Effectiveness of pregnant women’s active participation in their antenatal care for the control of malaria and anaemia in pregnancy in Ghana: a cluster randomized controlled trial

• Published in: Malaria Journal
• Main Authors: Gifty Dufie Ampofo, Harry Tagbor, Imelda Bates
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2018
• Subjects: Antenatal care; ANC; Malaria and anaemia in pregnancy; Active participation in antenatal care; Rapid diagnostic test; Haemoglobin colour scale; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-018-2387-1; https://doaj.org/article/6b47febf86414c1cafddd16ddb441573

Abstract Background The burden of malaria and anaemia in pregnancy remains high despite the availability of proven efficacious antenatal care interventions. Sub-optimal uptake of the interventions may be due to inadequate active participation of pregnant women in their antenatal care. It was hypothesized that providing opportunities for pregnant women to improve upon active participation in their antenatal care through malaria and anaemia point-of-care testing would improve adherence to ANC recommendations and interventions and lead to better pregnancy outcomes. Methods Fourteen antenatal clinics in the Ashanti region of Ghana were randomized into intervention (pregnant women participating in their care plus current routine care) and control (current routine care) arms. Pregnant women attending the clinics for the first time were recruited and followed up until delivery. Haemoglobin levels and malaria parasitaemia were measured at baseline, 4–8 weeks after recruitment and at 36–40 weeks gestation. Birth weight and pregnancy outcomes were also recorded. Results The overall mean age, gestational age and haemoglobin at baseline were 26.4 years, 17.3 weeks and 110 g/l, respectively, with no significant differences between groups; 10.7% had asymptomatic parasitaemia; 74.6% owned an ITN but only 48.8% slept under it the night before enrolment. The adjusted risk ratio by 8 weeks follow up and at 36–40 weeks gestation in the intervention versus the control was 0.97 (95% CI 0.78–1.22) and 0.92 (95% CI 0.63–1.34) for anaemia and 1.17 (95% CI 0.68–2.04) and 0.83 (95% CI 0.27–2.57) for parasitaemia. The adjusted risk ratio for low birth weight was 0.93 (95% CI 0.44–1.97) and for pregnancy complications (abortions, intrauterine fetal deaths and still births) was 0.77 (95% CI 0.17–3.52) in the intervention group versus controls. Conclusion Although its potential was evident, this study found no significant beneficial effect of women participating in their malaria and haemoglobin tests on pregnancy outcomes. Exploring factors ...