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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

Cumulative system effectiveness for the delivery of ITN through ANC stratified for health facility level 4 and 2/3 combined. Intermediate steps are as follows: step 1 attend ANC for first visit; step 2 ITN are in stock; step 3 an ITN is offered to the women; step 4 the women accepts and takes the ITN
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Fig4: Cumulative system effectiveness for the delivery of ITN through ANC stratified for health facility level 4 and 2/3 combined. Intermediate steps are as follows: step 1 attend ANC for first visit; step 2 ITN are in stock; step 3 an ITN is offered to the women; step 4 the women accepts and takes the ITN

Mentions: The overall cumulative effectiveness for the delivery of ITN during a first ANC visit was 65.3 % which is better than for the delivery of IPTp per policy (Table 5). Hospitals (level 4 health facilities) performed similarly to dispensaries and health centres combined (levels 2 and 3 respectively) where 63.1 and 67.4 % of first ANC attendees respectively were offered and took an ITN (Fig. 4). The ineffective step in the ITN delivery process for level 4 facilities was a woman being offered an ITN. Despite the cumulative effectiveness for level 2 and 3 facilities not reaching 80 %, all intermediate steps were considered effective (completed by >80 % of women). Stock-outs of ITNs was recorded in four of the eight health facilities included in this analysis restricted to first ANC visits, varying from 1 to 4 days of the survey.Table 5


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)

Cumulative system effectiveness for the delivery of ITN through ANC stratified for health facility level 4 and 2/3 combined. Intermediate steps are as follows: step 1 attend ANC for first visit; step 2 ITN are in stock; step 3 an ITN is offered to the women; step 4 the women accepts and takes the ITN
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Cumulative system effectiveness for the delivery of ITN through ANC stratified for health facility level 4 and 2/3 combined. Intermediate steps are as follows: step 1 attend ANC for first visit; step 2 ITN are in stock; step 3 an ITN is offered to the women; step 4 the women accepts and takes the ITN
Mentions: The overall cumulative effectiveness for the delivery of ITN during a first ANC visit was 65.3 % which is better than for the delivery of IPTp per policy (Table 5). Hospitals (level 4 health facilities) performed similarly to dispensaries and health centres combined (levels 2 and 3 respectively) where 63.1 and 67.4 % of first ANC attendees respectively were offered and took an ITN (Fig. 4). The ineffective step in the ITN delivery process for level 4 facilities was a woman being offered an ITN. Despite the cumulative effectiveness for level 2 and 3 facilities not reaching 80 %, all intermediate steps were considered effective (completed by >80 % of women). Stock-outs of ITNs was recorded in four of the eight health facilities included in this analysis restricted to first ANC visits, varying from 1 to 4 days of the survey.Table 5

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