scholarly journals Malaria Intermittent Preventive Treatment (IPTi) pharmacovigilance in Malawi: A case of Lilongwe district.

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Prestor J Kubalalika
Keyword(s):  
Side Effects ◽  
Community Health ◽  
Community Health Workers ◽  
Service Providers ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Health Facilities ◽  
World Health ◽  
District Health

Background: Intermittent Preventive Treatment with sulfadoxine-pyrimethamine in infants (SP-IPTi) is a malaria control strategy which, together with the delivery of routine childhood immunizations, as recommended by the World Health Organization (WHO) was implemented in  Lilongwe district of Malawi from September 2008 to November in 2009. A study was performed by Lilongwe District Health Office (DHO) in collaboration with funding from UNICEF to evaluate the safety of SP-IPTi and identify potential new Adverse Events (AEs) spontaneously identified, reported, monitored and evaluated.Methods: A cohort event monitoring study was conducted on 15, 000 infants in 4 Health Facilities (HFs) after administration of SP-IPTi to infants during routine immunizations. A total number of about 50 Community Health Workers (CHWs) and volunteers were trained in pharmacovigilance and supervised by senior personnel in all the five HFs.Infants received half tablets of SP immediately after receiving DPT-HepB+Hib (Pentavalent) 2 vaccine / (IPTi 1), Pentavalent 3 /(IPTi 2) at 10 and 14 weeks respectively and Measles vaccines/(IPTi 3) at 9 months. These children were recorded and their mothers were given diary cards with pictures of possible AEs. Community Health Workers (CHWs) and volunteers followed up every child after 10 days of administration/registration to collect the diary cards where parents indicated the types of AEs they observed on their children as well as starting and end dates of such possible AEs.The indicated AEs were entered into a computer database from all the collected diary cards according to HFs. Possible side effects/AEs that were looked for were; persistent crying, fever, vomiting, diarrhoea, skin rashes, abdominal pains, insomnia, nausea, mouth sores, and itching among other related possible side effects.Results: A total of 15,105 children received the IPTi and were followed in all four health facilities. Out of this, 50.3% (7,594) were male while 49.7% (7, 511) were females. Of these, 19.2% [1247], 95% CI (276-304) developed AEs as follows; 42% persistent crying, 28% fever, 18% vomiting, 5.2% skin rashes and 6.8% presented with other minor symptoms while 80.8% (13,858) did not develop any side effects.  43.2% (1254) of those who showed symptoms were IPTi1 recipients, 35.3% (1022) received IPTi2 while 21.5% (624) were from those who received IPTi3.  Conclusions: This study showed that simultaneous administration of SP-IPTi together with immunizations was a safe strategy for implementation with very minimal serious AEs to infants. In this case therefore strategies towards strengthening such spontaneous reporting in Malawi should not only be left to service providers but also to beneficiaries or their caregivers.

scholarly journals Malaria Knowledge and Experiences with Community Health Workers among Recently Pregnant Women in Malawi

2019 ◽  
Author(s):  
Ashley Malpass ◽  
Jobiba Chinkhumba ◽  
Elizabeth Davlantes ◽  
John Munthali ◽  
Katherine Wright ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
World Health ◽  
P Value ◽  
To Receive ◽  
In Pregnancy

Abstract Background The World Health Organization (WHO) recommends three or more doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to mitigate the negative effects of malaria in pregnancy (MIP). Many pregnant women in Malawi are not receiving the recommended number of doses. Community delivery of IPTp (cIPTp) is being piloted as a new approach to increase coverage. This survey assessed recently pregnant women’s knowledge of MIP and their experiences with community health workers (CHWs) prior to implementing cIPTp.Methods Data were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16-49 years who had a pregnancy resulting in a live birth in the previous 12 months. Survey questions were primarily open response and utilized review of the woman’s health passport whenever possible. Analyses accounted for selection weighting and clustering at the health facility level and explored heterogeneity between districts.Results A total of 370 women were interviewed. Women in both districts found their CHWs to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%, p=0.01); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%, p=0.02) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0% p=.03). Women in Nkhata Bay were more likely to receive 3+ doses of IPTp-SP (IPTp3) (59.2% vs 41.8%, p=0.0002). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so (adjusted odds ratio = 1.50, 95% confidence interval 0.97- 2.32, p-value 0.066).Conclusions Women reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+. Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage. Keywords: Malaria Pregnancy Community Health Workers Malawi Intermittent preventive treatment Sulfadoxine-pyrimethamine

scholarly journals Malaria knowledge and experiences with community health workers among recently pregnant women in Malawi

2020 ◽  
Author(s):  
Ashley Malpass ◽  
Jobiba Chinkhumba ◽  
Elizabeth Davlantes ◽  
John Munthali ◽  
Katherine Wright ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
World Health ◽  
P Value ◽  
To Receive ◽  
In Pregnancy

Abstract Background The World Health Organization recommends three or more doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to mitigate the negative effects of malaria in pregnancy (MIP). Many pregnant women in Malawi are not receiving the recommended number of doses. Community delivery of IPTp (cIPTp) is being piloted as a new approach to increase coverage. This survey assessed recently pregnant women’s knowledge of MIP and their experiences with community health workers (CHWs) prior to implementing cIPTp. Methods Data were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16-49 years who had a pregnancy resulting in a live birth in the previous 12 months. Survey questions were primarily open response and utilized review of the woman’s health passport whenever possible. Analyses accounted for selection weighting and clustering at the health facility level and explored heterogeneity between districts.Results A total of 370 women were interviewed. Women in both districts found their CHWs to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%, p=0.01); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%, p=0.02) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0% p=.03). Women in Nkhata Bay were more likely to receive 3+ doses of IPTp-SP (IPTp3) (59.2% vs 41.8%, p=0.0002). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so (adjusted odds ratio = 1.50, 95% confidence interval 0.97- 2.32, p-value 0.066). Conclusions Women reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+. Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage.

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

scholarly journals Toward a geography of community health workers in Niger: a geospatial analysis

2021 ◽  
Author(s):  
Nicholas P Oliphant ◽  
Nicolas Ray ◽  
Khaled Bensaid ◽  
Adama Ouedraogo ◽  
Asma Yaroh Gali ◽  
...  
Keyword(s):  
High Resolution ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Health Facilities ◽  
Health Coverage ◽  
Community Case Management ◽  
Front Line ◽  
Integrated Community Case Management ◽  
Geographical Accessibility

Background Little is known about the geography of community health workers (CHWs), their contribution to geographical accessibility of primary health care (PHC) services, and strategies for optimizing efficiency of CHW deployment in the context of universal health coverage (UHC). Methods Using a complete georeferenced census of front-line health facilities and CHWs in Niger and other high resolution spatial datasets, we modelled travel times to front-line health facilities and CHWs between 2000-2013, accounting for training, essential commodities, and maximum population capacity. We estimated additional CHWs needed to maximize geographical accessibility of the population beyond the reach of existing front-line health facilities and CHWs. We assessed the efficiency of geographical targeting of the existing CHW network compared to modelled CHW networks designed to optimize geographical targeting of the estimated population, under-five deaths, and plasmodium falciparum malaria cases. Results The percent of the population within 60 minutes walking to the nearest CHW increased from 0·0% to 17·5% between 2000-2013, with 15·5% within 60 minutes walking to the nearest CHW trained on integrated community case management (iCCM) — making PHC services and iCCM, specifically, geographically accessible for an estimated 2·3 million and 2·0 million additional people, respectively. An estimated 10·4 million people (59·0%) remained beyond a 60-minute catchment of front-line health facilities and CHWs. Optimal deployment of 8064 additional CHWs could increase geographic coverage of the estimated total population from 41·5% to 73·6%. Geographical targeting of the existing CHW network was inefficient but optimized CHW networks could improve efficiency by 55·0%-81·9%, depending on targeting metric. Interpretations We provide the first high-resolution maps and estimates of geographical accessibility to CHWs at national scale, highlighting improvements between 2000-2013 in Niger, geographies where gaps remained, approaches for improving targeting, and the importance of putting CHWs on the map to inform planning in the context of UHC.

scholarly journals Community Health Workers for Non-Communicable Diseases Prevention and Control in Bangladesh: A Qualitative Study

2020 ◽  
Author(s):  
Lal Rawal ◽  
Shamim Jubayer ◽  
Shohel R Choudhury ◽  
Sheikh Mohammad Shariful Islam ◽  
Abu Abdullah
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Prevention And Control ◽  
Health Workers ◽  
Community Support ◽  
Communicable Diseases ◽  
Health Facilities ◽  
Non Communicable Diseases ◽  
And Control ◽  
Central Level

Abstract Objective: To examine the barriers and facilitators to engaging Community Health Workers (CHWs) for Non-communicable Diseases (NCDs) prevention and control in Bangladesh.Design: We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders’ meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection, and data were analysed thematically.Setting: Data were collected from health facilities across three districts in Bangladesh, and two stakeholder consultative meetings were conducted at the central level.Participants: We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n=4); key informant interviews with central level health policymakers/ managers (n=15) and focus group discussions with CHWs (4 FGDs; total n=29). Participants in a stakeholder consultative meeting included members from the government (n=4), non-government organisations (n=2), private sector (n=1) and universities (n=2).Results: The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispatching of basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. The facilitating factors to engage CHWs included government commitment and program priority, development of NCD related policies and strategies, the establishment of NCD corners, community support systems, social recognition and staff motivation.Conclusion: Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for capacity building of CHWs, systems-level support and maximizing CHWs engagement to prevention and control of NCDs in Bangladesh.

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