Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

Abstract Background By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. Methods A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. Results Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%). Conclusions In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

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Evaluation of Thyroid Function in Pregnant Women Using Automated Immunoassays

Clinical Chemistry ◽

10.1093/clinchem/hvab009 ◽

2021 ◽

Author(s):

K Aaron Geno ◽

Matthew S Reed ◽

Mark A Cervinski ◽

Robert D Nerenz

Keyword(s):

Pregnant Women ◽

Equilibrium Dialysis ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Free Thyroxine ◽

Specific Reference ◽

Childbearing Age ◽

Thyroid Autoantibody ◽

The Impact

Abstract Introduction Automated free thyroxine (FT4) immunoassays are widely available, but professional guidelines discourage their use in pregnant women due to theoretical under-recoveries attributed to increased thyroid hormone binding capacity and instead advocate the use of total T4 (TT4) or free thyroxine index (FTI). The impact of this recommendation on the classification of thyroid status in apparently euthyroid pregnant patients was evaluated. Methods After excluding specimens with thyroid autoantibody concentrations above reference limits, thyroid-stimulating hormone (TSH), FT4, TT4, and T-uptake were measured on the Roche Cobas® platform in remnant clinical specimens from at least 147 nonpregnant women of childbearing age and pregnant women at each trimester. Split-sample comparisons of FT4 as measured by the Cobas and equilibrium dialysis were performed. Results FT4 decreased with advancing gestational age by both immunoassay and equilibrium dialysis. TSH declined during the first trimester, remained constant in the second, and increased throughout the third, peaking just before delivery. Interpretation of TT4 concentrations using 1.5-times the nonpregnant reference interval classified 13.6% of first trimester specimens below the lower reference limit despite TSH concentrations within trimester-specific reference intervals. Five FTI results from 480 pregnant individuals (about 1.0%) fell outside the manufacturer’s reference interval. Conclusions Indirect FT4 immunoassay results interpreted in the context of trimester-specific reference intervals provide a practical and viable alternative to TT4 or FTI. Declining FT4 and increasing TSH concentrations near term suggest that declining FT4 is not an analytical artifact but represents a true physiological change in preparation for labor and delivery.

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Current status of antenatal care of pregnant women—8 provinces in China, 2018

BMC Public Health ◽

10.1186/s12889-021-11154-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenling Hu ◽

Huanqing Hu ◽

Wei Zhao ◽

Aiqun Huang ◽

Qi Yang ◽

...

Keyword(s):

Health Services ◽

Antenatal Care ◽

Pregnant Women ◽

Community Health ◽

First Trimester ◽

Community Health Services ◽

Current Status ◽

Categorical Variables ◽

Chi Square ◽

Prenatal Care Visit

Abstract Background Antenatal care (ANC) played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. The objective of this study was to evaluate the current status of ANC emphasizing the number, timing, and content of examinations on a national scale. Methods The data was collected from maternal and newborn’s health monitoring system at 8 provinces in China. After ethical approval, all pregnant women registered in the system at their first prenatal care visit, we included 49,084 pregnant women who had delivered between January 1, 2018 and December 31, 2018. Descriptive statistics of all study variables were calculated proportions and chi-square for categorical variables. Results Of the 49,084 women included in this study, the mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% women received ANC examinations at least five times, 39.93% of the women received ANC examinations at least eight times and 16.66% of the women received ANC examinations at least 11 times. The proportion of first ANC examination in first trimester was 61.87%. The percentage of normative ANC examinations and the percentage of qualified ANC examinations were 30.98 and 8.03% respectively. Only 49.40% of the total women received all six kinds of examination items in first ANC examination: 91.47% received a blood test, 91.62% received a urine test, 81.56% received a liver function examination, 80.52% received a renal function examination, 79.07% received a blood glucose test, and 86.66% received a HIV/HBV/syphilis tests. 50.85% women received the first ANC examination in maternal and child health care (MCH) institutions, 14.07% in a general hospital, 18.83% in a township hospital, 13.15% in a community health services center, and 3.08% in an unspecified place. The proportion of women who received each of the ANC examination items in community health services center was the highest, but that in the MCH institutions was the lowest. Conclusions There is a big difference between the results of this study and the data in official reports, this study found the current status of antenatal care is not optimal in China, findings from this study suggest that the systematization, continuity and quality of ANC examinations need to be improved.

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Hazards of vaccination in pregnancy

Drug and Therapeutics Bulletin ◽

10.1136/dtb.11.4.13 ◽

1973 ◽

Vol 11 (4) ◽

pp. 13-15

Keyword(s):

Pregnant Women ◽

Yellow Fever ◽

Early Pregnancy ◽

First Trimester ◽

Childbearing Age ◽

Department Of Health ◽

Chemical Agents ◽

Women And Girls ◽

Yellow Fever Vaccination ◽

In Pregnancy

With the effects of certain chemical agents and rubella in mind, most authorities advise caution in the use of all vaccines during pregnancy and especially during the first trimester. The booklet issued by the Department of Health and Social Security1 lists pregnancy as a contra-indication to rubella, smallpox and polio vaccinations, with certain provisions, and the manufacturers’ literature adds yellow fever vaccination. Pregnant women wishing to travel obviously pose a problem. Neither the doctor nor the patient may be aware of an early pregnancy and this is always a hazard when vaccinating women and girls of childbearing age. However, apart from rubella and smallpox vaccinations, the risks are hypothetical.

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Knowledge Level and Anemia Incidence of Pregnant Mother in Working Area of Tanjung Kemuning Public Health Center Kaur District

Jurnal Sains Kesehatan ◽

10.37638/jsk.24.3.37-44 ◽

2017 ◽

Vol 24 (3) ◽

pp. 37-44

Author(s):

Santoso Ujang Effendi ◽

Buyung Keraman ◽

Andrek Sarnandes

Keyword(s):

Pregnant Women ◽

Community Health ◽

Health Center ◽

Community Health Center ◽

Sampling Technique ◽

Iron Nutrition ◽

Primary Data ◽

Bivariate Analysis ◽

Cross Sectional ◽

The Impact

The impact of the incidence of anemia in pregnant women who have less knowledge during pregnancy are abortion, preterm labor, fetal and uterine disorders, low birth weight (LBW), and high maternal mortality. This study aimed to study the relationship between the level of knowledge with the incidence of anemia in pregnant women at Tanjung Kemuning Community Health Center Kaur District. This type of research was Descriptive Correlation and the design used was Cross Sectional. The data in this study used the primary data obtained by distributing questionnaires. The population in this study was all pregnant women who checked pregnancy and did not check their pregnancy at Tanjung Kemuning Community Health Center of Kaur Regency from January to June 2016 as many as 66 pregnant women. Sampling technique are Total Sampling and obtained sampel counted 35 respondents. Data analysis was done by univariate and bivariate analysis with Chi-Square test and to know closeness using Contingency Coefficient (χ2) statistic test. The result of the research showed that there were 14 respondents (40.0%) of good knowledge, and 19 respondents (54,3%) did not experience anemia. There was a significant relationship between knowledge with the incidence of anemia in pregnant women in working area of Tanjung Kemuning Community Health Center Kaur District with a close category. Suggestion for Tanjung Kemuning Community Health Center Kaur District to increase the intake of iron nutrition in pregnant women by doing health promotion about anemia and giving iron tablets to pregnant woman. Keywords : anemia, knowledge, pregnant women

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Frequency of Fits in Pregnant Women with Previously Controlled Epilepsy

10.53350/pjmhs211571843 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1843-1846

Author(s):

Jawad Hussain ◽

Muhammad Saqib ◽

Nadia Khan ◽

Sohail Khan ◽

Fawad Jan ◽

...

Keyword(s):

Sleep Deprivation ◽

Pregnant Women ◽

Statistical Significance ◽

Drug Regimen ◽

Cross Sectional Study ◽

Childbearing Age ◽

Keywords Epilepsy ◽

Cross Sectional ◽

The Impact ◽

Epileptic Women

Background: Epilepsy drug therapy advancements have resulted in an increasing number of childbearing age well-controlled epileptic women. It is not surprising then, that the impact of pregnancy on the progression of epilepsy has sparked renewed interest. Aim: The aim of current study was to evaluate the frequency of fits or seizure in pregnant women with previously controlled epilepsy. Materials and Methods: This cross-sectional study was carried out on 98 pregnancies of 84 epileptic women during the period between August 2019 and August 2021in the department of neurology and gynaecology of Ayub Teaching Hospital, Abbottabad. All the pregnant women with less than three verified epileptic fits, pregnancy ended with abortion and incomplete seizure or fit frequency were excluded. All the patients were referred to Gynaecology and Neurology department for early pregnancy and planning by a neurologist and gynaecologist. Data analysis was done with SPSS version 23 with p<0.05 as statistical significance. Results: The association of fits frequency on pregnancy was studied and monitored in 84 epileptic women out of 98pregnancies. About 49 (50%) pregnancies were not affected by fits frequency. The fits frequency was increased in 36 (37%) pregnancies or puerperium while decreased in 13 (13%) pregnancies. Sleep deprivation or drug regimen on-compliances associated was increased in 30 (30.6%) pregnancies. Out of 19pregnancies, eight (42%) had improvement with sleep deprivation correction during none months pre-gestation. Antiepileptic drugs with low plasma concentration of uncontrolled epilepsy during pregnancy were found in 47%. Conclusion: Sleep deprivation, Non-compliance during pregnancy, and before and after pregnancy inadequate therapy all have a significant impact on the course of epilepsy during pregnancy. With proper medical care, pregnancy appears to have only a minor impact on the course of epilepsy. Keywords: Epilepsy, Frequency fits, Sleep Deprivation.

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Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

10.21203/rs.3.rs-33577/v1 ◽

2020 ◽

Author(s):

Zhihua Wan ◽

Huan Zhang ◽

Haigang Xu ◽

Yang Hu ◽

Cai Tan ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

First Trimester ◽

Jiangxi Province ◽

Adequate Treatment ◽

Maternal Treatment ◽

Syphilis Treatment ◽

Maternal Syphilis ◽

The Impact

Abstract Background Studies investigating the associations of maternal syphilis treatment during pregnancy with pregnancy outcomes mainly concentrated in economically developed areas. Limited data are available in economically underdeveloped areas, such as Jiangxi Province. The study aims to investigate the impact of maternal treatment during pregnancy on pregnancy outcomes in Jiangxi Province, China. Methods Data were obtained from the China’s Information System of Prevention of Mother-to-Child Transmission (PMTCT) of syphilis management in Jiangxi Province. All syphilis infected pregnant women who delivered at gestational age of 28 weeks or more and were registered in this system between 1 January 2013 and 31 December 2019 were enrolled. Pregnancy outcomes were evaluated by group-specific analyses according to their treatment status, adequacy and initiation time. Results 4210 pregnant women with syphilis infection were included in the analyses. Infants born to untreated mothers were at significantly higher risk for stillbirth (adjusted odds ratio (aOR) = 1.74, 95% CI, 1.01-3.00, P = 0.045), preterm birth (aOR = 1.27, 95% CI, 1.02–1.59, P = 0.034) and low birth weight (LBW) (aOR = 1.44; 95% CI, 1.11–1.86, P = 0.006) than those born to treated mothers after adjustment for confounding factors. Moreover, a significantly higher risk of stillbirth (aOR = 3.68; 95% CI, 1.62–8.34, P = 0.002), preterm birth (aOR = 2.26; 95% CI, 1.71-3.00, P < 0.001), LBW (aOR = 2.23; 95% CI, 1.59–3.14, P < 0.001) and congenital syphilis (CS) (aOR = 3.63; 95% CI, 1.80–7.31, P < 0.001) was found in infants exposed to mothers treated inadequately than those treated adequately. In addition, no pregnant women who initiated the treatment in the first trimester delivered a neonatal CS case. Compared with mothers who initiated treatment in the first trimester, those initiated in the third trimester suffered an increased risk of stillbirth (aOR = 4.48; 95% CI, 1.31–15.30, P = 0.017), preterm birth (aOR = 2.34; 95% CI, 1.61–3.40, P < 0.001) and LBW (aOR = 3.25; 95% CI, 1.97–5.37, P < 0.001). Conclusions Maternal treatment, especially early and adequate treatment, plays a crucial role in mitigating adverse pregnancy outcomes among syphilis infected women.

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87. Effectiveness of a Best Practice Advisory in Reducing Inappropriate Urine Cultures

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.289 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S159-S159

Author(s):

Margaret Cooper ◽

Katherine C Shihadeh ◽

Cory Hussain ◽

Timothy C Jenkins

Keyword(s):

Pregnant Women ◽

Best Practice ◽

Urine Culture ◽

Asymptomatic Bacteriuria ◽

Urinary Symptoms ◽

Intervention Period ◽

Post Intervention ◽

Absolute Increase ◽

Practice Advisory ◽

The Impact

Abstract Background Inappropriate urine cultures can contribute to overutilization of antibiotic treatment for asymptomatic bacteriuria. The objective of this study was to evaluate the appropriateness of urine cultures and the impact of a clinical decision support (CDS) intervention. Methods The CDS intervention involved embedding three questions in the urine culture order: whether the patient has fever, leukocytosis or urinary symptoms. When the answer to all three questions is no, a best practice advisory (BPA) alerts the provider that the patient may not meet criteria for a urine culture and suggests cancellation of the order. Cultures obtained in patients experiencing fever, leukocytosis, or urinary symptoms, and those who were pregnant, undergoing invasive urologic procedure, or < 3 years old were classified as appropriate. We performed a quasi-experimental study assessing appropriateness of urine cultures before and after implementation of the BPA. The pre-intervention period was 5/9/19 to 7/31/20 and the intervention period was 2/3/21 to 4/27/21. Random samples of 100 cases from pre- and post-intervention were reviewed to assess appropriateness. Results There were 12,679 and 8,270 urine cultures performed pre-intervention and post-intervention, respectively. In 100 cases reviewed pre-intervention, 74% of the cultures were appropriate. Of these, 54% were ordered due to fever or leukocytosis, 50% due to urinary symptoms, and 12% in pregnant women. Post-intervention, the BPA fired on 458 orders and 106 (23%) were subsequently discontinued. Of the 100 cases reviewed post-intervention, 5 orders were discontinued after the BPA fired. Of the remaining 95 cultures, 78% were appropriate. Of these, 41% were ordered for fever or leukocytosis, 69% for urinary symptoms, and 11% in pregnant women. The change in the proportion of appropriate cultures pre- and post-intervention was not statistically significant (74% vs 78%, respectively, p=0.906). Conclusion In nearly one quarter of urine cultures performed, there was not an appropriate indication. Our intervention led to cancellation of 23% urine culture orders and resulted in an absolute increase in 4% of the cultures being ordered appropriately. However, the change in appropriateness was not statistically significant. Disclosures All Authors: No reported disclosures

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Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

10.21203/rs.3.rs-33577/v3 ◽

2020 ◽

Author(s):

Zhihua Wan ◽

Huan Zhang ◽

Haigang Xu ◽

Yang Hu ◽

Cai Tan ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

Pregnancy Outcomes ◽

First Trimester ◽

Jiangxi Province ◽

Adequate Treatment ◽

Syphilis Treatment ◽

Maternal Syphilis ◽

The Impact

Abstract BackgroundStudies investigating the associations of maternal syphilis treatment with birth outcomes mainly concentrated in economically developed areas. Limited data are available in economically underdeveloped areas, such as Jiangxi Province. The study aims to investigate the impact of maternal treatment on birth outcomes in Jiangxi Province, China.MethodsData were obtained from the China’s Information System of Prevention of Mother-to-Child Transmission in Jiangxi Province. All syphilis infected pregnant women who delivered ≥28 gestational weeks and were registered in this system between 1 January 2013 and 31 December 2019 were enrolled. Pregnancy outcomes were evaluated by group-specific analyses according to their treatment status, adequacy and initiation time.Results4210 syphilis infected pregnant women were included in the analyses. Infants born to untreated mothers (n = 1364) were at significantly higher risk for stillbirth (adjusted odds ratio (aOR) = 1.74, 95% CI, 1.01-3.00, P = 0.045), preterm birth (aOR = 1.27, 95% CI, 1.02-1.59, P = 0.034) and low birth weight (LBW) (aOR = 1.44; 95% CI, 1.11-1.86, P = 0.006) than those born to treated mothers (n = 2846) after adjustment for confounding factors. A significantly higher risk of stillbirth (aOR = 3.68; 95% CI, 1.62-8.34, P = 0.002), preterm birth (aOR = 2.26; 95% CI, 1.71-3.00, P < 0.001), LBW (aOR = 2.23; 95% CI, 1.59-3.14, P < 0.001) and congenital syphilis (CS) (aOR = 3.63; 95% CI, 1.80-7.31, P < 0.001) was found in infants exposed to mothers treated inadequately (n = 1299) than those treated adequately (n = 1547). No pregnant women who initiated the treatment in the first trimester (n = 682) delivered a neonatal CS case. Compared with mothers who initiated treatment in the first trimester (n = 682), those initiated in the third trimester (n = 1234) suffered an increased risk of stillbirth (aOR = 4.48; 95% CI, 1.31-15.30, P = 0.017), preterm birth (aOR = 2.34; 95% CI, 1.61-3.40, P < 0.001) and LBW (aOR = 3.25; 95% CI, 1.97-5.37, P < 0.001). ConclusionsMaternal treatment, especially early and adequate treatment, plays a crucial role in mitigating adverse pregnancy outcomes among syphilis infected women.

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Iodine supplementation: compliance and association with adverse obstetric and neonatal outcomes

European Thyroid Journal ◽

10.1530/etj-21-0035 ◽

2022 ◽

Vol 11 (1) ◽

Author(s):

Maria Lopes-Pereira ◽

Anna Quialheiro ◽

Patrício Costa ◽

Susana Roque ◽

Nadine Correia Santos ◽

...

Keyword(s):

Pregnant Women ◽

Fetal Loss ◽

Family Health ◽

Neonatal Outcomes ◽

Vulnerable Groups ◽

Psychomotor Development ◽

Obstetric Outcomes ◽

Childbearing Age ◽

Iodine Supplementation ◽

The Impact

Objectives Over 1.9 billion people worldwide are living in areas estimated to be iodine insufficient. Strategies for iodine supplementation include campaigns targeting vulnerable groups, such as women in pre-conception, pregnancy and lactation. Portuguese women of childbearing age and pregnant women were shown to be mildly-to-moderately iodine deficient. As a response, in 2013, the National Health Authority (NHA) issued a recommendation that all women considering pregnancy, pregnant or breastfeeding, take a daily supplement of 150–200 μg iodine. This study explored how the iodine supplementation recommendation has been fulfilled among pregnant and lactating women in Portugal, and whether the reported iodine supplements intake impacted on adverse obstetric and neonatal outcomes. Design and methods Observational retrospective study on pregnant women who delivered or had a fetal loss in the Braga Hospital and had their pregnancies followed in Family Health Units. Results The use of iodine supplements increased from 25% before the recommendation to 81% after the recommendation. This was mostly due to an increase in the use of supplements containing iodine only. Iodine supplementation was protective for the number of adverse obstetric outcomes (odds ratio (OR) = 0.791, P = 0.018) and for neonatal morbidities (OR = 0.528, P = 0.024) after controlling for relevant confounding variables. Conclusion The recommendation seems to have succeeded in implementing iodine supplementation during pregnancy. National prospective studies are now needed to evaluate the impact of iodine supplementation on maternal thyroid homeostasis and offspring psychomotor development and on whether the time of the beginning of iodine supplementation (how early during preconception or pregnancy) is relevant to consider.

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Evaluation of a single screen and treat strategy to detect asymptomatic malaria among pregnant women from selected health facilities in Lindi region, Tanzania

Malaria Journal ◽

10.1186/s12936-020-03513-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Chonge Kitojo ◽

Frank Chacky ◽

Emmanuel S. Kigadye ◽

Joseph P. Mugasa ◽

Abdallah Lusasi ◽

...

Keyword(s):

Pregnant Women ◽

Intermittent Preventive Treatment ◽

First Trimester ◽

Asymptomatic Malaria ◽

Low Transmission ◽

The Past ◽

High Transmission ◽

History Of ◽

Asymptomatic Infections ◽

The Impact

Abstract Background In areas of high transmission, malaria in pregnancy (MiP) primarily causes asymptomatic infections; these infections nonetheless increase the risk of adverse maternal and fetal outcomes. In 2014, Tanzania initiated a single screening and treatment (SST) strategy for all pregnant women at their first antenatal care (ANC) visit using malaria rapid diagnostic tests (RDT) for surveillance purposes. However, there is paucity of data on the effectiveness of SST in the prevention of MiP. The objective of this study was to estimate the number of asymptomatic infections among pregnant women detected by SST, which would have been missed in the absence of the policy. Methods Data from pregnant women attending their first ANC visits between October 2017 and June 2018, including gestational age, history of fever, and RDT results, were abstracted from ANC registers in eight health centres in two randomly selected districts, Kilwa and Lindi, in Lindi Region. The proportion of symptomatic (with history of fever in the past 48 h) and asymptomatic pregnant women with positive RDTs were calculated and stratified by trimester (first, second and third). The study areas were categorized as low transmission with prevalence < 10% or moderate/high with ≥ 10%. Results Over the study period, 1,845 women attended their first ANC visits; 22.1% were in the first trimester (< 12 weeks gestation age). Overall 15.0% of the women had positive RDTs, and there was a trend towards higher malaria prevalence in the first (15.9%) and second (15.2%) trimesters, compared to the third (7.1%), although the differences were not statistically significant (p = 0.07). In total, 6.9% of women reported fever within the past 48 h and, of these, 96.1% were RDT positive. For every 100 pregnant women in the moderate/high and low transmission areas, SST identified 60 and 26 pregnant women, respectively, with asymptomatic infections that would have otherwise been missed. Among the 15.9% of women detected in the first trimester, 50.7% were asymptomatic. Conclusion In areas of moderate/high transmission, many infected women were asymptomatic, and would have been missed in the absence of SST. The benefits on maternal and fetal birth outcomes of identifying these infections depend heavily on the protection afforded by treatment, which is likely to be greatest for women presenting in the first trimester when intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) is contraindicated, and in areas with high SP resistance, such as most parts of Tanzania. An evaluation of the impact and cost-effectiveness of SST across different transmission strata is warranted.

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