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The Readiness of Malaria Services And Uptake of Intermittent Preventive Treatment in Pregnancy in Six Sub-Saharan Countries
24 Pages Posted: 30 Jan 2024
More...Abstract
Background: Malaria infection during pregnancy is associated with an increased risk of maternal death, as well as adverse birth outcomes. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is known to improve pregnancy outcome yet the coverage of IPTp-SP in antenatal care (ANC) in sub-Saharan Africa remains well below the target. This study aims to estimate how malaria service readiness affects the uptake of IPTp-SP during ANC visits in sub-Saharan African countries.
Methods: This study included 3,267 pregnant women attending ANC for the first time and 2,797 pregnant women who had attended ANC more than a month ago in six sub-Saharan African countries. The primary predictors were the readiness of malaria services at each institution, including the presence of IPTp-SP guidelines, SP availability, integration of IPTp-SP service into ANC, and provider training on IPTp-SP. The outcome variable indicates whether a pregnant woman received IPTp-SP at her current ANC visit. A modified Poisson regression model estimated the associations between malaria service readiness and IPTp-SP uptake for women eligible for the first and subsequent doses.
Findings: For women eligible for their first dose, visiting an institution with available SP was associated with an increased probability of receiving IPTp-SP (RR= 1.43, 95% CI: 1.22~1.67, p <0.001). For women eligible for their next dose, the availability of SP (RR= 1.17, 95% CI: 1.04~1.32, p =0.008) and integration of IPTp-SP service into ANC (RR= 1.82, 95% CI: 1.21~2.74, p =0.004) in the institution were associated with increased likelihood of IPTp-SP uptake. Counterfactual predictions indicated that enhanced provider training could boost IPTp-SP uptake in high-uptake countries, while better SP availability and IPTp-SP integration into ANC would significantly impact low-uptake countries.
Interpretation: For better IPTp-SP coverage, strategies should be customized. High uptake countries should focus on provider training, while low uptake ones should ensure IPTp-SP availability and service integration.
Funding: This research is funded by the Major Project of the National Social Science Fund of China (Grant ID: 20VMG027 & 20&ZD147).
Declaration of Interest: The authors declare that they have no competing interests.
Keywords: IPTp-SP, ANC, malaria service readiness
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