Hill, Jenny, Kassoum Kayentao, Mahamoudou Touré, Sory Diarwara, Jane Bruce, James Smedley, Ogobara K. Doumbo, Feiko O. ter. Kuile, and Jayne Webster. “Effectiveness of Antenatal Clinics to Deliver Intermittent Preventive Treatment and Insecticide Treated Nets for the Control of Malaria in Pregnancy in Mali: A Household Survey.” PLoS ONE  9, no. 3 (2014). doi:10.1371/journal.pone.0092102

URL: www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0092102

Abstract

Background: WHO recommends intermittent-preventive-treatment (IPTp) with sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) to prevent malaria in pregnancy in sub-Saharan Africa, however uptake remains unacceptably low. We evaluated the effectiveness of antenatal clinics (ANC) to deliver two doses of IPTp and ITNs to pregnant women in Segou district, Mali.

Results: Of 81% of recently pregnant women who made at least one ANC visit, 59% of these attended during the eligible gestational age for IPTp. Of these, 82% reported receiving one dose of SP and 91% attended ANC again, of whom 66% received a second dose, resulting in a cumulative effectiveness for 2-dose IPTp of 29%, most of whom used an ITN (90%). Cumulative effectiveness of 2-dose SP by directly observed therapy (DOT) was very low (6%). ITN use was 92%, and ANC was the main source (81%). Reported and ANC-card data showed some doses of SP are given to women in their first trimester. Women were less likely to receive two doses by DOT if they were married (OR 0.10; CI 0.03, 0.40), or lived <5 km from the health facility (OR 0.34; CI 0.14, 0.83). A high household person-LLIN ratio predicted low ITN use in pregnant women (OR 0.16; CI 0.04, 0.55).

Conclusion: Our findings suggest poor adherence by health workers to provision of IPTp by eligible gestational age and DOT, contributing to low effectiveness of this strategy in this setting. ITN delivery and use among women was substantially higher. Efforts to improve health worker adherence to IPTp guidelines are needed to improve service delivery of IPTp.

Malaria infection during pregnancy can lead to maternal anemia and low birth weight infants, which in turn contributes to infant mortality. To control malaria infection during pregnancy in sub-Saharan Africa, where malaria transmission is high, the World Health Organization and the Roll Back Malaria campaign advocate intermittent drug treatment during the second trimester and delivery of insecticide treated bed nets. Hill et al. examine the effectiveness of these interventions in Mali, where uptake is known to be low, in an attempt to identify barriers that prevent these relatively low-cost interventions from having the desired impact.