Abstract
BackgroundInnovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria.MethodsThis before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20.ResultsDuring the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%).ConclusionCommunity-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.
Highlights
Innovative community strategies to increase intermittent preventive treatment with sulfadoxinepyrimethamine (IPTp-SP) coverage is advocated in rural areas, where health infrastructure is weakest and malaria transmission highest
At least 3 doses of Intermit‐ tent preventive treatment in pregnancy (IPTp)-SP should be given at antenatal care visits starting as early as possible in the second trimester up to the time of delivery, with at least a month interval between doses [1]
Study area This study was conducted in the Ebiriogu community, which is located in the Okuzzu-Ukawu political ward in Ukawu Development Centre in Onicha local government area (LGA) of Ebonyi State, Southeast Nigeria
Summary
Innovative community strategies to increase intermittent preventive treatment with sulfadoxinepyrimethamine (IPTp-SP) coverage is advocated in rural areas, where health infrastructure is weakest and malaria transmission highest. At least 3 doses of IPTp-SP should be given at antenatal care visits starting as early as possible in the second trimester up to the time of delivery, with at least a month interval between doses [1]. This has been adopted and incorporated into the Nigerian national policy on malaria prevention and control during pregnancy [4]. IPTp reduces maternal malaria episodes, maternal and fetal anaemia, placental parasitaemia, low birth weight (LBW), and neonatal mortality [1]
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