scholarly journals Access to and use of preventive intermittent treatment for Malaria during pregnancy: a qualitative study in Chókwè district, Southern Mozambique

2018 ◽  
Author(s):  
Paulo Arnaldo ◽  
Isabel Cambe ◽  
Amílcar Magasso ◽  
Sérgio Chicumbe ◽  
Eduard Rovira-Vallbona ◽  
...  
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Malaria During Pregnancy ◽  
In Pregnancy

AbstractBackgroundMalaria remains a significant health problem in Mozambique, particularly to pregnant women and children less than five years old. Intermittent preventive treatment is recommended for malaria prevention in pregnancy (IPTp). Despite the widespread use and cost-effectiveness of this intervention, the coverage remains low. In this study, we aimed to explore the factors limiting the access and use of IPTp-SP in Chókwè district.Methods and findingsWe used qualitative research methods through semi-structured interviews to collect data from 46 pregnant women and four health care staff from Chókwè, a rural area of southern Mozambique. Data were transcribed, manually coded and analysed using content and thematic method. Participants were not aware of pregnancy-related risks of malaria infection or the benefit of malaria prevention in pregnancy. Late and infrequently antenatal care (ANC) attendance, concerns about the long waiting time at ANC consultations,plus reluctance to disclose the pregnancy early, emerged as driving factors for inadequate IPTp delivery.ConclusionsPregnant women experience substantial barriers to receive adequate IPTp-SP dosing for malaria prevention. Poor awareness, non-compliance with ANC attendance and poor attitude of health care staff were main barriers to IPTp-SP delivery. There is a need to strengthen actions that improve awareness about malaria and prevention among pregnant women, as well as quality services across the ANC services in order to increase IPTp-SP uptake.

scholarly journals Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys

2020 ◽  
Author(s):  
Clara Pons-Duran ◽  
Mireia Llach ◽  
Charfudin Sacoor ◽  
Sergi Sanz ◽  
Eusebio Macete ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Reproductive Age ◽  
Cluster Sampling ◽  
Household Surveys ◽  
Cross Sectional ◽  
Sub Saharan ◽  
In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, baseline information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.

scholarly journals Intermittent preventive treatment for malaria in pregnancy: Is directly observed therapy still necessary? A prospective cohort study in a tertiary hospital, Southern Nigeria

2020 ◽  
Vol 4 ◽  
pp. 34-39
Author(s):  
Ubong Akpan ◽  
Udeme Asibong ◽  
Zibrin Okhormbe ◽  
Mabel Ekott ◽  
Saturday Etuk
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Rural Areas ◽  
Venous Blood ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Tertiary Hospital ◽  
Control Group ◽  
Directly Observed Therapy ◽  
In Pregnancy

Objective: Malaria is a major cause of indirect maternal death. In the last two decades several efforts have been made to combat the menace of this disease especially among pregnant women and children in developing countries. Directly observed therapy (DOT) was recommended to enhance the uptake of intermittent preventive treatment (IPT) of malaria with sulfadoxine – pyrimethamine among pregnant women. Due to challenges involved in the practice of DOT especially with regards to shortage of man power and clean water in rural areas, there is need to evaluate impact of DOT on the effectiveness of treatment. Material and Methods: A cohort study was carried out among 320 healthy pregnant women receiving ante natal care with equal assignment of subjects. The study group (160) received two doses of IPT by DOT while 160 matched controls were given prescription for self- drug administration at home. Malaria tests were done using microscopy method and the hemoglobin values determined using centrifuge one month after the second dose of IPT. Umbilical cord blood samples were obtained for a repeat microscopy at delivery. Results: The results showed that there were no statistical significant differences in the venous blood parasitemia, placental parasitemia and anaemia between the DOT group and the control group (P = 0.215; P = 0.100; P = 0.966) respectively. Lower social class was the main predictor of anaemia in pregnancy (P = 0.032). Conclusion: The delivery of IPT through DOT may not influence uptake in some settings. Effort may need to be channeled into ante natal education and women empowerment.

scholarly journals Quality of Sulfadoxine-Pyrimethamine Given as Antimalarial Prophylaxis in Pregnant Women in Selected Health Facilities in Central Region of Ghana

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Danny F. Yeboah ◽  
Richmond Afoakwah ◽  
Ekene K. Nwaefuna ◽  
Orish Verner ◽  
Johnson N. Boampong
Keyword(s):  
Pregnant Women ◽  
Central Region ◽  
Malaria Infection ◽  
High Performance ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Health Facilities ◽  
African Countries ◽  
Malaria During Pregnancy

The use of sulfadoxine-pyrimethamine (SP) as an intermittent preventive treatment (IPT) against malaria during pregnancy has become a policy in most sub-Sahara African countries and crucially depends on the efficacy of SP. This study sets out to evaluate the effectiveness of the SP given to the pregnant women in some selected health facilities in the Central Region of Ghana to prevent maternal malaria in pregnant women. A total of 543 pregnant women recruited from 7 selected health centres in Central Region of Ghana participated in the study. Parasite density ofPlasmodium falciparumwas determined from peripheral blood of the pregnant women using microscopy. High performance liquid chromatography (HPLC) and dissolution tester were used to determine the quality of the SP. Malaria infection was recorded in 11.2% of pregnant women who had a history of SP consumption. SP failed the dissolution test. Pregnant women who did not receive IPT-SP were 44%. Low haemoglobin level was recorded in 73.5% of the pregnant women. The results indicated that SP was substandard. IPT-SP is ineffective in preventing malaria infection.

scholarly journals Monitoring Compliance and Acceptability of Intermittent Preventive Treatment of Malaria Using Sulfadoxine Pyrimethamine after Ten Years of Implementation in Tanzania

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mdetele B. Ayubu ◽  
Winifrida B. Kidima
Keyword(s):  
Pregnant Women ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Antenatal Clinic ◽  
Drug Uptake ◽  
Cross Sectional ◽  
Start Date ◽  
Malaria During Pregnancy ◽  
Endemic Areas

Intermittent preventive treatment using SP (IPTp-SP) is still a superior interventional approach to control malaria during pregnancy. However its rate of use has gone down tremendously in malaria endemic areas. This study forms part of a larger study aimed at monitoring the compliance of IPTp-SP policy in malaria endemic areas of Tanzania. Two cross-sectional studies were conducted in Dar es Salaam and Njombe Regions of Tanzania. Overall, 540 pregnant women and 21 healthcare workers were interviewed using structured questionnaires. This study revealed that 63% of women were not willing to take SP during pregnancy while 91% would only take it if they tested positive for malaria during antennal visits. 63% of the interviewed women did not know the recommended dose of SP required during pregnancy, despite the fact that 82% of the women were aware of the adverse effect of malaria during pregnancy. It was found out that 54% of pregnant women (30–40 weeks) took single dose, 34% took two doses, and 16% did not take SP at the time of interview. It was also found that SP was not administered under direct observed therapy in 86% of women. There was no significant relationship between number of doses received by pregnant women and antenatal clinic (ANC) start date (r2 = 0.0033, 95% CI (−0.016 to 0.034)). However positive correlation between drug uptake and drug availability was revealed (p=0.0001). Knowledge on adverse effects of placental malaria among pregnant women was significantly associated with drug uptake (OR 11.81, 95% CI (5.755–24.23), p=0.0001). We conclude that unavailability of drugs in ANC is the major reason hindering the implementation of IPTp-SP.

scholarly journals A Socio-Ecological Approach To Understanding The Factors Influencing The Uptake Of Intermittent Preventive Treatment Of Malaria In Pregnancy (IPTp) In South Western Nigeria.

2020 ◽  
Author(s):  
Gertrude Nsorma Nyaaba ◽  
Atinuke O Olaleye ◽  
Mary O Obiyan ◽  
Oladapo Walker ◽  
Dilly OC Anumba
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Healthcare Providers ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
Public Healthcare ◽  
Birth Attendants ◽  
Faith Based ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy (MiP) remains a key cause of poor maternal and neonatal health outcomes. Two key strategies globally promoted to address MiP require pregnant women in malaria-endemic regions to sleep under insecticide-treated bed nets (ITNs) and take at least three doses of intermittent preventive treatment (IPTp) during pregnancy. Particularly in the African region where weak health systems grapple with prevailing socio-cultural and traditional practices, several multilevel factors influence the effective uptake of these strategies. This study explores the factors for the poor uptake of IPTp and use of ITNs in lower socio-economic communities in Nigeria. Methods: We conducted semi-structured interviews (SSI) and focus group discussions (FGD) with a total of 201 key stakeholders in 6 communities in Ogun State, South-western Nigeria. Twelve SSIs were conducted with traditional birth attendants (TBAs), faith-based birth attendants and healthcare providers operating in public health facilities. Community leaders (7), pregnant women (30) and 20 caregivers were also individually interviewed. Sixteen FGDs were conducted with multi- and first- time pregnant women grouped by location and pregnancy experiences. A thematic approach were used for data analysis. Results: At the individual and social levels, there is high general awareness of MiP, its consequences and ITNs but a low awareness of IPTp, with type of antenatal care (ANC) provider being a key factor influencing access to IPTp. Choice of type of ANC provider, which facilitates access to IPTp and ITNs, is influenced by experiences of relatives with ANC providers, attitudes of ANC providers and community perceptions of the type of ANC providers. Concurrent use of multiple ANC providers and ANC providers’ relationships further influence acceptability and coverage for IPTp and ITN use. At the health sector level, there is low awareness about preventive malarial strategies including IPTp among TBAs and faith-based birth attendants, in contrast to high IPTp awareness among public healthcare providers. Conclusion: The findings highlight several factors that influence the utilisation of IPTp services and call for greater synergy and sensitisation between the three groups of healthcare providers towards improving access to and acceptability of IPTp for improving maternal and child outcomes.

scholarly journals Factors Associated with Anemia in Pregnancy in Cascades Region in Burkina Faso

2015 ◽  
pp. 663-664
Author(s):  
Ilboudo Bernard ◽  
Savadogo G. Léon Blaise ◽  
Kinda Maurice ◽  
Guiguemde T. Robert ◽  
Dramaix-wilmet Michèle ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Anemia In Pregnancy ◽  
Prevalence Of Anemia ◽  
In Pregnancy

Objectives: To analyze the factors associated with anemia in pregnancy in the Cascades region in Burkina Faso. Methods: A cross-sectional study was carried out in antenatal clinics of the Cascades region in Burkina Faso during one month from May to June 2012. We collected data on socio-demographics and health characteristics of pregnant women attending these clinics. Hemoglobin was measured to assess anemia. Factors associated with anemia were identified through a multivariate analysis. Results: A total of 1763 pregnant women, irrespectively of pregnancy stage, were enrolled. The mean (SD) hemoglobin level was 10.6 (1.4) g/dl. The prevalence of anemia in pregnancy was 58.9%, 3.2% of them being severe. Factors associated with anemia were the absence of intermittent preventive treatment of malaria with sulfadoxin-pyrimetamin (OR = 1.3, 95% CI: 1.0-1.7), number of pregnancies >6 (OR = 1.4, 95% CI: 1.1-1.9). Moderate consumption of local alcohol extracted from Palmyra was associated with a lower prevalence of anemia (OR = 0.7, 95% CI: 0.5-0.9). Surprisingly, anemia was not associated with supplementation with folic acid + iron (p = 0.60). Conclusions: Interventions which aim to reduce the prevalence of anemia in pregnancy in Burkina Faso should improve the coverage of the intermittent preventive treatment of malaria and support the limitation of births.

scholarly journals Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

2020 ◽  
Author(s):  
Steven Chifundo Azizi
Keyword(s):  
Health Survey ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Demographic And Health Survey ◽  
World Health ◽  
Limited Effectiveness ◽  
Malaria During Pregnancy ◽  
Health Organization ◽  
Sulphadoxine Pyrimethamine

Abstract Background: Malawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp with SP among pregnant women in Malawi after the adoption and operationalisation of updated WHO IPTp-SP policy. Methods: The 2015-16 Malawi Demographic and Health Survey dataset was analysed. Of 1,219 women aged 15-49 years who had live births and the children were born after the date of July 2015, 1,069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account a complex survey sample design. Results: Of the 1,069 women, 447 (42%, 95% CI: 38.1-45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR=0.71, 95% CI 0.49-1.02) and (AOR=0.12, 95% CI 0.06-0.21) respectively. Conclusions: To achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. Moreover, there is limited effectiveness of an increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp with SP doses during pregnancy.

scholarly journals Population Pharmacokinetics of Mefloquine Intermittent Preventive Treatment for Malaria in Pregnancy in Gabon

2018 ◽  
Vol 63 (2) ◽  
pp. e01113-18 ◽  
Author(s):  
Michael Ramharter ◽  
Matthias Schwab ◽  
Ghyslain Mombo-Ngoma ◽  
Rella Zoleko Manego ◽  
Daisy Akerey-Diop ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Pharmacokinetic Analysis ◽  
Population Pharmacokinetic ◽  
Blood Concentrations ◽  
Split Dose ◽  
Dosing Regimens ◽  
In Pregnancy

ABSTRACT Mefloquine was evaluated as an alternative for intermittent preventive treatment of malaria in pregnancy (IPTp) due to increasing resistance against the first-line drug sulfadoxine-pyrimethamine (SP). This study determined the pharmacokinetic characteristics of the mefloquine stereoisomers and the metabolite carboxymefloquine (CMQ) when given as IPTp in pregnant women. Also, the relationship between plasma concentrations of the three analytes and cord samples was evaluated, and potential covariates influencing the pharmacokinetic properties were assessed. A population pharmacokinetic analysis was performed with 264 pregnant women from a randomized controlled trial evaluating a single and a split-dose regimen of two 15-mg/kg mefloquine doses at least 1 month apart versus SP-IPTp. Both enantiomers of mefloquine and its carboxy-metabolite (CMQ), measured in plasma and cord samples, were applied for pharmacokinetic modelling using NONMEM 7.3. Both enantiomers and CMQ were described simultaneously by two-compartment models. In the split-dose group, mefloquine bioavailability was significantly increased by 5%. CMQ induced its own metabolism significantly. Maternal and cord blood concentrations were significantly correlated (r2 = 0.84) at delivery. With the dosing regimens investigated, prophylactic levels are not constantly achieved. A modeling tool for simulation of the pharmacokinetics of alternative mefloquine regimens is presented. This first pharmacokinetic characterization of mefloquine IPTp indicates adequate exposure in both mefloquine regimens; however, concentrations at delivery were below previously suggested threshold levels. Our model can serve as a valuable tool for researchers and clinicians to develop and optimize alternative dosing regimens for IPTp in pregnant women.

scholarly journals Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation

2019 ◽  
Vol 20 ◽  
Author(s):  
Rebecca J. Schwei ◽  
Natalie Guerrero ◽  
Alissa L. Small ◽  
Elizabeth A. Jacobs
Keyword(s):  
Health Care ◽  
Limited English Proficient ◽  
Health Care Systems ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Team Members ◽  
Medical Interpreters ◽  
Care Systems

AbstractPurposeThe purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.BackgroundLanguage barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.MethodsWe conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.FindingsPhysicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.

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