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Effectiveness of the delivery of interventions to prevent malaria in pregnancy in Kenya.

Dellicour S, Hill J, Bruce J, Ouma P, Marwanga D, Otieno P, Desai M, Hamel MJ, Kariuki S, Webster J - Malar. J. (2016)

Bottom Line: The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively.This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities.The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. stephanie.dellicour@lstmed.ac.uk.

ABSTRACT

Background: Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC).

Methods: A cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated.

Results: Overall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively.

Conclusion: This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level.

No MeSH data available.


Related in: MedlinePlus

Intermediate steps in the delivery of IPTp-SP and ITN through antenatal care
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Fig2: Intermediate steps in the delivery of IPTp-SP and ITN through antenatal care

Mentions: Data were collected on paper forms and were double entered into EpiData (Version 3.1, EpiData Association, Odense, Denmark) and validated before being transferred to Stata (Version 13, 2013; College Station, TX) for analysis. Each intermediate step required for the effective delivery of IPTp and ITNs through ANC as per WHO guidelines [6] and Kenyan national policy [13] (Fig. 1) defined the framework for analysis (Fig. 2). The data collected were used to quantify: (1) the proportion of ANC attendees who successfully completed a designated intermediate step in the delivery of each intervention from those who completed the previous step, (2) the cumulative systems effectiveness corresponding to the proportion of eligible ANC attendees who successfully completed all intermediate steps to the designated point in the overall delivery process, and (3) design effect (DE) and intra-cluster correlation coefficients (ICC) between health facilities for each intermediate step in the delivery of IPTp and ITNs. Predictors of ineffective intermediate steps will be described in a separate paper together with results from the qualitative data.Fig. 1


Effectiveness of the delivery of interventions to prevent malaria in pregnancy in Kenya.

Dellicour S, Hill J, Bruce J, Ouma P, Marwanga D, Otieno P, Desai M, Hamel MJ, Kariuki S, Webster J - Malar. J. (2016)

Intermediate steps in the delivery of IPTp-SP and ITN through antenatal care
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835845&req=5

Fig2: Intermediate steps in the delivery of IPTp-SP and ITN through antenatal care
Mentions: Data were collected on paper forms and were double entered into EpiData (Version 3.1, EpiData Association, Odense, Denmark) and validated before being transferred to Stata (Version 13, 2013; College Station, TX) for analysis. Each intermediate step required for the effective delivery of IPTp and ITNs through ANC as per WHO guidelines [6] and Kenyan national policy [13] (Fig. 1) defined the framework for analysis (Fig. 2). The data collected were used to quantify: (1) the proportion of ANC attendees who successfully completed a designated intermediate step in the delivery of each intervention from those who completed the previous step, (2) the cumulative systems effectiveness corresponding to the proportion of eligible ANC attendees who successfully completed all intermediate steps to the designated point in the overall delivery process, and (3) design effect (DE) and intra-cluster correlation coefficients (ICC) between health facilities for each intermediate step in the delivery of IPTp and ITNs. Predictors of ineffective intermediate steps will be described in a separate paper together with results from the qualitative data.Fig. 1

Bottom Line: The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively.This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities.The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. stephanie.dellicour@lstmed.ac.uk.

ABSTRACT

Background: Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC).

Methods: A cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated.

Results: Overall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively.

Conclusion: This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level.

No MeSH data available.


Related in: MedlinePlus