Details:

Alternative Title:
PLoS One
Personal Author:
Hill, Jenny ; Dellicour, Stephanie ; Bruce, Jane ; Ouma, Peter ; Smedley, James ; ... More +
Hill, Jenny ; Dellicour, Stephanie ; Bruce, Jane ; Ouma, Peter ; Smedley, James ; Otieno, Peter ; Ombock, Maurice ; Kariuki, Simon ; Desai, Meghna ; Hamel, Mary J. ; ter Kuile, Feiko O. ; Webster, Jayne Less -
Description:
Background

Malaria in pregnancy can have devastating consequences for mother and baby. Coverage with the WHO prevention strategy for sub-Saharan Africa of intermittent-preventive-treatment (IPTp) with two doses of sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) in pregnancy is low. We analysed household survey data to evaluate the effectiveness of antenatal clinics (ANC) to deliver IPTp and ITNs to pregnant women in Nyando district, Kenya.

Methods

We assessed the systems effectiveness of ANC to deliver IPTp and ITNs to pregnant women and the impact on low birthweight (LBW). Logistic regression was used to identify predictors of receipt of IPTp and ITN use during pregnancy.

Results

Among 89% of recently pregnant women who attended ANC at least once between 4–9 months gestation, 59% reported receiving one dose of SP and 90% attended ANC again, of whom 57% received a second dose, resulting in a cumulative effectiveness for IPTp of 27%, most of whom used an ITN (96%). Overall ITN use was 89%, and ANC the main source (76%). Women were less likely to receive IPTp if they had low malaria knowledge (0.26, 95% CI 0.08–0.83), had a child who had died (OR 0.36, 95% CI 0.14–0.95), or if they first attended ANC late (OR 0.20, 95% CI 0.06–0.67). Women who experienced side effects to SP (OR 0.18, CI 0.03–0.90) or had low malaria knowledge (OR 0.78, 95% CI 0.11–5.43) were less likely to receive IPTp by directly observed therapy. Ineffective delivery of IPTp reduced its potential impact by 231 LBW cases averted (95% CI 64–359) per 10,000 pregnant women.

Conclusion

IPTp presents greater challenges to deliver through ANC than ITNs in this setting. The reduction in public health impact on LBW resulting from ineffective delivery of IPTp is estimated to be substantial. Urgent efforts are required to improve service delivery of this important intervention.


Subjects:
[+]
Adolescent Adult Ambulatory Care Facilities Antimalarials Drug Combinations Female Humans Infant, Low Birth Weight Insecticide-Treated Bednets / Statistics & Numerical Data* Malaria Middle Aged Mosquito Control Patient Acceptance Of Health Care Pregnancy Pregnancy Complications, Parasitic Prenatal Care Pyrimethamine Sulfadoxine Young Adult
Source:
PLoS One. 2013; 8(6).
Document Type:
Journal Article
Place as Subject:
Kenya
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:e09e6f5196deac2f4a6dda8d6ce1e14685280f5cd78a06b7c689c2fbfe008e25
Download URL:
https://stacks.cdc.gov/view/cdc/21469/cdc_21469_DS1.pdf
File Type:

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