Effectiveness of the delivery of interventions to prevent malaria in pregnancy in Kenya

Malaria Journal

Research

Jenny Hill¹  Stephanie Dellicour¹  Jayne Webster²  Jane Bruce²  Meghna Desai³  Mary J. Hamel³  Simon Kariuki⁴  Peter Otieno⁴  Peter Ouma⁴  Doris Marwanga⁴ 

[1] Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK;Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK;Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya;

关键词: Malaria in pregnancy;    Antenatal care;    Intermittent preventive treatment;    Insecticide-treated nets;    Systems effectiveness;    Service delivery;    Predictors;    Kenya;    Sub-Saharan Africa;   

DOI  :  10.1186/s12936-016-1261-2

 received in 2015-12-19, accepted in 2016-03-31,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCoverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC).MethodsA cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated.ResultsOverall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively.ConclusionThis study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level.

【 授权许可】

CC BY   
© Dellicour et al. 2016

【 图 表 】

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