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

Malaria Journal

Chinyere Benedicta Nzeh¹  Odii Ogonna Okoro¹  Chinwendu Daniel Ndukwe¹  Chigozie Jesse Uneke¹  Ijeoma Nkem Okedo-Alex²  Ifeyinwa Chizoba Akamike²  Adaoha Pearl Agu²  Chihurumnanya Nwachi Alo³  Dejene Derseh Abateneh⁴ 

[1] African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria;African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria;Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria;Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria;Menelik II College of Medicine and Health Sciences, Kotebe Metropolitan University, P.O.Box 3268, Addis Ababa, Ethiopia;

关键词: Malaria;    Pregnancy;    Sulfadoxine-pyrimethamine;    Effectiveness;    Community-directed distribution;    Satisfaction;    Nigeria;   

DOI  :  10.1186/s12936-020-03468-2

来源: Springer

【 摘 要 】

BackgroundInnovative 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.MethodsThis 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.ResultsDuring 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%).ConclusionCommunity-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.

【 授权许可】

CC BY