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Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania

BACKGROUND: Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. However, different settings have reported coverage levels well below the target 80%. Antenatal implementatio...

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Autores principales: Marchant, Tanya, Nathan, Rose, Jones, Caroline, Mponda, Hadji, Bruce, Jane, Sedekia, Yovitha, Schellenberg, Joanna, Mshinda, Hassan, Hanson, Kara
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630326/
https://www.ncbi.nlm.nih.gov/pubmed/19094198
http://dx.doi.org/10.1186/1475-2875-7-260
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author Marchant, Tanya
Nathan, Rose
Jones, Caroline
Mponda, Hadji
Bruce, Jane
Sedekia, Yovitha
Schellenberg, Joanna
Mshinda, Hassan
Hanson, Kara
author_facet Marchant, Tanya
Nathan, Rose
Jones, Caroline
Mponda, Hadji
Bruce, Jane
Sedekia, Yovitha
Schellenberg, Joanna
Mshinda, Hassan
Hanson, Kara
author_sort Marchant, Tanya
collection PubMed
description BACKGROUND: Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. However, different settings have reported coverage levels well below the target 80%. Antenatal implementation guidelines in Tanzania recommend IPTp first dose to be given at the second antenatal visit, and second dose at the third visit. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. METHODS: Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 210 clusters sampled using two-stage cluster sampling from 21 randomly selected districts. Female residents who reported a livebirth in the previous year were asked questions about malaria prevention during that pregnancy and individual characteristics including education, pregnancy history, and marital status. The RCH facility serving each cluster was also surveyed, and information collected about drug stocks, health education delivery, and the timing of antenatal care delivery by clinic users. RESULTS: The national IPTp coverage had declined over the survey period being 71% for first dose in 2005 falling to 65% in 2007 (χ(2 )2.9, p = 0.05), and 38% for second dose in 2005 but 30% in 2007 (χ(2 )4.4, p = 0.01). There was no evidence of any individual factors being associated with second dose coverage beyond living in an urban area. Availability of sulphadoxine-pyrimethamine at RCH had decreased year on year from 85% of clinics in stock in 2005 to 60% in 2007 (χ(2 )20.6, p < 0.001). This reduction was evident in rural but not urban clinics. If safety recommendations and national antenatal care guidelines for IPTp delivery were followed, in 2007 only 76% of pregnant women could have received IPTp first dose and only 46% could have received second dose. CONCLUSION: There is scope to improve IPTp first and second dose coverage at national scale within existing systems by improving stock at RCH, and by revising the existing guidelines to recommend delivery of IPTp after quickening, rather than at a pre-defined antenatal visit.
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spelling pubmed-26303262009-01-24 Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania Marchant, Tanya Nathan, Rose Jones, Caroline Mponda, Hadji Bruce, Jane Sedekia, Yovitha Schellenberg, Joanna Mshinda, Hassan Hanson, Kara Malar J Research BACKGROUND: Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. However, different settings have reported coverage levels well below the target 80%. Antenatal implementation guidelines in Tanzania recommend IPTp first dose to be given at the second antenatal visit, and second dose at the third visit. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. METHODS: Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 210 clusters sampled using two-stage cluster sampling from 21 randomly selected districts. Female residents who reported a livebirth in the previous year were asked questions about malaria prevention during that pregnancy and individual characteristics including education, pregnancy history, and marital status. The RCH facility serving each cluster was also surveyed, and information collected about drug stocks, health education delivery, and the timing of antenatal care delivery by clinic users. RESULTS: The national IPTp coverage had declined over the survey period being 71% for first dose in 2005 falling to 65% in 2007 (χ(2 )2.9, p = 0.05), and 38% for second dose in 2005 but 30% in 2007 (χ(2 )4.4, p = 0.01). There was no evidence of any individual factors being associated with second dose coverage beyond living in an urban area. Availability of sulphadoxine-pyrimethamine at RCH had decreased year on year from 85% of clinics in stock in 2005 to 60% in 2007 (χ(2 )20.6, p < 0.001). This reduction was evident in rural but not urban clinics. If safety recommendations and national antenatal care guidelines for IPTp delivery were followed, in 2007 only 76% of pregnant women could have received IPTp first dose and only 46% could have received second dose. CONCLUSION: There is scope to improve IPTp first and second dose coverage at national scale within existing systems by improving stock at RCH, and by revising the existing guidelines to recommend delivery of IPTp after quickening, rather than at a pre-defined antenatal visit. BioMed Central 2008-12-18 /pmc/articles/PMC2630326/ /pubmed/19094198 http://dx.doi.org/10.1186/1475-2875-7-260 Text en Copyright © 2008 Marchant et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Marchant, Tanya
Nathan, Rose
Jones, Caroline
Mponda, Hadji
Bruce, Jane
Sedekia, Yovitha
Schellenberg, Joanna
Mshinda, Hassan
Hanson, Kara
Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania
title Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania
title_full Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania
title_fullStr Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania
title_full_unstemmed Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania
title_short Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania
title_sort individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in tanzania
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630326/
https://www.ncbi.nlm.nih.gov/pubmed/19094198
http://dx.doi.org/10.1186/1475-2875-7-260
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