scholarly journals Determinants of Uptake of Malaria Preventive Interventions among Pregnant Women in Eastern Uganda

2020 ◽  
Author(s):  
Solomon Tsebeni Wafula ◽  
Hilbert Mendoza ◽  
Aisha Nalugya ◽  
David Musoke ◽  
Peter Waiswa
Keyword(s):  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Wealth Quintile ◽  
Malaria Prevention ◽  
Sub Saharan Africa ◽  
Insecticide Treated Nets ◽  
Cross Sectional ◽  
Itn Use ◽  
Eastern Uganda

Abstract Background Consistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage of these interventions during pregnancy in sub-Saharan Africa is still suboptimal. In this study, we investigated the uptake of IPTp and ITNs, and associated factors among women during their recent pregnancy in Eastern Uganda. Methods This was a cross-sectional study conducted among 2,062 women who had delivered within the last 12 months in three districts in Eastern Uganda. The primary outcomes were consistent ITN use and optimal uptake (at least 3 doses) of IPTp. A modified Poisson regression was used to examine the association between consistent ITN use and the uptake of optimal doses of IPTp with independent variables. Data were analyzed using Stata 14 software. Results The level of uptake of IPTp3 (at least three doses) was 14.7 %, while IPTp2 (at least two doses) was 60.0%. The majority (86.4%) of mothers reported regularly sleeping under mosquito nets for the full duration of pregnancy. Uptake of IPTp3 was associated with engaging in farming (adjusted PR = 1.71, 95% CI [1.28 – 2.28]) or business (adjusted PR = 1.60, 95% CI [1.05 – 2.44]), and attending at least 4 antenatal care (ANC) visits (adjusted PR = 1.72, 95%CI [1.34 – 2.22]). On the other hand, consistent ITN use was associated with belonging to the fourth wealth quintile (adjusted PR = 1.08, 95% CI [1.02 – 1.14]) or fifth wealth quintile (adjusted PR = 1.08, 95% CI [1.02- 1.15]), and attending at least 4 ANC visits (adjusted PR = 1.07, 95% CI [1.03- 1.11]). Conclusion Uptake of IPTp3 and consistent ITN use during pregnancy were lower than recommended guidelines, thus threatening the progress so far made towards malaria elimination. Our findings highlight the need for more efforts to enhance utilisation of ANC services, which is likely to increase the uptake of these two key malaria preventive measures during pregnancy.

scholarly journals Determinants of uptake of malaria preventive interventions among pregnant women in eastern Uganda

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Solomon Tsebeni Wafula ◽  
Hilbert Mendoza ◽  
Aisha Nalugya ◽  
David Musoke ◽  
Peter Waiswa
Keyword(s):  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Wealth Quintile ◽  
Malaria Prevention ◽  
Sub Saharan Africa ◽  
Insecticide Treated Nets ◽  
Cross Sectional ◽  
Itn Use ◽  
Eastern Uganda

Abstract Background Consistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage and utilization of these interventions during pregnancy in sub-Saharan Africa is still suboptimal. This study aimed to determine the uptake of IPTp and ITNs and associated factors among women during their recent pregnancy in Eastern Uganda. Methods This was a cross-sectional study conducted among 2062 women who had delivered within the last 12 months prior to the start of the study in three districts of Eastern Uganda. The primary outcomes were consistent ITN use and optimal uptake (at least 3 doses) of IPTp. A modified Poisson regression was used to examine the association between consistent ITN use and the uptake of optimal doses of IPTp with independent variables. Data were analysed using Stata 14 software. Results The level of uptake of IPTp3 (at least three doses) was 14.7%, while IPTp2 (at least two doses) was 60.0%. The majority (86.4%) of mothers reported regularly sleeping under mosquito nets for the full duration of pregnancy. Uptake of IPTp3 was associated with engaging in farming (adjusted PR = 1.71, 95% CI [1.28–2.28]) or business (adjusted PR = 1.60, 95% CI [1.05–2.44]), and attending at least 4 antenatal care (ANC) visits (adjusted PR = 1.72, 95% CI [1.34–2.22]). On the other hand, consistent ITN use was associated with belonging to the fourth wealth quintile (adjusted PR = 1.08, 95% CI [1.02–1.14]) or fifth wealth quintile (adjusted PR = 1.08, 95% CI [1.02–1.15]), and attending at least 4 ANC visits (adjusted PR = 1.07, 95% CI [1.03–1.11]). Conclusion Uptake of IPTp3 and consistent ITN use during pregnancy were lower and higher than the current Ugandan national targets, respectively. Study findings highlight the need for more efforts to enhance utilization of ANC services, which is likely to increase the uptake of these two key malaria preventive measures during pregnancy.

scholarly journals Determinants of uptake of malaria preventive interventions among pregnant women in eastern Uganda

2021 ◽  
Author(s):  
Solomon Tsebeni Wafula ◽  
Hilbert Mendoza ◽  
Aisha Nalugya ◽  
David Musoke ◽  
Peter Waiswa
Keyword(s):  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Wealth Quintile ◽  
Malaria Prevention ◽  
Sub Saharan Africa ◽  
Insecticide Treated Nets ◽  
Cross Sectional ◽  
Itn Use ◽  
Eastern Uganda

Abstract BackgroundConsistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage of these interventions during pregnancy in sub-Saharan Africa is still suboptimal. This study aimed to determine the uptake of IPTp and ITNs and associated factors among women during their recent pregnancy in Eastern Uganda. MethodsThis was a cross-sectional study conducted among 2,062 women who had delivered within the last 12 months prior to the start of the study in three districts of Eastern Uganda. The primary outcomes were consistent ITN use and optimal uptake (at least 3 doses) of IPTp. A modified Poisson regression was used to examine the association between consistent ITN use and the uptake of optimal doses of IPTp with independent variables. Data were analysed using Stata 14 software.Results The level of uptake of IPTp3 (at least three doses) was 14.7 %, while IPTp2 (at least two doses) was 60.0%. The majority (86.4%) of mothers reported regularly sleeping under mosquito nets for the full duration of pregnancy. Uptake of IPTp3 was associated with engaging in farming (adjusted PR = 1.71, 95% CI [1.28 – 2.28]) or business (adjusted PR = 1.60, 95% CI [1.05 – 2.44]), and attending at least 4 antenatal care (ANC) visits (adjusted PR = 1.72, 95%CI [1.34 – 2.22]). On the other hand, consistent ITN use was associated with belonging to the fourth wealth quintile (adjusted PR = 1.08, 95% CI [1.02 – 1.14]) or fifth wealth quintile (adjusted PR = 1.08, 95% CI [1.02- 1.15]), and attending at least 4 ANC visits (adjusted PR = 1.07, 95% CI [1.03- 1.11]). Conclusion Uptake of IPTp3 and consistent ITN use during pregnancy were lower and higher than the current Ugandan national targets, respectively. Study findings highlight the need for more efforts to enhance utilization of ANC services, which is likely to increase the uptake of these two key malaria preventive measures during pregnancy.

scholarly journals Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys

2020 ◽  
Author(s):  
Clara Pons-Duran ◽  
Mireia Llach ◽  
Charfudin Sacoor ◽  
Sergi Sanz ◽  
Eusebio Macete ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Reproductive Age ◽  
Cluster Sampling ◽  
Household Surveys ◽  
Cross Sectional ◽  
Sub Saharan ◽  
In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, baseline information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.

The Economics of Malaria Prevention

2018 ◽  
Author(s):  
Bénédicte Apouey ◽  
Gabriel Picone ◽  
Joshua Wilde
Keyword(s):  
Financial Constraints ◽  
Intermittent Preventive Treatment ◽  
Indoor Residual Spraying ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Sub Saharan Africa ◽  
Bed Nets ◽  
Preventive Behaviors ◽  
Mosquito Net ◽  
Positive Externalities

Malaria is a potentially life-threatening disease transmitted through the bites of female anopheline mosquitos infected with protozoan parasites. Malaria remains one of the major causes of mortality by infectious disease: in 2015, there were an estimated 212 million cases and 429,000 deaths globally, according to the 2016 World Malaria Report. Children under 5 years in sub-Saharan Africa bear the greatest burden of the disease worldwide. However, most of these cases could be prevented or treated. Several methods are highly effective in preventing malaria: in particular, sleeping under an insecticide-treated mosquito net (ITN), indoor residual spraying (IRS), and taking intermittent preventive treatment for pregnant women (IPTp). Regarding treatment, artesiminin-based combination therapy (ACT) is recommended as first-line treatment in many countries. Compared with other actions, malaria prevention behaviors have some specific features. In particular, they produce public health externalities. For example, bed net usage creates positive externalities since bed nets not only directly protect the user, but also reduce transmission probabilities through reduction in the number of disease hosts, and in the case of ITNs, reduction of the vector itself. In contrast, ACT uptake creates both positive externalities when individuals with malaria are treated, and negative externalities in the case of overtreatment that speeds up the spread of long-run parasite resistance. Moreover, ITNs, IPTp, and ACTs are experience goods (meaning individuals only ascertain their benefits upon usage), which implies that current preventive actions are linked to past preventive behaviors. Malaria prevention and eradication produce unambiguous benefits across various domains: economic conditions, educational outcomes, survival, fertility, and health. However, despite the high private returns to prevention, the adoption of antimalarial products and behaviors remains relatively low in malaria-affected areas. A variety of explanations have been proposed for low adoption rates, including financial constraints, high prices, and absence of information. While recent studies highlight that all of these factors play a role, the main barrier to adoption is probably financial constraints. This finding has implications regarding the appropriate pricing policy for these health products. In addition, there is a shortage of causally identified research on the effect of cultural and psychological barriers to the adoption of preventive behaviors. The literature which does exist is from a few randomized control trials of few individuals in very specific geographic and cultural contexts, and may not be generalizable. As a result, there are still ample opportunities for research on applying the insights of behavioral economics to malaria-preventive behavior in particular. Moreover, little research has been done on the supply side, such as whether free or heavily subsidized distribution of prevention technologies is fiscally sustainable; finding effective methods to solve logistical problems which lead to shortages and ineffective alternative treatments to fill the gap; or training sufficient healthcare workers to ensure smooth and effective delivery. Given these gaps in the literature, there are still multiple fruitful avenues for research which may have a first-order effect on reducing the prevalence of malaria in the developing world.

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 Malaria prevention knowledge, attitudes, and practices in Zambezia Province, Mozambique

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Liliana de Sousa Pinto ◽  
Jorge A. H. Arroz ◽  
Maria do Rosário O. Martins ◽  
Zulmira Hartz ◽  
Nuria Negrao ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Early Recognition ◽  
Behavioural Change ◽  
Intermittent Preventive Treatment ◽  
Malaria Prevention ◽  
Insecticide Treated Nets ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Prevention Messages

Abstract Background In Mozambique, socio-economic and cultural factors influence the wide adoption of disease preventive measures that are relevant for malaria control strategies to promote early recognition of disease, prompt seeking of medical care, sleeping under insecticide-treated nets (ITNs), and taking intermittent preventive treatment for pregnant women. However, there is a critical information gap regarding previous and ongoing malaria social and behavioural change (SBC) interventions. The aim of this study is to assess the knowledge, attitudes, practices of beneficiaries of SBC interventions. Methods A descriptive cross-sectional survey was undertaken in 2018 in two rural districts of Zambezia Province, Mozambique. A structured questionnaire was administered to 773 randomly selected households. Respondents were the adult heads of the households. Descriptive statistics were done. Results The main results show that 96.4% of respondents recalled hearing about malaria in the previous 6 months, 90.0% had knowledge of malaria prevention, and 70.0% of preventive measures. Of the 97.7% respondents that had received ITNs through a mass ITN distribution campaign, 81.7% had slept under an ITN the night before the survey. In terms of source of health information, 70.5% mentioned the role of community volunteers in dissemination of malaria prevention messages, 76.1% of respondents considered worship places (churches and mosques) to be the main places where they heard key malaria prevention messages, and 79.1% asserted that community dialogue sessions helped them better understand how to prevent malaria. Conclusions Results show that volunteers/activists/teachers played an important role in dissemination of key malaria prevention messages, which brought the following successes: community actors are recognized and people have knowledge of malaria transmission, signs and symptoms, preventive measures, and where to get treatment. There is, however, room for improvement on SBC messaging regarding some malaria symptoms (anaemia and convulsions) and operational research is needed to ascertain the drivers of malaria prevalence and inform the SBC approach.

scholarly journals Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Julia Scott ◽  
Mufaro Kanyangarara ◽  
Abel Nhama ◽  
Eusebio Macete ◽  
William John Moss ◽  
...  
Keyword(s):  
Age Groups ◽  
Universal Coverage ◽  
Malaria Prevention ◽  
Sub Saharan Africa ◽  
Cross Sectional Survey ◽  
Community Based ◽  
Cross Sectional ◽  
Factors Associated ◽  
Itn Use ◽  
Sub Saharan

Abstract Background Insecticide-treated net (ITN) use is crucial for preventing malaria infection. Despite significant improvements in ITN access and use over the past two decades, many malaria-endemic countries in sub-Saharan Africa have not yet reached global targets for universal coverage of ITNs. To reduce the gaps in ITN use, it is important to understand the factors associated with ITN use. The goal of this analysis was to determine the factors associated with ITN use in Manica District, Mozambique. Methods A cross-sectional community-based survey was conducted from October to November 2019. Households were randomly selected, and all members of selected households were eligible to participate. Data on socio-demographic characteristics, housing construction and the ownership, use and characteristics of ITNs were collected using structured questionnaires. Factors independently associated with ITN use were identified using generalized estimating equations multivariate logistic regression. Results Of the 302 households surveyed, 209 (69.2%) owned at least one ITN and 176 (58.3%) had one ITN for every two household members. The multivariate analysis indicated that the odds of ITN use was significantly lower among individuals in households with 3 or more members. However, the odds of ITN use was significantly higher among older age groups, poorer households, and as the number of ITNs in a household increased. Conclusions The findings of this analysis highlight the need for behaviour change communication strategies targeting young people and ITN distribution campaigns targeting larger households to increase ITN ownership, thereby improving ITN use in Manica District.

scholarly journals Maternal Factors of Newborn Low Birthweight in Malaria Endemic Settings of Nanoro, Rural Burkina Faso

2020 ◽  
Author(s):  
Moussa Lingani ◽  
Henri S. Zango ◽  
Innocent Valéa ◽  
Daniel Valia ◽  
Maïmouna Sanou ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Low Birthweight ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Sub Saharan Africa ◽  
Bed Nets ◽  
P Value ◽  
Maternal Factors ◽  
Cross Sectional ◽  
Increased Risk

Abstract Background. In sub-Saharan Africa, the intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine (IPTp-SP) strategy is recommended to limit malaria consequences on birth outcomes. Ten year after IPTp-SP was adopted in Burkina Faso, we assessed the magnitude of low birthweight (LBW) and its maternal factors in Nanoro.Methods. A secondary analysis of data from a cross-sectional study was carried out in women who gave birth at Nanoro peripheral health centers using a binary multivariate logistic regression. Maternal socio-demographic factors, gyneco-obstetrical history and relevant medical characteristics were evaluated to identify associated factors. A p-value less than 0.05 was considered statistically significant.Results. Of 291 delivery records examined, 14 % of women received three or more doses of SP while 80% used bed nets the night before their admission for delivery. Malaria was detected in 36.1% and anemia in 52.9% of women. The average neonate birthweight was 2933 g and 12 % of them were born with a low birthweight. After multivariate analysis, first delivery (OR = 8.84, [95% CI: 3.72-21.01]), and being multiparous with history of stillbirth (OR = 5.03, [95% CI: 1.54-16.40]) were significantly associated with an increased risk of LBW.Conclusion. LBW is still prevalent in rural Nanoro and the uptake of three or more doses of SP for the IPTp was low. In addition, to improving the coverage of IPTp-SP to improve birthweight, an extension of the target of antenatal care to other known causes of LBW including curable sexually transmitted infections may be necessary.

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