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Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

BACKGROUND: Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implemen...

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Autores principales: Okedo-Alex, Ijeoma Nkem, Akamike, Ifeyinwa Chizoba, Alo, Chihurumnanya Nwachi, Agu, Adaoha Pearl, Nzeh, Chinyere Benedicta, Ndukwe, Chinwendu Daniel, Okoro, Odii Ogonna, Abateneh, Dejene Derseh, Uneke, Chigozie Jesse
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648974/
https://www.ncbi.nlm.nih.gov/pubmed/33160375
http://dx.doi.org/10.1186/s12936-020-03468-2
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author Okedo-Alex, Ijeoma Nkem
Akamike, Ifeyinwa Chizoba
Alo, Chihurumnanya Nwachi
Agu, Adaoha Pearl
Nzeh, Chinyere Benedicta
Ndukwe, Chinwendu Daniel
Okoro, Odii Ogonna
Abateneh, Dejene Derseh
Uneke, Chigozie Jesse
author_facet Okedo-Alex, Ijeoma Nkem
Akamike, Ifeyinwa Chizoba
Alo, Chihurumnanya Nwachi
Agu, Adaoha Pearl
Nzeh, Chinyere Benedicta
Ndukwe, Chinwendu Daniel
Okoro, Odii Ogonna
Abateneh, Dejene Derseh
Uneke, Chigozie Jesse
author_sort Okedo-Alex, Ijeoma Nkem
collection PubMed
description BACKGROUND: Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. METHODS: This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20. RESULTS: During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%). CONCLUSION: Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.
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spelling pubmed-76489742020-11-09 Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria Okedo-Alex, Ijeoma Nkem Akamike, Ifeyinwa Chizoba Alo, Chihurumnanya Nwachi Agu, Adaoha Pearl Nzeh, Chinyere Benedicta Ndukwe, Chinwendu Daniel Okoro, Odii Ogonna Abateneh, Dejene Derseh Uneke, Chigozie Jesse Malar J Research BACKGROUND: Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. METHODS: This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20. RESULTS: During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%). CONCLUSION: Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement. BioMed Central 2020-11-07 /pmc/articles/PMC7648974/ /pubmed/33160375 http://dx.doi.org/10.1186/s12936-020-03468-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Okedo-Alex, Ijeoma Nkem
Akamike, Ifeyinwa Chizoba
Alo, Chihurumnanya Nwachi
Agu, Adaoha Pearl
Nzeh, Chinyere Benedicta
Ndukwe, Chinwendu Daniel
Okoro, Odii Ogonna
Abateneh, Dejene Derseh
Uneke, Chigozie Jesse
Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria
title Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria
title_full Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria
title_fullStr Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria
title_full_unstemmed Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria
title_short Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria
title_sort reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural south-east, nigeria
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648974/
https://www.ncbi.nlm.nih.gov/pubmed/33160375
http://dx.doi.org/10.1186/s12936-020-03468-2
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