Abstract
BackgroundCoverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC).MethodsA cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated.ResultsOverall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively.ConclusionThis study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1261-2) contains supplementary material, which is available to authorized users.
Highlights
Coverage with malaria in pregnancy interventions remains unacceptably low
World Health Organization (WHO) recommends effective case management, prevention through insecticide-treated bed-nets (ITN) and intermittent preventive treatment (IPTp) with sulfadoxine–pyrimethamine for the control of malaria in pregnancy [6], which are proven to be efficacious and cost-effective interventions delivered through the antenatal care (ANC) platform
This study found that the systems effectiveness of antenatal clinics (ANC) to deliver intermittent preventive treatment in pregnancy (IPTp) was unacceptably low and only slightly better for ITNs
Summary
Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC). WHO recommends effective case management, prevention through insecticide-treated bed-nets (ITN) and intermittent preventive treatment (IPTp) with sulfadoxine–pyrimethamine for the control of malaria in pregnancy [6], which are proven to be efficacious and cost-effective interventions delivered through the antenatal care (ANC) platform. The aim of this study was to measure the effectiveness of ANC to deliver IPTp and ITNs, and to gain an understanding of where bottlenecks occur in the delivery process. The study does not intend to measure coverage of MiP interventions, which would require assessment of the whole pregnancy period (i.e. after birth) at the population level
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