scholarly journals Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ijeoma Nkem Okedo-Alex ◽  
Ifeyinwa Chizoba Akamike ◽  
Chihurumnanya Nwachi Alo ◽  
Adaoha Pearl Agu ◽  
Chinyere Benedicta Nzeh ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Rural Areas ◽  
Large Scale ◽  
Health Centre ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Antenatal Clinic ◽  
Post Intervention ◽  
Before And After

Abstract Background Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. Methods This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20. Results During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%). Conclusion Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

scholarly journals Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

2020 ◽  
Author(s):  
Ijeoma Nkem Okedo-Alex ◽  
Ifeyinwa Chizoba Akamike ◽  
Chihurumnanya Alo ◽  
Adaoha Pearl Agu ◽  
Chinyere Benedicta Nzeh ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Rural Areas ◽  
Large Scale ◽  
Health Centre ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Antenatal Clinic ◽  
Post Intervention ◽  
Before And After

Abstract Background Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. Methods This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20.Results During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P <0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P <0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P <0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%).Conclusions Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

scholarly journals Reaching the unreached: Effectiveness and Satisfaction with Community-Directed Distribution of Suphadoxine-Pyrimethamine for preventing Malaria in Pregnancy in rural South-East, Nigeria

2020 ◽  
Author(s):  
Ijeoma Nkem Okedo-Alex ◽  
Ifeyinwa Chizoba Akamike ◽  
Chihurumnanya Alo ◽  
Adaoha Pearl Agu ◽  
Chinyere Benedicta Nzeh ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Rural Areas ◽  
Large Scale ◽  
Health Centre ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Antenatal Clinic ◽  
Post Intervention ◽  
Before And After

Abstract Background: Innovative community strategies to increase Intermittent Preventive Treatment with Suphadoxine-Pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. Methods: This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitisations on malaria prevention, house to house directly observed IPTp-SP administration, and follow-up visits by trained community-selected Community Directed Distributors (CDDs). Monthly IPTp-SP coverage was assessed over five months and data analysed using SPSS version 20.Results: During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P<0.001) by the 4th month post-initiation of the community-directed distribution of IPTp. Sleeping under Insecticide Treated Net (ITN) the night before the survey increased from 62.4% to 84.3% (P<0.001) while reporting of fever during pregnancy decreased from 64.9% to 17.0% (P<0.001). Although antenatal clinic utilisation increased in the primary health centre serving the community, traditional birth attendants, and patent medicine vendors in the community remained more patronised. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%).Conclusions: Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. We recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

scholarly journals Reaching the unreached: Effectiveness and Satisfaction with Community-Directed Distribution of Suphadoxine-Pyrimethamine for preventing Malaria in Pregnancy in rural South-East, Nigeria

2020 ◽  
Author(s):  
Ijeoma Nkem Okedo-Alex ◽  
Ifeyinwa Chizoba Akamike ◽  
Chihurumnanya Alo ◽  
Adaoha Pearl Agu ◽  
Chinyere Benedicta Nzeh ◽  
...  
Keyword(s):  
Rural Areas ◽  
Large Scale ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Antenatal Clinic ◽  
Post Intervention ◽  
Birth Attendants ◽  
Itn Use

Abstract Background Innovative community strategies to increase Intermittent Preventive Treatment with Suphadoxine-Pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructures are weakest and malaria transmission highest. This study was a proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria.Methods This before-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house to house directly observed IPTp-SP administration and follow-up visits by trained community-selected Community Directed Distributors (CDDs). Monthly coverage IPTp-SP coverage was assessed over five months using SPSS version 20.Results During the study, 229, 232, 217, 121 and 34 women received 1-5 IPT doses respectively. The uptake of ≥3 IPTp doses increased from 31.4% to 71.6% (P<0.001). Sleeping under Insecticide Treated Net (ITN) the night before the survey increased from 62.4% to 84.3% (P<0.001) while reporting of fever during pregnancy decreased from 64.9% to 17.0% (P<0.001). Although antenatal clinic utilization increased in the primary health center serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%) and preferred community IPTp administration to facility administration (92.3%).Conclusions Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. We recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

scholarly journals The provider’s checklist to improve pregnant women coverage by intermittent preventive malaria treatment in Mali: a pilot implementation study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Issa Doumbia ◽  
Fomba Seydou ◽  
Koné Diakalia ◽  
Issam Bennis
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Treatment Protocol ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Comprehensive Treatment ◽  
Routine Practice ◽  
Health Providers ◽  
Before And After ◽  
Adoption Level

Abstract Background Intermittent preventive treatment of malaria in pregnancy (IPTp) is a comprehensive treatment protocol of anti-malarial drugs administered to pregnant women to prevent malaria, started at the fourth pregnancy month, with at least three doses of sulfadoxine–pyrimethamine (SP), taken as directly observed treatment (DOT) every 30 days at intervals until childbirth, in combination with other preventive measures. This paper introduces feasibility and adoption concepts as implementation research outcomes (IRO), allowing after a defined intervention, to assess the coverage improvement by IPTp for women attending a reference district hospital in Mali. Specifically, the purpose is to evaluate the feasibility of a reminder tool (provider checklist) to enhance pregnant women’s adoption of information about IPTp-SP uptake as immediate and sustained women practices. Methods The implementation strategy used a reminder checklist about malaria knowledge and the recommended preventive tools. Then, the checklist feasibility was assessed during routine practices with the adoption-level about pregnant women’ knowledge. Quantitative data were collected through a questionnaire distributed to a non-probability purposive sampling targeting 200 pregnant women divided into two groups before and after the checklist intervention. In contrast, the qualitative data were based on in-depth face-to-face gynaecologists’ interviews. Results Both the IROs (feasibility and adoption) were satisfactory. The gynaecologists agreed to the use of this checklist during routine practice with a recommendation to generalize it to other health providers. After a gynaecologist visit, a significant increase of the adoption-level about prior knowledge and preventive tools was noticed. A total of 83% of participants were not knowledgeable about malaria disease before checklist use versus 15% after. Similarly, coverage of women’s SP DOT rose from 0 to 59% after introducing the checklist and the IPTp-SP uptake after the visit was highly significant in the second group. The latter reached 95% of pregnant women with 4–8 months’ gestational age, that mostly respected all SP future visits as theoretically scheduled. Conclusions Generalizing such a checklist reminder will improve women’s knowledge about malaria prevention.

scholarly journals Intermittent preventive treatment for malaria in pregnancy: Is directly observed therapy still necessary? A prospective cohort study in a tertiary hospital, Southern Nigeria

2020 ◽  
Vol 4 ◽  
pp. 34-39
Author(s):  
Ubong Akpan ◽  
Udeme Asibong ◽  
Zibrin Okhormbe ◽  
Mabel Ekott ◽  
Saturday Etuk
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Rural Areas ◽  
Venous Blood ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Tertiary Hospital ◽  
Control Group ◽  
Directly Observed Therapy ◽  
In Pregnancy

Objective: Malaria is a major cause of indirect maternal death. In the last two decades several efforts have been made to combat the menace of this disease especially among pregnant women and children in developing countries. Directly observed therapy (DOT) was recommended to enhance the uptake of intermittent preventive treatment (IPT) of malaria with sulfadoxine – pyrimethamine among pregnant women. Due to challenges involved in the practice of DOT especially with regards to shortage of man power and clean water in rural areas, there is need to evaluate impact of DOT on the effectiveness of treatment. Material and Methods: A cohort study was carried out among 320 healthy pregnant women receiving ante natal care with equal assignment of subjects. The study group (160) received two doses of IPT by DOT while 160 matched controls were given prescription for self- drug administration at home. Malaria tests were done using microscopy method and the hemoglobin values determined using centrifuge one month after the second dose of IPT. Umbilical cord blood samples were obtained for a repeat microscopy at delivery. Results: The results showed that there were no statistical significant differences in the venous blood parasitemia, placental parasitemia and anaemia between the DOT group and the control group (P = 0.215; P = 0.100; P = 0.966) respectively. Lower social class was the main predictor of anaemia in pregnancy (P = 0.032). Conclusion: The delivery of IPT through DOT may not influence uptake in some settings. Effort may need to be channeled into ante natal education and women empowerment.

scholarly journals Monitoring Compliance and Acceptability of Intermittent Preventive Treatment of Malaria Using Sulfadoxine Pyrimethamine after Ten Years of Implementation in Tanzania

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mdetele B. Ayubu ◽  
Winifrida B. Kidima
Keyword(s):  
Pregnant Women ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Antenatal Clinic ◽  
Drug Uptake ◽  
Cross Sectional ◽  
Start Date ◽  
Malaria During Pregnancy ◽  
Endemic Areas

Intermittent preventive treatment using SP (IPTp-SP) is still a superior interventional approach to control malaria during pregnancy. However its rate of use has gone down tremendously in malaria endemic areas. This study forms part of a larger study aimed at monitoring the compliance of IPTp-SP policy in malaria endemic areas of Tanzania. Two cross-sectional studies were conducted in Dar es Salaam and Njombe Regions of Tanzania. Overall, 540 pregnant women and 21 healthcare workers were interviewed using structured questionnaires. This study revealed that 63% of women were not willing to take SP during pregnancy while 91% would only take it if they tested positive for malaria during antennal visits. 63% of the interviewed women did not know the recommended dose of SP required during pregnancy, despite the fact that 82% of the women were aware of the adverse effect of malaria during pregnancy. It was found out that 54% of pregnant women (30–40 weeks) took single dose, 34% took two doses, and 16% did not take SP at the time of interview. It was also found that SP was not administered under direct observed therapy in 86% of women. There was no significant relationship between number of doses received by pregnant women and antenatal clinic (ANC) start date (r2 = 0.0033, 95% CI (−0.016 to 0.034)). However positive correlation between drug uptake and drug availability was revealed (p=0.0001). Knowledge on adverse effects of placental malaria among pregnant women was significantly associated with drug uptake (OR 11.81, 95% CI (5.755–24.23), p=0.0001). We conclude that unavailability of drugs in ANC is the major reason hindering the implementation of IPTp-SP.

scholarly journals Prevalence of Anaemia among Pregnant Women in the First Antenatal Care (ANC) Clinic Visit in St. Mary's Hospital Okpoga, Okpokwu Local Government Area, Benue State, Nigeria

2021 ◽  
pp. 30-37
Author(s):  
P. N. Atser ◽  
E. B. Iorliam ◽  
M. Ochogwu ◽  
J. Ondoma ◽  
S. Wuam
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Formal Education ◽  
Medical Condition ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Educational Status ◽  
Antenatal Clinic ◽  
Clinic Visit ◽  
Pregnant Mothers

Aims: The study was carried out to determine the prevalence of anaemia among pregnant women attending St. Mary's Hospital Okpoga, Benue State, Nigeria, with respect to demographic factors, socio-economic and underlying medical determinants among pregnant women. Methodology: A retrospective study design was used for the study. The study of 858 pregnant women who booked for antenatal care (ANC) between March 2019 to March 2020 was done. Their records were retrieved from the Records Department and the ANC unit using a standard proforma. Results: The findings revealed that prevalence of anaemia among pregnant women at booking was (55.2%). The highest prevalence of anaemia by age range 15-20 years was (62.2%), by educational status, highest prevalence was among those with no formal education (84.3%), by occupation highest prevalence was among house wives (59.9%). By underlying medical condition – severe form of parasitaemia (78.5%), by degree of severity, mild form of anaemia 74.1%, was most prevalent. By parity, it was highest among multiparous women (66.9%), by habitants it was highest among rural habitants (73.9%) while prevalence by gestational age it was highest among pregnant mothers who were in their 3rd trimester (60%) in the first antenatal care (ANC) visit. Conclusion: Pregnant mothers need to book early for antenatal clinic to access services such as intermittent preventive treatment, uptake of iron supplements and anthelmintics. They should also be empowered economically to access ANC in order to reduce the problem of anaemia in pregnancy.

scholarly journals Determinants of uptake of first dose of intermittent preventive treatment among pregnant women in a secondary health Centre in Maiduguri, Nigeria

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ahmed Dahiru Balami ◽  
Salmiah Md. Said ◽  
Nor Afiah Mohd. Zulkefli ◽  
Norsa’adah Bachok ◽  
Bala Audu
Keyword(s):  
Pregnant Women ◽  
Health Centre ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Chi Squared ◽  
Level Of Knowledge ◽  
To Receive ◽  
Take All

Abstract Background Studies on uptake of first dose of intermittent preventive treatment in pregnancy (IPTp) are lacking, despite it being a predictor of subsequent doses. This study aimed at assessing the determinants of uptake of first dose of IPTp among pregnant women at the State Specialist Hospital, Maiduguri. Methods A cross-sectional study was conducted, in which respondents were selected using a systematic random sampling method, and structured questionnaires were used to obtain information from them. Chi-squared test was used to determine factors associated with uptake of first IPTp dose, while a further multivariate logistic regression was performed to determine its predictors. Results Three hundred and eighty respondents answered the survey, whose ages ranged from 15 to 45 years, and 86.8% were multigravid. Sixty five percent of them were aware of IPTp, and 34.7% believed that IPTp could be harmful to their pregnancies. Over a half of the respondents (52.9%) believed that taking all their IPTp medicines was very good for their pregnancies, while 45.0% felt that taking their IPTp medicines was very pleasant. Only two respondents (0.5%) stated that it was very untrue that their significant others thought that they should take all their IPTp medicines. Half of the respondents said it was very easy for them to take all their IPTp medicines even if they were experiencing mild discomforts while taking them. Less than a half (42.37%) had received their first dose of IPTp. In bivariate as well as multivariate analysis, only higher level of knowledge was significantly associated with uptake of first IPTp dose. Those with better knowledge of IPTp were about twice more likely to have taken their first dose of IPTp, compared to those with lower knowledge of IPTp (AOR = 1.85; 95% CI: 1.17–2.92). Conclusions Knowledge of IPTp as well as its uptake, were sub-optimal in this study. Since knowledge of IPTp significantly predicts uptake of the first dose of IPTp, there is the need to implement health education campaigns to raise the awareness of pregnant women and their families on the need to receive and comply with it.

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