Abstract
BackgroundThe burden of malaria and anaemia in pregnancy remains high despite the availability of proven efficacious antenatal care interventions. Sub-optimal uptake of the interventions may be due to inadequate active participation of pregnant women in their antenatal care. It was hypothesized that providing opportunities for pregnant women to improve upon active participation in their antenatal care through malaria and anaemia point-of-care testing would improve adherence to ANC recommendations and interventions and lead to better pregnancy outcomes.MethodsFourteen antenatal clinics in the Ashanti region of Ghana were randomized into intervention (pregnant women participating in their care plus current routine care) and control (current routine care) arms. Pregnant women attending the clinics for the first time were recruited and followed up until delivery. Haemoglobin levels and malaria parasitaemia were measured at baseline, 4–8 weeks after recruitment and at 36–40 weeks gestation. Birth weight and pregnancy outcomes were also recorded.ResultsThe overall mean age, gestational age and haemoglobin at baseline were 26.4 years, 17.3 weeks and 110 g/l, respectively, with no significant differences between groups; 10.7% had asymptomatic parasitaemia; 74.6% owned an ITN but only 48.8% slept under it the night before enrolment. The adjusted risk ratio by 8 weeks follow up and at 36–40 weeks gestation in the intervention versus the control was 0.97 (95% CI 0.78–1.22) and 0.92 (95% CI 0.63–1.34) for anaemia and 1.17 (95% CI 0.68–2.04) and 0.83 (95% CI 0.27–2.57) for parasitaemia. The adjusted risk ratio for low birth weight was 0.93 (95% CI 0.44–1.97) and for pregnancy complications (abortions, intrauterine fetal deaths and still births) was 0.77 (95% CI 0.17–3.52) in the intervention group versus controls.ConclusionAlthough its potential was evident, this study found no significant beneficial effect of women participating in their malaria and haemoglobin tests on pregnancy outcomes. Exploring factors influencing health worker compliance to health intervention implementation and patient adherence to health interventions within this context will contribute in future to improving intervention effectiveness.Trial registration ISRTCTN88917252
Highlights
The burden of malaria and anaemia in pregnancy remains high despite the availability of proven efficacious antenatal care interventions
Malaria and anemia [hemoglobin (Hb) < 110 g/l] during pregnancy in sub-Saharan Africa remain a concern despite proven efficacious antenatal care (ANC) interventions
Factors that contribute to low intervention effectiveness include inaccessibility or unavailability of ANC clinics, unavailability of resources needed for intervention implementation and lack of adherence of ANC staff and pregnant women to these interventions [6]
Summary
The burden of malaria and anaemia in pregnancy remains high despite the availability of proven efficacious antenatal care interventions. Factors that contribute to low intervention effectiveness include inaccessibility or unavailability of ANC clinics, unavailability of resources needed for intervention implementation and lack of adherence of ANC staff and pregnant women to these interventions [6]. Health system issues such as unclear policy and guidance, stock outs, user fees, poor organization leading to poor quality of care, poor healthcare provider performance as well as factors concerning pregnant women such as poor timing of ANC clinic visits, education, age, marital status, knowledge about malaria and IPTp, socio-economic status and parity have been identified as key determinants to the uptake of IPTp and ITN during antenatal care [7]
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