Abstract
BackgroundBurkina 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.MethodsIn 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.ResultsCHWs 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.ConclusionsCommunity-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.
Highlights
Burkina Faso is among ten countries with the highest rates of malaria cases and deaths in the world
Views of facility healthcare workers (HCWs) provided in the semi-structured baseline interviews focused on the frequency of antenatal care (ANC) contacts at the health centre level, and their awareness of community healthcare workers (CHWs) and their activities at the village levels
All facility HCWs noted that the community based IPTp (c-IPTp) approach was a new concept and some expressed reservations about the ability of CHWs
Summary
Burkina Faso is among ten countries with the highest rates of malaria cases and deaths in the world. Low uptake of IPTp has been a common phenomenon across many high-burden malaria endemic countries [1, 5, 6]. It is normally delivered during the course of ANC visits at a healthcare facility. Community-based delivery has been shown to improve IPTp uptake among pregnant women [14, 15] including in a previous study of female CHWs based in Burkina Faso [16] as well as when CHWs were deployed to conduct active malaria testing among pregnant women [17]. The intensified delivery of IPTp through an existing CHW network has the potential to boost the percentage of women reached for the recommended number of IPTp doses and enhance ANC attendance through CHW referrals
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