A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi
Abstract Background Malaria in pregnancy doubles the risk of low birthweight; up to 11% of all neonatal deaths in sub-Saharan Africa are associated with malaria in pregnancy. To prevent these and other adverse health consequences, the World Health Organization recommends administering intermittent p...
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ftdoajarticles:oai:doaj.org/article:6dd7458504e24fe6bfab03a7ada466c1 2023-05-15T15:18:11+02:00 A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi Beth L. Rubenstein Jobiba Chinkhumba Ethel Chilima Collins Kwizombe Ashley Malpass Shelby Cash Katherine Wright Peter Troell Humphrey Nsona Fannie Kachale Doreen Ali Evans Kaunda Sosten Lankhulani Michael Kayange Don P. Mathanga John Munthali Julie R. Gutman 2022-06-01T00:00:00Z https://doi.org/10.1186/s12936-022-04216-4 https://doaj.org/article/6dd7458504e24fe6bfab03a7ada466c1 EN eng BMC https://doi.org/10.1186/s12936-022-04216-4 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-022-04216-4 1475-2875 https://doaj.org/article/6dd7458504e24fe6bfab03a7ada466c1 Malaria Journal, Vol 21, Iss 1, Pp 1-13 (2022) Malaria Pregnancy Community Health Workers Malawi Intermittent preventive treatment Sulfadoxine-pyrimethamine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2022 ftdoajarticles https://doi.org/10.1186/s12936-022-04216-4 2022-12-31T01:53:08Z Abstract Background Malaria in pregnancy doubles the risk of low birthweight; up to 11% of all neonatal deaths in sub-Saharan Africa are associated with malaria in pregnancy. To prevent these and other adverse health consequences, the World Health Organization recommends administering intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine for all pregnant women at each antenatal care (ANC) visit, starting as early as possible in the second trimester. The target is for countries to administer a minimum of three doses (IPTp3+) to at least 85% of pregnant women. Methods A cluster randomized, controlled trial was conducted to assess the effect of delivery of IPTp by community health workers on the coverage of IPTp3 + and ANC visits in Malawi. Community delivery of IPTp was implemented within two districts in Malawi over a 21-month period, from November 2018 to July 2020. In control sites, IPTp was delivered at health facilities. Representative samples of women who delivered in the prior 12 months were surveyed at baseline (n = 370, December 2017) and endline (n = 687, August 2020). A difference in differences analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results Overall IPTp coverage increased over the study period. At baseline, women received a mean of 2.3 IPTp doses (range 0–5 doses) across both arms, and at endline, women received a mean of 2.8 doses (range 0–9 doses). Despite overall increases, the change in IPTp3 + coverage was not significantly different between intervention and control groups (6.9%, 95% CI: -5.9%, 19.6%). ANC4 + coverage increased significantly in the intervention group compared with the control group, with a difference-in-differences of 25.3% points (95% CI: 1.3%, 49.3%). Conclusions In order to reduce the burden of malaria in pregnancy, new strategies are needed to improve uptake of effective interventions such as IPTp. While community health workers’ delivery of IPTp ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 21 1 |
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English |
topic |
Malaria Pregnancy Community Health Workers Malawi Intermittent preventive treatment Sulfadoxine-pyrimethamine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Malaria Pregnancy Community Health Workers Malawi Intermittent preventive treatment Sulfadoxine-pyrimethamine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Beth L. Rubenstein Jobiba Chinkhumba Ethel Chilima Collins Kwizombe Ashley Malpass Shelby Cash Katherine Wright Peter Troell Humphrey Nsona Fannie Kachale Doreen Ali Evans Kaunda Sosten Lankhulani Michael Kayange Don P. Mathanga John Munthali Julie R. Gutman A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi |
topic_facet |
Malaria Pregnancy Community Health Workers Malawi Intermittent preventive treatment Sulfadoxine-pyrimethamine Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background Malaria in pregnancy doubles the risk of low birthweight; up to 11% of all neonatal deaths in sub-Saharan Africa are associated with malaria in pregnancy. To prevent these and other adverse health consequences, the World Health Organization recommends administering intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine for all pregnant women at each antenatal care (ANC) visit, starting as early as possible in the second trimester. The target is for countries to administer a minimum of three doses (IPTp3+) to at least 85% of pregnant women. Methods A cluster randomized, controlled trial was conducted to assess the effect of delivery of IPTp by community health workers on the coverage of IPTp3 + and ANC visits in Malawi. Community delivery of IPTp was implemented within two districts in Malawi over a 21-month period, from November 2018 to July 2020. In control sites, IPTp was delivered at health facilities. Representative samples of women who delivered in the prior 12 months were surveyed at baseline (n = 370, December 2017) and endline (n = 687, August 2020). A difference in differences analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. Results Overall IPTp coverage increased over the study period. At baseline, women received a mean of 2.3 IPTp doses (range 0–5 doses) across both arms, and at endline, women received a mean of 2.8 doses (range 0–9 doses). Despite overall increases, the change in IPTp3 + coverage was not significantly different between intervention and control groups (6.9%, 95% CI: -5.9%, 19.6%). ANC4 + coverage increased significantly in the intervention group compared with the control group, with a difference-in-differences of 25.3% points (95% CI: 1.3%, 49.3%). Conclusions In order to reduce the burden of malaria in pregnancy, new strategies are needed to improve uptake of effective interventions such as IPTp. While community health workers’ delivery of IPTp ... |
format |
Article in Journal/Newspaper |
author |
Beth L. Rubenstein Jobiba Chinkhumba Ethel Chilima Collins Kwizombe Ashley Malpass Shelby Cash Katherine Wright Peter Troell Humphrey Nsona Fannie Kachale Doreen Ali Evans Kaunda Sosten Lankhulani Michael Kayange Don P. Mathanga John Munthali Julie R. Gutman |
author_facet |
Beth L. Rubenstein Jobiba Chinkhumba Ethel Chilima Collins Kwizombe Ashley Malpass Shelby Cash Katherine Wright Peter Troell Humphrey Nsona Fannie Kachale Doreen Ali Evans Kaunda Sosten Lankhulani Michael Kayange Don P. Mathanga John Munthali Julie R. Gutman |
author_sort |
Beth L. Rubenstein |
title |
A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi |
title_short |
A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi |
title_full |
A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi |
title_fullStr |
A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi |
title_full_unstemmed |
A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi |
title_sort |
cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in malawi |
publisher |
BMC |
publishDate |
2022 |
url |
https://doi.org/10.1186/s12936-022-04216-4 https://doaj.org/article/6dd7458504e24fe6bfab03a7ada466c1 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 21, Iss 1, Pp 1-13 (2022) |
op_relation |
https://doi.org/10.1186/s12936-022-04216-4 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-022-04216-4 1475-2875 https://doaj.org/article/6dd7458504e24fe6bfab03a7ada466c1 |
op_doi |
https://doi.org/10.1186/s12936-022-04216-4 |
container_title |
Malaria Journal |
container_volume |
21 |
container_issue |
1 |
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1766348408694505472 |