Malaria knowledge and experiences with community health workers among recently pregnant women in Malawi (original) (raw)
Related papers
Public Health, 2008
Background: The impact of intermittent preventive treatment (IPTp) on malaria in pregnancy is well known. However, in countries where this policy is implemented, poor access and low compliance have been widely reported. Novel approaches are needed to deliver this intervention. Objective: To assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer IPTp with sulphadoxine-pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. Study design: An intervention study compared the delivery of IPTp in the community with routine delivery of IPTp at health units. The primary outcome measures were the proportion of adolescents and primigravidae accessed, and the proportion of women who received two doses of SP. The study also assessed the effect of the intervention on access to malaria treatment, antenatal care, other services and related costs. Results: More women (67.5%) received two doses of SP through the community approach compared with health units (39.9%; Po0.0001). Women who accessed IPTp in the community were at an earlier stage of pregnancy (21.0 weeks of gestation) than women who accessed IPTp at health units (23.1 weeks of gestation; Po0.0001). However, health units were visited by a higher proportion of primigravidae (23.6% vs (A.K. Mbonye). 20.0%; Po0.04) and adolescents (28.4% vs 25.0%; Po0.03). Generally, women who accessed IPTp at health units made more visits for malaria treatment (2.6 (1.0-4.7) vs 1.8 (1.4-2.2); Po0.03). At recruitment, more women who accessed IPTp at health units sought malaria treatment compared with those who accessed IPTp in the community (56.9% vs 49.2%). However, at delivery, a high proportion of women who accessed IPTp in the community had sought malaria treatment (70.3%), suggesting the possibility that the novel approach had a positive impact on care seeking for malaria. Similarly, utilization of antenatal care, insecticide-treated nets and delivery care by women in the community was high. The total costs per woman receiving two doses of SP for IPTp were 4093 Uganda shillings (US$ 2.3) for women who accessed IPTp at health units, and 4491 Uganda shillings (US$ 2.6) for women who accessed IPTp in the community. Conclusion: The community approach was effective for the delivery of IPTp, although women still accessed and benefited from malaria treatment and other services at health units. However, the costs for accessing malaria treatment and other services are high and could be a limiting factor in mitigating the burden of malaria in Uganda.
BMC Health Services Research, 2014
Background: Universal access to and utilization of malaria prevention measures is defined as every person at malaria risk sleeping under a quality insecticide-treated mosquito net (ITN) and every pregnant woman at risk receiving at least two doses of sulfadoxine-pyrimethamine (SP). This study aimed to determine factors affecting accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania. Methods: Women of reproductive age with children <5 years old or those who had been pregnant during the past 5 years were included in the study. A structured questionnaire was used to seek information on malaria knowledge, accessibility and utilization of malaria interventions during pregnancy. Results: A total of 297 women (mean age=29±6.8 years) were involved. Seventy percent of the women had attained primary school education. About a quarter of women had two children of <5 years while over 58% had ≥3 children. Most (71.4%) women had medium general knowledge on malaria while only eight percent of them had good knowledge on malaria in pregnancy. A significant proportion of women were not aware of the reasons for taking SP during pregnancy (35%), timing for SP (18%), and the effect of malaria on pregnancy (45.8%). Timing for first dose of SP for intermittent preventive treatment in pregnancy (IPTp) was 1-3 months (28.4%) and 4-6 months (36.8%). Some 78.1% were provided with SP under supervision of the health provider. Knowledge on malaria in pregnancy had a significant association with levels of education (p=0.024). Ninety-eight percent had an ITN, mostly (87.1%) received free from the government. All women attended the ANC during their last pregnancy. The coverage of IPT1 was 53.5% and IPTp2 was 41.1%. The proportion of women making more ANC visits decreased with increasing parity.
BMJ Global Health
IntroductionIntermittent preventive treatment in pregnancy with sulphadoxine pyrimethamine (IPTp) is a key malaria prevention strategy in sub-Saharan African countries. We conducted an anthropological study as part of a project aiming to evaluate a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in four countries (the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria), to understand the social context in order to identify key factors that could influence C-IPTp acceptability.MethodsA total of 796 in-depth interviews and 265 focus group discussions were undertaken between 2018 and 2021 in the four countries with pregnant women, women of reproductive age, traditional and facility-based healthcare providers, community leaders, and relatives of pregnant women. These were combined with direct observations (388) including both community-based and facility-based IPTp delivery. Grounded theory guided the overall study design a...
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007
a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r h e a l t h . c o m / j o u r n a l s / t r s t Summary Community delivery of intermittent preventive treatment of malaria in pregnancy (IPTp) is one potential option that could mitigate malaria in pregnancy. However, there is concern that this approach may lead to complacency among women with low access to essential care at health units. A non-randomised community trial assessed a new delivery system of IPTp through traditional birth attendants, drug shop vendors, community reproductive health workers and adolescent peer mobilisers (the intervention) compared with IPTp at health units (control). The study enrolled a total of 2081 pregnant women with the new approaches. Data on care-seeking practices before and after the intervention were collected. The majority of women with the new approaches accessed IPTp in the second trimester and adhered to two doses of sulfadoxine/pyrimethamine (SP) (1404/2081; 67.5%). Antenatal care (four recommended visits) increased from 3.4% (27/805) to 56.8% (558/983) (P < 0.001). The proportion of women delivering at health units increased from 34.3% (276/805) to 41.5% (434/1045) (P = 0.02), whilst the proportion of women seeking care for malaria at health units increased from 16.7% (128/767) to 36.0% (146/405) (P < 0.001). Similarly, use of insecticide-treated nets increased from 7.7% (160/2081) to 22.4% (236/1055) (P < 0.001). In conclusion, the community-based system was effective in delivering IPTp, whilst women still accessed and benefited from essential care at health units.
Tropical Medicine & International Health, 2007
Background In 1998, Kenya adopted intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) for malaria prevention during pregnancy. We conducted a survey in 2002 among women who had recently delivered in the rural neighbouring areas Asembo and Gem and reported coverage of 19% of at least one dose and 7% of two or more doses of SP. Health care workers (HCW) in Asembo were retrained on IPTp in 2003.Objectives To evaluate if IPTp coverage increased and if the training in Asembo led to better coverage than in Gem, and to identify barriers to the effective implementation of IPTp.Methods Community-based cross-sectional survey among a simple random sample of women who had recently delivered in April 2005, interviews with HCW of antenatal clinics (ANC) in Asembo and Gem.Results Of the 724 women interviewed, 626 (86.5%) attended the ANC once and 516 (71.3%) attended two or more times. Overall IPTp coverage was 41% for at least one dose, and 21% for at least two doses of SP. In Asembo, coverage increased from 19% in 2002 to 61% in 2005 for at least one dose and from 7% to 17% for two doses of SP. In Gem, coverage increased from 17% to 28% and 7% to 11%, respectively. Interviews of HCW in both Asembo and Gem revealed confusion about appropriate timing, and lack of direct observation of IPTp.Conclusion Training of HCW and use of simplified IPTp messages may be a key strategy in achieving Roll Back Malaria targets for malaria prevention in pregnancy in Kenya.Données de base En 1998, le Kenya a adopté le traitement préventif intermittent (TPI) à base de sulfadoxine-pyriméthamine (SP) pour la prévention de la malaria pendant la grossesse. Nous avons conduit une surveillance en 2002 chez les femmes qui avaient récemment accouché dans l'environnement rural voisin de Asembo et Gem et avons rapporté une couverture de 19% pour au moins une dose et de 7% pour deux doses ou plus de SP. Les agents de santé de Asembo ont été en formation de recyclage sur le TPI en 2003.Objectifs Evaluer si la couverture TPI a augmenté et si la formation à Asembo a menéà une meilleure couverture qu’à Gem et identifier les barrières à l'implémentation efficace du TPI.Méthodes Etude transversale basée sur la communauté sur un échantillon aléatoire simple de femmes qui avaient récemment accouché en avril 2005. Entretien avec les agents de santé des cliniques prénatales à Asembo et à Gem.Résultats Sur 724 femmes interviewées, 626 (86,5%) se sont présentées à la clinique prénatale une fois et 516 (71,3%) deux fois ou plus. La couverture totale était de 41% pour au moins une dose et 21% pour au moins deux doses de SP. A Asembo, la couverture a augmenté de 19% en 2002 à 61% en 2005 pour au moins une dose et de 7%à 17% pour deux doses de SP. A Gem, la couverture a augmenté de 17%à 28% et de 7%à 11%, respectivement. Les entretiens avec les agents de santéà Asembo et à Gem ont révélé une confusion au sujet de la synchronisation appropriée et le manque d'observation directe du TPI.Conclusion La formation des agents de santé et l'utilisation de messages simplifiés pour le TPI peuvent constituer une stratégie clé pour atteindre l'objectif du programme ≪reculer la malaria≫ pour la prévention de la malaria dans la grossesse au Kenya.Données de base En 1998, le Kenya a adopté le traitement préventif intermittent (TPI) à base de sulfadoxine-pyriméthamine (SP) pour la prévention de la malaria pendant la grossesse. Nous avons conduit une surveillance en 2002 chez les femmes qui avaient récemment accouché dans l'environnement rural voisin de Asembo et Gem et avons rapporté une couverture de 19% pour au moins une dose et de 7% pour deux doses ou plus de SP. Les agents de santé de Asembo ont été en formation de recyclage sur le TPI en 2003.Objectifs Evaluer si la couverture TPI a augmenté et si la formation à Asembo a menéà une meilleure couverture qu’à Gem et identifier les barrières à l'implémentation efficace du TPI.Méthodes Etude transversale basée sur la communauté sur un échantillon aléatoire simple de femmes qui avaient récemment accouché en avril 2005. Entretien avec les agents de santé des cliniques prénatales à Asembo et à Gem.Résultats Sur 724 femmes interviewées, 626 (86,5%) se sont présentées à la clinique prénatale une fois et 516 (71,3%) deux fois ou plus. La couverture totale était de 41% pour au moins une dose et 21% pour au moins deux doses de SP. A Asembo, la couverture a augmenté de 19% en 2002 à 61% en 2005 pour au moins une dose et de 7%à 17% pour deux doses de SP. A Gem, la couverture a augmenté de 17%à 28% et de 7%à 11%, respectivement. Les entretiens avec les agents de santéà Asembo et à Gem ont révélé une confusion au sujet de la synchronisation appropriée et le manque d'observation directe du TPI.Conclusion La formation des agents de santé et l'utilisation de messages simplifiés pour le TPI peuvent constituer une stratégie clé pour atteindre l'objectif du programme ≪reculer la malaria≫ pour la prévention de la malaria dans la grossesse au Kenya.Antecedentes En 1998, Kenia adoptó el tratamiento preventivo intermitente (IPTp) con sulfadoxina pirimetamina (SP) para la prevención de la malaria durante el embarazo. En el 2002 se realizó una encuesta entre mujeres con un parto reciente en las áreas rurales vecinas a Asembo y Gem, y con una cobertura reportada del 19% para al menos una dosis y del 7% para dos o más dosis de SP. Los trabajadores sanitarios (TSs) en Asembo fueron entrenados de nuevo en IPTp en el 2003.Objetivos Evaluar el incremento de la cobertura de IPTp, y si el entrenamiento resultó en una mejor cobertura que en Gem, e identificar las barreras para una implementación efectiva del IPTp.Métodos Ensayo croseccional basado en la comunidad entre mujeres elegidas al azar con un parto reciente en Abril del 2005 y entrevistas con trabajadores sanitarios en clínicas antenatales de Asembo y Gem.Resultados De las 724 mujeres entrevistadas, 626 (86.5%) visitaron la clínica antenatal una vez y 516 (71.3%) se visitaron dos o más veces. En total, la cobertura del IPTp fue de 41% para al menos una dosis, y 21% para al menos dos dosis de SP. En Asembo, la cobertura aumentó de 19% en el 2002 a 61% en el 2005 para al menos una dosis y del 7% al 17% para al menos dos dosis de SP. En Gem, la cobertura aumentó del 17% al 28% y del 7% al 11%, respectivamente. Las entrevistas con los TSs, tanto de Asembo como de Gem mostraron que existe confusión sobre los tiempos adecuados, y hay una falta de observación directa del IPTp.Conclusión El entrenamiento de los TSs y el uso de mensajes simplificados sobre el IPTp podría ser una estrategia clave para alcanzar los objetivos de Roll Back Malaria para la prevención de la malaria durante el embarazo en Kenia.Antecedentes En 1998, Kenia adoptó el tratamiento preventivo intermitente (IPTp) con sulfadoxina pirimetamina (SP) para la prevención de la malaria durante el embarazo. En el 2002 se realizó una encuesta entre mujeres con un parto reciente en las áreas rurales vecinas a Asembo y Gem, y con una cobertura reportada del 19% para al menos una dosis y del 7% para dos o más dosis de SP. Los trabajadores sanitarios (TSs) en Asembo fueron entrenados de nuevo en IPTp en el 2003.Objetivos Evaluar el incremento de la cobertura de IPTp, y si el entrenamiento resultó en una mejor cobertura que en Gem, e identificar las barreras para una implementación efectiva del IPTp.Métodos Ensayo croseccional basado en la comunidad entre mujeres elegidas al azar con un parto reciente en Abril del 2005 y entrevistas con trabajadores sanitarios en clínicas antenatales de Asembo y Gem.Resultados De las 724 mujeres entrevistadas, 626 (86.5%) visitaron la clínica antenatal una vez y 516 (71.3%) se visitaron dos o más veces. En total, la cobertura del IPTp fue de 41% para al menos una dosis, y 21% para al menos dos dosis de SP. En Asembo, la cobertura aumentó de 19% en el 2002 a 61% en el 2005 para al menos una dosis y del 7% al 17% para al menos dos dosis de SP. En Gem, la cobertura aumentó del 17% al 28% y del 7% al 11%, respectivamente. Las entrevistas con los TSs, tanto de Asembo como de Gem mostraron que existe confusión sobre los tiempos adecuados, y hay una falta de observación directa del IPTp.Conclusión El entrenamiento de los TSs y el uso de mensajes simplificados sobre el IPTp podría ser una estrategia clave para alcanzar los objetivos de Roll Back Malaria para la prevención de la malaria durante el embarazo en Kenia.
PloS one, 2011
Background: Malaria during pregnancy (MiP) results in adverse birth outcomes and poor maternal health. MiP-related morbidity and mortality is most pronounced in sub-Saharan Africa, where recommended MiP interventions include intermittent preventive treatment, insecticide-treated bednets and appropriate case management. Besides their clinical efficacy, the effectiveness of these interventions depends on the attitudes and behaviours of pregnant women and the wider community, which are shaped by social and cultural factors. Although these factors have been studied largely using quantitative methods, qualitative research also offers important insights. This article provides a comprehensive overview of qualitative research on social and cultural factors relevant to uptake of MiP interventions in sub-Saharan Africa.
2013
Even though it appears as if countries in sub-Saharan Africa have made important progress in IPTp implementation, coverage levels remain low. Various studies done have come out with various findings ranging from lack of knowledge to negative attitudes of woman towards the program. The purpose of this study was to determine the association between knowledge and utilization of IPTp by pregnant women attending ANC services at Dangamvura and Sakubva Mutare city clinics. Pender’s health promotion model was used to guide and direct the study. A descriptive correlation design was used for the study. The author examined the strength of the relationship between knowledge and utilisation of IPTp by pregnant women attending ANC at Dangamvura and Sakubva Mutare Clinics. A sample of 80 women who were attending ANC visits was selected by systematic random sampling. Data were collected through face to face interviews using a structured questionnaire. Interview guide consisted of questions on kno...
Malaria Journal, 2016
Background: In Uganda, the Government has promoted the use of intermittent preventive treatment of malaria in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) as malaria control strategies for pregnant women. However, their utilization among pregnant women is low. This study aimed at assessing factors associated with use of IPTp for malaria and ITNs by pregnant women in Buwunga sub-county, Bugiri District. Methods: This was a cross-sectional study, conducted in Buwunga sub-county, Bugiri District, employing quantitative data collection tools. A total of 350 household members were randomly selected to participate in the study. Data were entered and analysed using Epi info version 3.5.1; bivariable and multivariable analysis was done to assess the factors associated with use of IPTp and ITNs among pregnant women. Results: The level of uptake of IPTp1 (at least one dose) was 63.7 % while IPTp2 (at least two doses) was 42.0 %. More than half (58.6 %) of the mothers had slept under an ITN the night before the survey. Slightly more than half (51.9 %) of the mothers mentioned stock outs as the major reason for not accessing IPTp and ITNs. The main factors that were statistically significant for IPTp2 uptake were the knowledge of mothers on IPTp2 (AOR 2.48 95 % CI 1.53-4.02) and providing women with free clean water at the antenatal care (ANC) clinic (AOR 3.63 95 % CI 2.06-6.39). Factors that were significant for ITN utilization included education level of mothers (AOR 2.03 95 % CI 1.09-3.78), ease of access (AOR 2.74 95 % CI 1.65-4.52), and parity (AOR 1.71 95 % CI 1.01-1.29). Conclusion: The level of uptake of the two recommended doses of sulfadoxine-pyrimethamine (SP) tablets for malaria prevention (IPTp2) was low, slightly more than half of the mothers slept under an ITN the night before the survey. Appropriate measures to increase the level of uptake of IPTp2 and coverage of ITNs among pregnant women should be implemented, and these include providing health education about IPTp and ITNs, and ensuring that mothers are provided with free safe clean water at ANC clinic.
2021
Background Burkina Faso is among ten countries with the highest rates of malaria cases and deaths in the world. Delivery and coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) is insufficient in Burkina Faso; In a 2016 survey, only 22% of eligible women had received their third dose of IPTp. It is also an extremely rural country and one with an established cadre of community healthcare workers (CHWs). To better meet the needs of pregnant women, an enhanced programme was established to facilitate distribution of IPTp at the community level by CHWs. Methods In order to assess the perceptions of CHWs and facility healthcare workers (HCWs) involved in this programme rollout, semi-structured interviews were conducted at three high malaria burden health districts in Burkina Faso. Interviews were conducted at baseline with 104 CHWs and 35 HCWs prior to the introduction of community based IPTp (c-IPTp) to assess capacity and any areas of concern. At endline, interv...