Abstract
BackgroundNearly 20 years after the adoption by the government of Malawi of the provision of intermittent preventive treatment in pregnancy (IPTp) for malaria, only 55 % of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) in 2010. Although several reasons for the low coverage have been suggested, few studies have examined the views of health care providers. This study examined the experiences of the nurses and midwives in providing antenatal care (ANC) services.MethodsThis study was conducted in health facilities in Malawi that provide routine ANC services. Providers of ANC in Malawi were selected from in eight health care facilities of Malawi. Selected providers were interviewed using a semi-structured interview guide designed to address a series of themes related to their working conditions and their delivery of IPTp.ResultsNurses displayed detailed knowledge of ANC services and the rationale behind them. Nurses understood that they should provide two doses of IPTp during a pregnancy, but they did not agree on the timing of the doses. Nurses gave SP as directly observed therapy (DOT) at the clinic. Nurses did not give SP pills to women to take home with them because they did not trust that women would take the pills. Women who resisted taking SP explained they do not take drugs if they had not eaten, or they feared side effects, or they were not sick. Reasons for not giving the first or second dose of SP included a delay in the first ANC visit, testing positive for HIV, and presenting with malaria. None of the nurses were able to show any specific written guidelines on when to give SP. The challenges faced by the nurses include being overworked and persuading women to take SP under observation.ConclusionThe findings show that the nurses had gained the knowledge and technical skills to provide appropriate ANC services. With regard to IPTp, nurses need guidelines that would be available at the health facility about how and when to give SP. The adoption of the WHO guidelines and their diffusion to health care facilities could help increase the coverage of IPTp2 (at least two doses of sulfadoxine-pyrimethamine) in Malawi.
Highlights
20 years after the adoption by the government of Malawi of the provision of intermittent preventive treatment in pregnancy (IPTp) for malaria, only 55 % of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) in 2010
After further studies had demonstrated the safety of providing SP later in pregnancy, World Health Organization (WHO) revised its policy in 2012 to recommend that SP be given at every antenatal care (ANC) visit after the first trimester up until the time of delivery with an interval of one month between doses, [6]
The nurses, midwives, and clinical officers working in these health facilities had all been trained to work in any department of a hospital in addition to providing ANC services; they indicated that they routinely worked in various departments of the facility
Summary
20 years after the adoption by the government of Malawi of the provision of intermittent preventive treatment in pregnancy (IPTp) for malaria, only 55 % of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) in 2010. Yoder et al BMC Health Services Research (2015) 15:354 pregnant women should be given SP in the first two ANC visits after quickening [4]. In 2007 WHO recommended that pregnant women be given two or three doses of SP after the first trimester of gestation [5]. After further studies had demonstrated the safety of providing SP later in pregnancy, WHO revised its policy in 2012 to recommend that SP be given at every ANC visit after the first trimester up until the time of delivery with an interval of one month between doses, [6]. As countries in SSA adopt WHO guidelines and seek to implement them at national levels, they have set targets for coverage of at least two doses of IPTp and sought ways to assess their success.
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