Abstract

BackgroundIntermittent preventive treatment of malaria in pregnancy (IPTp) is a comprehensive treatment protocol of anti-malarial drugs administered to pregnant women to prevent malaria, started at the fourth pregnancy month, with at least three doses of sulfadoxine–pyrimethamine (SP), taken as directly observed treatment (DOT) every 30 days at intervals until childbirth, in combination with other preventive measures. This paper introduces feasibility and adoption concepts as implementation research outcomes (IRO), allowing after a defined intervention, to assess the coverage improvement by IPTp for women attending a reference district hospital in Mali. Specifically, the purpose is to evaluate the feasibility of a reminder tool (provider checklist) to enhance pregnant women’s adoption of information about IPTp-SP uptake as immediate and sustained women practices.MethodsThe implementation strategy used a reminder checklist about malaria knowledge and the recommended preventive tools. Then, the checklist feasibility was assessed during routine practices with the adoption-level about pregnant women’ knowledge. Quantitative data were collected through a questionnaire distributed to a non-probability purposive sampling targeting 200 pregnant women divided into two groups before and after the checklist intervention. In contrast, the qualitative data were based on in-depth face-to-face gynaecologists’ interviews.ResultsBoth the IROs (feasibility and adoption) were satisfactory. The gynaecologists agreed to the use of this checklist during routine practice with a recommendation to generalize it to other health providers. After a gynaecologist visit, a significant increase of the adoption-level about prior knowledge and preventive tools was noticed. A total of 83% of participants were not knowledgeable about malaria disease before checklist use versus 15% after. Similarly, coverage of women’s SP DOT rose from 0 to 59% after introducing the checklist and the IPTp-SP uptake after the visit was highly significant in the second group. The latter reached 95% of pregnant women with 4–8 months’ gestational age, that mostly respected all SP future visits as theoretically scheduled.ConclusionsGeneralizing such a checklist reminder will improve women’s knowledge about malaria prevention.

Highlights

  • Intermittent preventive treatment of malaria in pregnancy (IPTp) is a comprehensive treatment protocol of anti-malarial drugs administered to pregnant women to prevent malaria, started at the fourth pregnancy month, with at least three doses of sulfadoxine–pyrimethamine (SP), taken as directly observed treatment (DOT) every 30 days at intervals until childbirth, in combination with other preventive measures

  • In sub-Saharan Africa, it is estimated that 25 to 30 million women are at risk of contracting Plasmodium falciparum during pregnancy [4]

  • The SP first dose is administered to pregnant women under directly observed treatment (DOT) [6]

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Summary

Introduction

Intermittent preventive treatment of malaria in pregnancy (IPTp) is a comprehensive treatment protocol of anti-malarial drugs administered to pregnant women to prevent malaria, started at the fourth pregnancy month, with at least three doses of sulfadoxine–pyrimethamine (SP), taken as directly observed treatment (DOT) every 30 days at intervals until childbirth, in combination with other preventive measures. Among the multiple prevention strategies identified, intermittent preventive treatment (IPTp) with sulfadoxine–pyrimethamine (SP) is recommended by the World Health Organization (WHO) in P. falciparum-stable transmission areas as an effective intervention [5]. This IPTp consists of administering at least three doses of SP in pregnancy from the 4th month until delivery, with at least one month between the different doses. The SP first dose is administered to pregnant women under directly observed treatment (DOT) [6] This intervention’s effectiveness as preventive treatment is provided to reduce maternal malaria episodes, maternal and foetal anaemia, placental parasitaemia, low birth weight, and neonatal mortality [7, 8]. The prevalence of malaria parasitaemia in northeast Nigeria has been reduced by 40%, anaemia by 41%, and low birth weight by 37% [9]

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