scholarly journals A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Burkina Faso

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Julie R. Gutman ◽  
Daniel K. Stephens ◽  
Justin Tiendrebeogo ◽  
Ousmane Badolo ◽  
Mathurin Dodo ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Randomized Trial ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cluster Randomized Trial ◽  
Malaria In Pregnancy ◽  
Community Level ◽  
Cluster Randomized ◽  
In Pregnancy

scholarly journals A Cluster Randomized Trial of Delivery of Intermittent Preventive Treatment of Malaria in Pregnancy at the Community Level in Burkina Faso

2020 ◽  
Author(s):  
Julie Gutman ◽  
Daniel K Stephens ◽  
Justin Tiendrebeogo ◽  
Ousmane Badolo ◽  
Mathurin Dodo ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Intermittent Preventive Treatment ◽  
Intervention Group ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
World Health ◽  
Control Group ◽  
P Value ◽  
Cluster Randomized ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as possible in the second trimester. Global IPTp coverage in targeted countries remains unacceptably low. Community delivery of IPTp was explored as a means to improve coverage. Methods: A cluster randomized, controlled trial was conducted in 12 health facilities in a 1:1 ratio to either an intervention group (IPTp delivered by CHWs) or a control group (standard practice, with IPTp delivered at HFs) in three districts of Burkina Faso to assess the effect of IPTp administration by community health workers (CHWs) on the coverage of IPTp and antenatal care (ANC). The districts and facilities were purposively selected taking into account malaria epidemiology, IPTp coverage, and the presence of active CHWs. Pre- and post-intervention surveys were carried out in March 2017 and July–August 2018, respectively. A difference in differences (DiD) analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results: Altogether 374 and 360 women were included in the baseline and endline surveys, respectively. At baseline, women received a median of 2.1 doses; by endline, women received a median of 1.8 doses in the control group and 2.8 doses in the intervention group (p-value <.0001). There was a non-statistically significant increase in the proportion of women attending four ANC visits in the intervention compared to control group (DiD= 12.6%, p-value= 0.16). By the endline, administration of IPTp was higher in the intervention than control, with a DiD of 17.6% for IPTp3 (95% confidence interval (CI) -16.3, 51.5; p-value 0.31) and 20.0% for IPTp4 (95% CI -7.2, 47.3; p-value= 0.15). Conclusions: Community delivery of IPTp could potentially lead to a greater number of IPTp doses delivered, with no apparent decrease in ANC coverage.

scholarly journals A Cluster Randomized Trial of Delivery of Intermittent Preventive Treatment of Malaria in Pregnancy at the Community Level in Burkina Faso

2020 ◽  
Author(s):  
Julie Gutman ◽  
Daniel K Stephens ◽  
Justin Tiendrebeogo ◽  
Ousmane Badolo ◽  
Mathurin Dodo ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Intermittent Preventive Treatment ◽  
Intervention Group ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
World Health ◽  
Control Group ◽  
P Value ◽  
Cluster Randomized ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as possible in the second trimester. Global IPTp coverage in targeted countries remains unacceptably low. Community delivery of IPTp was explored as a means to improve coverage. Methods: A cluster randomized, controlled trial was conducted in 12 health facilities in a 1:1 ratio to either an intervention group (IPTp delivered by CHWs) or a control group (standard practice, with IPTp delivered at HFs) in three districts of Burkina Faso to assess the effect of IPTp administration by community health workers (CHWs) on the coverage of IPTp and antenatal care (ANC). The districts and facilities were purposively selected taking into account malaria epidemiology, IPTp coverage, and the presence of active CHWs. Pre- and post-intervention surveys were carried out in March 2017 and July–August 2018, respectively. A difference in differences (DiD) analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results: Altogether 374 and 360 women were included in the baseline and endline surveys, respectively. At baseline, women received a median of 2.1 doses; by endline, women received a median of 1.8 doses in the control group and 2.8 doses in the intervention group (p-value <.0001). There was a non-statistically significant increase in the proportion of women attending four ANC visits in the intervention compared to control group (DiD= 12.6%, p-value= 0.16). By the endline, administration of IPTp was higher in the intervention than control, with a DiD of 17.6% for IPTp3 (95% confidence interval (CI) -16.3, 51.5; p-value 0.31) and 20.0% for IPTp4 (95% CI -7.2, 47.3; p-value= 0.15). Conclusions: Community delivery of IPTp could potentially lead to a greater number of IPTp doses delivered, with no apparent decrease in ANC coverage.

scholarly journals A Cluster Randomized Trial of Delivery of Intermittent Preventive Treatment of Malaria in Pregnancy at the Community Level in Burkina Faso

2020 ◽  
Author(s):  
Julie Gutman ◽  
Daniel K Stephens ◽  
Justin Tiendrebeogo ◽  
Ousmane Badolo ◽  
Mathurin Dodo ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Intermittent Preventive Treatment ◽  
Intervention Group ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
World Health ◽  
Control Group ◽  
P Value ◽  
Cluster Randomized ◽  
In Pregnancy

Abstract Background Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as possible in the second trimester. Global IPTp coverage in targeted countries remains unacceptably low. Community delivery of IPTp was explored as a means to improve coverage. Methods A cluster randomized, controlled trial was conducted in 12 health facilities in a 1:1 ratio to either an intervention group (IPTp delivered by CHWs) or a control group (standard practice, with IPTp delivered at HFs) in three districts of Burkina Faso to assess the effect of IPTp administration by community health workers (CHWs) on the coverage of IPTp and antenatal care (ANC). The districts and facilities were purposively selected taking into account malaria epidemiology, IPTp coverage, and the presence of active CHWs. Pre- and post-intervention surveys were carried out in March 2017 and July–August 2018, respectively. A difference in differences (DiD) analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results Altogether 374 and 360 women were included in the baseline and endline surveys, respectively. At baseline, women received a median of 2.1 doses; by endline, women received a median of 1.8 doses in the control group and 2.8 doses in the intervention group (p-value <.0001). There was a non-statistically significant increase in the proportion of women attending four ANC visits in the intervention compared to control group (DiD= 12.6%, p-value= 0.16). By the endline, administration of IPTp was higher in the intervention than control, with a DiD of 17.6% for IPTp3 (95% confidence interval (CI) -16.3, 51.5; p-value 0.31) and 20.0% for IPTp4 (95% CI -7.2, 47.3; p-value= 0.15). Conclusions Community delivery of IPTp could potentially lead to a greater number of IPTp doses delivered, with no apparent decrease in ANC coverage.

Effect of Personalized Support at Home on the Prevalence of Anemia in Pregnancy in Burkina Faso: A Cluster Randomized Trial

2021 ◽  
Author(s):  
Bernard Ilboudo ◽  
Léon G. B. Savadogo ◽  
Isidore Traoré ◽  
Clément Z. Meda ◽  
Maurice Kinda ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Pregnant Women ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Antenatal Visit ◽  
Anemia In Pregnancy ◽  
Cluster Randomized ◽  
Prevalence Of Anemia ◽  
In Pregnancy ◽  
At Home

Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1–74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1–41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was –19.8% (95% CI: –30.2% to –9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309–0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.

scholarly journals Intermittent preventive treatment of malaria delivered to primary schoolchildren provided effective individual protection in Jinja, Uganda: secondary outcomes of a cluster-randomized trial (START-IPT)

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Andrea M. Rehman ◽  
Catherine Maiteki-Sebuguzi ◽  
Samuel Gonahasa ◽  
Jaffer Okiring ◽  
Simon P. Kigozi ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cluster Randomized Trial ◽  
Adjusted Risk ◽  
School Based ◽  
Primary Schoolchildren ◽  
Secondary Outcomes ◽  
Cluster Randomized ◽  
The Impact

Abstract Background Intermittent preventive treatment (IPT) of malaria is recommended as policy for certain high-risk populations, but not currently for schoolchildren. A cluster-randomized trial was conducted to evaluate the effect of IPT with dihydroartemisinin–piperaquine (DP) on primary schoolchildren in Jinja, Uganda. Results of the impact of IPT of schoolchildren on community-level transmission have been reported previously. Here, secondary outcomes from a school-based survey are presented. Methods Eighty-four clusters (one primary school plus 100 households) were randomized to intervention and control (1:1 ratio). Participants from intervention schools received monthly IPT with DP for up to 6 rounds (June–December 2014). At endline (November–December 2014), randomly selected children from all 84 schools were surveyed (13 per school) and thick blood smears were done. Those with fever or history of fever were tested with rapid diagnostic tests (RDTs) for malaria. Haemoglobin was measured in every fifth participant. Outcome measures included prevalence of asexual parasites and gametocytes (by microscopy), and prevalence of anaemia. Prevalence outcomes were analysed using generalized linear Poisson models with log link function, incorporating a cluster-level random intercept and quantified using prevalence risk ratios. Results Among 23,280 students listed on the 42 intervention school registers, 10,079 (43.3%) aged 5–20 years were enrolled into the IPT intervention and received at least one dose of DP; of these, 9286 (92.1%) received at least one full (3-day) course. In total, 1092 children were enrolled into the final school survey (546 per arm) and had a thick blood smear done; of these, 255 had haemoglobin measured (129 intervention, 126 control). Children in the intervention arm were less likely to have asexual parasites (9.2% intervention vs 44.1% control, adjusted risk ratio [aRR] 0.22 [95% CI 0.16–0.30] p < 0.001), gametocytes (3.1% intervention vs 9.5% control, aRR 0.34 [95% CI 0.20–0.56] p < 0.001), fever (20.2% intervention vs 56.2% control, aRR 0.35 [95% CI 0.25–0.50] p < 0.001), or symptomatic malaria (5.1% intervention vs 35.7% control, aRR 0.14 [95% CI 0.08–0.26] p < 0.001). Prevalence of anaemia and mean haemoglobin were similar in both study arms. Conclusions School-aged children are a major reservoir of malaria parasites. Delivering IPT to schoolchildren would benefit individual children and may reduce transmission. School-based IPT could help to intensify malaria control toward elimination, and should be considered for policies and programmes. Trial registration Clinicaltrials.gov (NCT02009215), Registered 11 December 2013. https://clinicaltrials.gov/ct2/show/NCT02009215

scholarly journals Community-based delivery of intermittent preventive treatment of malaria in pregnancy in Burkina Faso: a qualitative study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Danielle Burke ◽  
Justin Tiendrebeogo ◽  
Courtney Emerson ◽  
Susan Youll ◽  
Julie Gutman ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Healthcare Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Structured Interviews ◽  
Community Based ◽  
Community Healthcare ◽  
Malaria Burden ◽  
In Pregnancy

Abstract Background Burkina Faso is among ten countries with the highest rates of malaria cases and deaths in the world. Delivery and coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) is insufficient in Burkina Faso; In a 2016 survey, only 22% of eligible women had received their third dose of IPTp. It is also an extremely rural country and one with an established cadre of community healthcare workers (CHWs). To better meet the needs of pregnant women, an enhanced programme was established to facilitate distribution of IPTp at the community level by CHWs. Methods In order to assess the perceptions of CHWs and facility healthcare workers (HCWs) involved in this programme rollout, semi-structured interviews were conducted at three high malaria burden health districts in Burkina Faso. Interviews were conducted at baseline with 104 CHWs and 35 HCWs prior to the introduction of community based IPTp (c-IPTp) to assess capacity and any areas of concern. At endline, interviews were conducted with 29 CHWs and 21 HCWs to identify key facilitators and suggestions for further implementation of the c-IPTp programme. Results CHWs reported feeling capable of supporting c-IPTp delivery and facilitating linkage to antenatal care (ANC). They noted that the opportunity for enhanced training and close and ongoing connections with facility HCWs and supportive supervision were imperative. Both CHWs and HCWs perceived this approach as acceptable to community members and noted the importance of close community engagement, monthly meetings between CHWs and facility HCWs, and maintaining regular supplies of sulfadoxine–pyrimethamine (SP). Those interviewed noted that it was beneficial to have the involvement of both female and male CHWs. Conclusions Community-based delivery of IPTp was feasible and acceptable to both facility HCWs and CHWs. This approach has the potential to strengthen delivery and uptake of IPTp and ANC both in Burkina Faso and across the region.

scholarly journals A Non-Inferiority, Individually Randomized Trial of Intermittent Screening and Treatment versus Intermittent Preventive Treatment in the Control of Malaria in Pregnancy

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0132247 ◽  
Author(s):  
Harry Tagbor ◽  
Matthew Cairns ◽  
Kalifa Bojang ◽  
Sheick Oumar Coulibaly ◽  
Kassoum Kayentao ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
In Pregnancy

scholarly journals A Cluster Randomized Trial of Delivery of Intermittent Preventive Treatment of Malaria in Pregnancy at the Community Level in Malawi

2021 ◽  
Author(s):  
Beth Rubenstein ◽  
Jobiba Chinkhumba ◽  
Ethel Chilima ◽  
Collins Kwizombe ◽  
Ashley Malpass ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Difference In Differences ◽  
Cluster Randomized ◽  
In Pregnancy

Abstract Background Malaria in pregnancy doubles the risk of low birthweight and causes 11% of all neonatal deaths in sub-Saharan Africa. To prevent these and other adverse health consequences, the World Health Organization recommends administering intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine for all pregnant women at each antenatal care (ANC) visit, starting as early as possible in the second trimester. The target is for countries to administer a minimum of three doses (IPTp3+) to at least 85% of pregnant women. Methods A cluster randomized, controlled trial was conducted to assess the effect of delivery of IPTp by community health workers on the coverage of IPTp3+ and ANC visits in Malawi. Community delivery of IPTp was implemented within two districts in Malawi over a 21-month period, from November 2018 to July 2020. In control sites, IPTp was delivered at health facilities. Representative samples of women who delivered in the prior 12 months were surveyed at baseline (n=370, December 2017) and endline (n=687, August 2020). A difference in differences analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results Overall IPTp coverage increased over the study period. At baseline, women received a mean of 2.3 IPTp doses (range 0–5 doses) across both arms, and at endline, women received a mean of 2.8 doses (range 0–9 doses). Despite overall increases, the change in IPTp3+ coverage was not significantly different between intervention and control groups (6.9%, 95% CI: -5.9%, 19.6%). ANC4+ coverage increased significantly in the intervention group compared with the control group, with a difference-in-differences of 25.3 percentage points (95% CI: 1.3%, 49.3%). Conclusions In order to reduce the burden of malaria in pregnancy, new strategies are needed to improve uptake of effective interventions such as IPTp. While community health workers’ delivery of IPTp did not increase uptake in this study, they may be effective in other settings or circumstances. Further research can help identify the health systems characteristics that are conducive to community delivery of IPTp and the operational requirements for effective implementation. Trial registration: ClinicalTrials.gov Identifier: NCT03376217. Registered December 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03376217

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