Evaluation of the implementation of single screening and treatment for the control of malaria in pregnancy in Eastern Indonesia: a systems effectiveness analysis

Jayne Webster,Din Syafruddin,Ansariadi Ansariadi,Jenny Hill,Chandra Umbu Reku Landuwulang,Jane Bruce,Faustina Helena Burdam,Rukhsana Ahmed,Jeanne Rini Poespoprodjo

doi:10.1186/s12936-018-2448-5

Abstract

BackgroundIndonesia introduced single screening and treatment (SST) of pregnant women for the control of malaria in pregnancy in 2012. Under this policy pregnant women are screened for malaria at their first antenatal clinic (ANC) visit and on subsequent visits are tested for malaria only if symptomatic. The implementation of this policy in two districts of Indonesia was evaluated. Cross sectional survey structured observations of the ANC visit and exit interviews with pregnant women were conducted to assess health provider compliance with SST guidelines. Systems effectiveness analysis was performed on components of the strategy. Multiple logistic regression was used to test for predictors of women being screened at their first ANC visit.ResultsA total of 865 and 895 ANC visits in Mimika and West Sumba across seven and ten health facilities (plus managed health posts) respectively, were included in the study. Adherence to malaria screening at first ANC visit among pregnant women was 51.4% (95% CI 11.9, 89.2) in health facilities in Mimika (94.8% in health centres) and 24.8% (95% CI 10.3, 48.9) in West Sumba (60.0% in health centres). Reported fever was low amongst women presenting for their second and above ANC visit (2.8% in Mimika and 3.5% in West Sumba) with 89.5% and 46.2% of these women tested for malaria in Mimka and West Sumba, respectively. Cumulative systems effectiveness for SST on first visit to ANC was 7.6% for Mimika and 0.1% for West Sumba; and for second or above visits to ANC was 0.7% in Mimika and 0% in West Sumba. Being screened on a 1st visit to ANC was associated with level of health facility in both sites.ConclusionCumulative systems effectiveness of the SST strategy was poor in both sites. Both elements of the SST strategy, screening on first visit and passive case detection on second and above visits, was driven by the difference in implementation of malaria testing in health centres and health posts, and by low malaria transmission levels and reported fever.

Highlights

Indonesia introduced single screening and treatment (SST) of pregnant women for the control of malaria in pregnancy in 2012
In West Sumba, except for one health centre and its health posts that formed 29.2% of the overall sample, antenatal clinic (ANC) visits sampled across health facilities were more evenly spread
Equipment for ANC, including RDTs when available, was taken on outreach days from the health centres to the health posts, and at the time of the study lack of RDTs in the health centres meant that the majority of health posts in both sites did not have access to RDTs

Summary

Introduction

Indonesia introduced single screening and treatment (SST) of pregnant women for the control of malaria in pregnancy in 2012. Under this policy pregnant women are screened for malaria at their first antenatal clinic (ANC) visit and on subsequent visits are tested for malaria only if symptomatic. Webster et al Malar J (2018) 17:310 effects of MiP depend upon the level of transmission, the malaria species and the level of immunity in pregnant women. Both P. falciparum and P. vivax contribute to the burden of MiP in Indonesia. Plasmodium falciparum malaria infections in pregnancy are associated with severe maternal anaemia, fetal loss and low birth weight (LBW), whilst P. vivax is associated with maternal anaemia, LBW and preterm births [6,7,8]

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