Intermittent preventive treatment of malaria in pregnancy: the effect of new delivery approaches on access and compliance rates in Uganda.

Abstract

OBJECTIVE:

To assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer intermittent preventive treatment (IPT) with sulfadoxine-pyremethamine to pregnant women, and reach those most at risk of malaria and increase access and compliance to it.

METHODS:

The study was designed to assess new approaches of delivering IPT through these groups and compare it with IPT at health units. The primary outcome measures were: the proportion of adolescents and primigravidae accessed; gestational age at recruitment and the proportion of women who completed two doses of sulfadoxine-pyremethamine.

RESULTS:

Two thousand seven hundred and eighty-five pregnant women (78% of those in the study area) participated. With new approaches, 92.4% of the women received IPT during the second trimester as recommended by the policy, vs. 76.1% at health units, P < 0.0001. Of the women who received two doses of sulfadoxine-pyremethamine, 39.9% were at health units (control) vs. 67.5% through new approaches (P < 0.0001). Women using the new approaches also accessed IPT early: the mean gestational age when receiving the first dose of sulfadoxine-pyremethamine was 21.0 weeks vs. 23.1 weeks at health units (P < 0.0001). However, the health units were used by a higher proportion of primigravidae (23.6% vs. 20.0%, P < 0.04), and this was also the case for adolescents (28.4% vs. 25.0%, P < 0.03). This intervention was acceptable with 89.1% of the women at the new approaches intending to use IPT in future.

CONCLUSIONS:

The new approaches increased access to and compliance with IPT. We recommend a review of the policy to allow the provision of IPT through the new approaches.

• Authors: Anthony K Mbonye, Pascal Magnussen, I B Bygbjerg
• Journal: Tropical medicine & international health : TM & IH (Trop Med Int Health) Vol. 12 Issue 4 Pg. 519-31 (Apr 2007) ISSN: 1360-2276 [Print] England
• PMID: 17445143 (Publication Type: Journal Article)

Chemical References

• Antimalarials
• Drug Combinations
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Pyrimethamine

Topics

• Adolescent
• Adult
• Age Distribution
• Antimalarials (therapeutic use)
• Child
• Delivery of Health Care (methods, organization & administration)
• Drug Combinations
• Female
• Gestational Age
• Gravidity
• Health Personnel
• Health Services Accessibility
• Humans
• Malaria (epidemiology, prevention & control, psychology)
• Patient Compliance
• Patient Education as Topic (methods)
• Patient Satisfaction
• Pregnancy
• Pregnancy Complications, Infectious (epidemiology, prevention & control, psychology)
• Pregnancy Trimester, Second
• Pyrimethamine (therapeutic use)
• Rural Health
• Sulfadoxine (therapeutic use)
• Uganda (epidemiology)