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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

a Cumulative system effectiveness for the delivery of IPTp-SP by DOT through ANC and b Cumulative system effectiveness for the delivery of IPTp-SP through ANC either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them. Intermediate steps are as follows: step 1, Eligible pregnant women attend ANC in her second trimester; step 2, SP is in stock; step 3, SP is given to the pregnant women; step 4, the correct dose of SP is given (three tablets); step 5, the pregnant women take IPTp-SP by DOT (a) or either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them (b)
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Fig3: a Cumulative system effectiveness for the delivery of IPTp-SP by DOT through ANC and b Cumulative system effectiveness for the delivery of IPTp-SP through ANC either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them. Intermediate steps are as follows: step 1, Eligible pregnant women attend ANC in her second trimester; step 2, SP is in stock; step 3, SP is given to the pregnant women; step 4, the correct dose of SP is given (three tablets); step 5, the pregnant women take IPTp-SP by DOT (a) or either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them (b)

Mentions: Out of the 748 observations in the eight health facilities, 546 participants were eligible for IPTp according to national policy (Table 4). Of the 202 not eligible, 117 (16 %) were HIV positive and assumed to be taking daily cotrimoxazole, 14 had a gestation <16 weeks and/or hadn’t felt the baby move, and gestational age was unknown for 86 participants (note these are not mutually exclusive categories). Of the eligible women, only 45.8 % were given IPTp by DOT per policy. This was similar for level 4 (39.8 %) and levels 2 and 3 combined (53.3 %) (Fig. 3a). Two intermediate steps were identified as ineffective in the delivery of IPTp in level 4 facilities, namely: being given any SP (74.0 %) and being given IPTp by DOT (67.3 %). For health facilities level 2 and 3, the only ineffective step was being given IPTp by DOT (70.1 %) as 80.3 % of eligible women were given SP during their ANC visit.Table 4


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)

a Cumulative system effectiveness for the delivery of IPTp-SP by DOT through ANC and b Cumulative system effectiveness for the delivery of IPTp-SP through ANC either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them. Intermediate steps are as follows: step 1, Eligible pregnant women attend ANC in her second trimester; step 2, SP is in stock; step 3, SP is given to the pregnant women; step 4, the correct dose of SP is given (three tablets); step 5, the pregnant women take IPTp-SP by DOT (a) or either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: a Cumulative system effectiveness for the delivery of IPTp-SP by DOT through ANC and b Cumulative system effectiveness for the delivery of IPTp-SP through ANC either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them. Intermediate steps are as follows: step 1, Eligible pregnant women attend ANC in her second trimester; step 2, SP is in stock; step 3, SP is given to the pregnant women; step 4, the correct dose of SP is given (three tablets); step 5, the pregnant women take IPTp-SP by DOT (a) or either by DOT or pregnant women having three tablets of SP at exit and knowing how to take them (b)
Mentions: Out of the 748 observations in the eight health facilities, 546 participants were eligible for IPTp according to national policy (Table 4). Of the 202 not eligible, 117 (16 %) were HIV positive and assumed to be taking daily cotrimoxazole, 14 had a gestation <16 weeks and/or hadn’t felt the baby move, and gestational age was unknown for 86 participants (note these are not mutually exclusive categories). Of the eligible women, only 45.8 % were given IPTp by DOT per policy. This was similar for level 4 (39.8 %) and levels 2 and 3 combined (53.3 %) (Fig. 3a). Two intermediate steps were identified as ineffective in the delivery of IPTp in level 4 facilities, namely: being given any SP (74.0 %) and being given IPTp by DOT (67.3 %). For health facilities level 2 and 3, the only ineffective step was being given IPTp by DOT (70.1 %) as 80.3 % of eligible women were given SP during their ANC visit.Table 4

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