Cargando…

Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya

BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative stra...

Descripción completa

Detalles Bibliográficos
Autores principales: Hill, Jenny, Ouma, Peter, Oluoch, Seth, Bruce, Jane, Kariuki, Simon, Desai, Meghna, Webster, Jayne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690090/
https://www.ncbi.nlm.nih.gov/pubmed/33238999
http://dx.doi.org/10.1186/s12936-020-03505-0
_version_ 1783613997879132160
author Hill, Jenny
Ouma, Peter
Oluoch, Seth
Bruce, Jane
Kariuki, Simon
Desai, Meghna
Webster, Jayne
author_facet Hill, Jenny
Ouma, Peter
Oluoch, Seth
Bruce, Jane
Kariuki, Simon
Desai, Meghna
Webster, Jayne
author_sort Hill, Jenny
collection PubMed
description BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. METHODS: A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. RESULTS: A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). CONCLUSIONS: The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT.
format Online
Article
Text
id pubmed-7690090
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-76900902020-11-30 Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya Hill, Jenny Ouma, Peter Oluoch, Seth Bruce, Jane Kariuki, Simon Desai, Meghna Webster, Jayne Malar J Research BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. METHODS: A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. RESULTS: A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). CONCLUSIONS: The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT. BioMed Central 2020-11-25 /pmc/articles/PMC7690090/ /pubmed/33238999 http://dx.doi.org/10.1186/s12936-020-03505-0 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
Hill, Jenny
Ouma, Peter
Oluoch, Seth
Bruce, Jane
Kariuki, Simon
Desai, Meghna
Webster, Jayne
Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya
title Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya
title_full Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya
title_fullStr Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya
title_full_unstemmed Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya
title_short Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya
title_sort intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western kenya
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690090/
https://www.ncbi.nlm.nih.gov/pubmed/33238999
http://dx.doi.org/10.1186/s12936-020-03505-0
work_keys_str_mv AT hilljenny intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya
AT oumapeter intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya
AT oluochseth intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya
AT brucejane intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya
AT kariukisimon intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya
AT desaimeghna intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya
AT websterjayne intermittentscreeningandtreatmentwithdihydroartemisininpiperaquineforthepreventionofmalariainpregnancyimplementationfeasibilityinaroutinehealthcaresystemsettinginwesternkenya