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Research
Addmore Chadambuka
University of Zimbabwe College of Health Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2407-1172
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Background Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulphadoxine/ Pyrimethamine (SP) is used for the prevention of malaria among pregnant women in Zimbabwe. The program is integrated into routine Antenatal care (ANC) where a minimum of three doses is recommended during each pregnancy. The third dose coverage for Chiredzi District has consistently been below the 80% target coverage. We evaluated IPTp implementation in Chiredzi to understand the reasons for underperformance.
Methods An analytical cross-sectional study was conducted using a Process-Outcome evaluation with the Logical Framework Approach. We interviewed 50 women in postnatal care and determined ANC services accessed using their ANC booklets. Health workers were interviewed for knowledge of the program. Stock availability and drug delivery records were reviewed using checklists at five high-volume sites. Epi Info 7.2.4.0™ was used for data capturing and analysis. The software was used to calculate frequencies, medians, proportions, odds ratios and p-values at a 95% confidence interval. The outcome variable was receiving ≥3 doses of SP which was computed against the independent variables such as client-related characteristics to determine which factors were contributory using univariate and bivariate analysis.
Results Only 12/50 (24%) women received ≥3 doses of SP during their pregnancy. Two (4%) women started their ANC visits in the first trimester. Thirty-three (66%) had missed at least one SP dose during their ANC visit because of medicine unavailability. Knowing the number of times SP is given (OR 11.9; 95% CI 2.54-55.8) and having attended at least 4 ANC visits (OR 13.6; 95% CI 1.59 -116.0) increased the likelihood of receiving adequate SP dosing.
Conclusions The IPTp-SP program in Chiredzi District was underperforming, we attributed this largely to health system factors. Erratic supply and stock-outs of SP resulted in clients missing SP doses. Clients also missed SP doses because of late ANC booking and lack of knowledge on IPTp benefits. Improving stock management and raising community awareness on prevention of malaria among pregnant women was recommended.
Keywords
Malaria, Intermittent Preventive Treatment in Pregnancy, Sulphadoxine/ Pyrimethamine, Zimbabwe
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Reviewer #1 agreed
On 09 Nov, 2021
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Subject Areas
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This preprint is under consideration at Malaria Journal. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Addmore Chadambuka
University of Zimbabwe College of Health Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2407-1172
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 09 Nov, 2021
No community comments so far
Reviews received
Received 10 Nov, 2021
Reviewers invited
Invitations sent on 09 Nov, 2021
Reviewer #1 agreed
On 09 Nov, 2021
Editor invited
On 28 Oct, 2021
Editor assigned
On 27 Oct, 2021
Submission checks complete
On 26 Oct, 2021
First submitted
On 25 Oct, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulphadoxine/ Pyrimethamine (SP) is used for the prevention of malaria among pregnant women in Zimbabwe. The program is integrated into routine Antenatal care (ANC) where a minimum of three doses is recommended during each pregnancy. The third dose coverage for Chiredzi District has consistently been below the 80% target coverage. We evaluated IPTp implementation in Chiredzi to understand the reasons for underperformance.
Methods An analytical cross-sectional study was conducted using a Process-Outcome evaluation with the Logical Framework Approach. We interviewed 50 women in postnatal care and determined ANC services accessed using their ANC booklets. Health workers were interviewed for knowledge of the program. Stock availability and drug delivery records were reviewed using checklists at five high-volume sites. Epi Info 7.2.4.0™ was used for data capturing and analysis. The software was used to calculate frequencies, medians, proportions, odds ratios and p-values at a 95% confidence interval. The outcome variable was receiving ≥3 doses of SP which was computed against the independent variables such as client-related characteristics to determine which factors were contributory using univariate and bivariate analysis.
Results Only 12/50 (24%) women received ≥3 doses of SP during their pregnancy. Two (4%) women started their ANC visits in the first trimester. Thirty-three (66%) had missed at least one SP dose during their ANC visit because of medicine unavailability. Knowing the number of times SP is given (OR 11.9; 95% CI 2.54-55.8) and having attended at least 4 ANC visits (OR 13.6; 95% CI 1.59 -116.0) increased the likelihood of receiving adequate SP dosing.
Conclusions The IPTp-SP program in Chiredzi District was underperforming, we attributed this largely to health system factors. Erratic supply and stock-outs of SP resulted in clients missing SP doses. Clients also missed SP doses because of late ANC booking and lack of knowledge on IPTp benefits. Improving stock management and raising community awareness on prevention of malaria among pregnant women was recommended.
Figure 1
Figure 2
Figure 3
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