Abstract
BackgroundIntermittent preventive treatment of malaria in pregnancy (IPTp) using sulphurdoxine-pyrimethamine (SP) is one of key malaria control strategies in Africa. Yet, IPTp coverage rates across Africa are still low due to several demand and supply constraints. Many countries implement the IPTp-SP strategy at antenatal care (ANC) clinics. This paper reports from a study on the knowledge and experience of health workers (HWs) at ANC clinics regarding psychosocial, behavioural and health system barriers to IPTp-SP delivery and uptake in Tanzania.MethodsData were collected through questionnaire-based interviews with 78 HWs at 28 ANC clinics supplemented with informal discussions with current and recent ANC users in Mkuranga and Mufindi districts. Qualitative data were analysed using a qualitative content analysis approach. Quantitative data derived from interviews with HWs were analysed using non-parametric statistical analysis.ResultsThe majority of interviewed HWs were aware of the IPTp-SP strategy’s existence and of the recommended one month spacing of administration of SP doses. Some HWs were unsure of that it is not recommended to administer IPTp-SP and ferrous/folic acid concurrently. Others were administering three doses of SP per client following instruction from a non-governmental agency while believing that this was in conflict with national guidelines. About half of HWs did not find it appropriate for the government to recommend private ANC providers to provide IPTp-SP free of charge since doing so forces private providers to recover the costs elsewhere. HWs noted that pregnant women often register at clinics late and some do not comply with the regularity of appointments for revisits, hence miss IPTp and other ANC services. HWs also noted some amplified rumours among clients regarding health risks and treatment failures of SP used during pregnancy, and together with clients’ disappointment with waiting times and the sharing of cups at ANC clinics for SP, limit the uptake of IPTp-doses.ConclusionHWs still question SP’s treatment advantages and are confused about policy ambiguity on the recommended number of IPTp-SP doses and other IPTp-SP related guidelines. IPTp-SP uptake is further constrained by pregnant women’s perceived health risks of taking SP and of poor service quality.
Highlights
Intermittent preventive treatment of malaria in pregnancy (IPTp) using sulphurdoxine-pyrimethamine (SP) is one of key malaria control strategies in Africa
That is why the World Health Organization (WHO) has urged ministries of health (MoH) in malaria endemic countries to ensure that they prioritize identification, institutionalizing and strengthening of all measures aimed at promoting effective control of malaria in pregnancy (MiP) and in under-five children who are most vulnerable to malaria infections and their morbidity and mortality consequences [2,4]
Removing such worries could not be solved overnight using a single approach, there is an obvious need for strengthening a multi- and intra- sectoral and disciplinary problem-tackling approach to address issues relating to teenage pregnancies, late antenatal care (ANC) registration by the women of low and high parities, shortage of essential supplies such as drinking water and water cups, importance of child spacing, as well as enhancing people’s knowledge about the risks of MiP and Intermittent preventive treatment of malaria during pregnancy (IPTp) in particular
Summary
Intermittent preventive treatment of malaria in pregnancy (IPTp) using sulphurdoxine-pyrimethamine (SP) is one of key malaria control strategies in Africa. Despite many health programmes having been instituted and others still being recommended, besides the advances in the newly recommended control methods, malaria in pregnancy (MiP) and in children under five years remains one of topmost public health problems calling for attention to be paid to in tropical and sub-tropical countries. This is due to the persisting epidemiological, systemic and operational challenges, and tropical sub-Saharan Africa (SSA) is the region mainly hit [2,3]. There has been a prolonged research and policy debate on whether this policy ambition is realistic and, if so, would lead to the anticipated universal service coverage within and outside Africa [6,7,8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
