met the inclusion criteria; 4 (27%) were categorized as care seeking, 4 (27%) as background, and 7 (47%) as facility readiness.

Eight (53%) articles mentioned SP stock outs, 3 (20%) mentioned poor provider knowledge of IPTp guidelines despite recent training, and 5 (33%) discussed barriers to ANC including distance, wait times, poor service quality, cost, and unfriendly providers. One study found only 30% of targeted health workers received recommended supervision.  A 2015 survey of 52 health facilities revealed limited access to ANC due to financial and geographic barriers; 2018 surveys revealed similar findings. Self-treatment and care-seeking delays were reported even when distance was not a barrier.

Our review revealed well-documented barriers to MIP services that could be mitigated by reducing stock outs, improving access to healthcare by removing fees and providing services closer to women’s homes, and targeted behavior change. These findings can be used to guide coordinated donor and government efforts to address management, financial, and human resource gaps to improve MIP services.

Authors and Affiliations

Catherine Dentinger(1), Natasha Hansen(2), Susan Youll(2), Annett Cotte(1), Mary Lindsay(3), Chiarella Matten(4), Vololoniala Aimee Ravaoarinosy(5). 1.Centers for Disease Control and Prevention, Atlanta, GA, United States, States, 3.US Agency for International Development, Washington, DC, United States, 4.Institut Pasteur de Madagascar, Antananarivo, Madagascar, 5.National Malaria Control Program, Antananarivo, Madagascar 2.US Agency for International  Development, Washington DC, DC, United States

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