Background: The World Health Organization recommends a minimum of three doses of quality-assured sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp), in moderate to high malaria transmission areas in sub-Saharan Africa. This treatment prevents malaria in pregnancy contributing to reduced maternal and infant morbidity and mortality. Currently, coverage of IPTp lags behind coverage of antenatal care (ANC) visits; in Nigeria, 57% of women attended four or more ANC visits, whereas only 17% received the recommended three or more doses of IPTp. The innovative program aimed to close this gap by providing counseling on the benefits of comprehensive ANC, referral to ANC and community distribution of IPTp (C-IPTp), complementing IPTp at ANC.
Methods: The data for this study were extracted from the maternity record books for pregnant women at 25 public health facilities in Ebonyi State, Nigeria. The outcome of interest was defined as the receipt of three or more doses of IPTp (IPTp3) and the primary covariate was referral to ANC by a community health worker for any visit. Descriptive statistics were reported and the results from the multi-level regressions are reported as adjusted odds and prevalence ratios with corresponding 95% confidence intervals.
Results: Of the 936 women included in the analysis, 24.47% received the recommended three or more IPTp doses and 61.32% were referred by a community health worker (CHW) for at least one ANC visit. There was no difference in the average number of ANC visits between women who received C-IPTp and those who received IPTp exclusively at a facility. There were no maternal characteristics associated with CHW referral. Women who were referred by a CHW had 60% greater odds (95% CI: 1.08-2.38) of receiving IPTp3 than those who were never referred.
Conclusion: The results indicate that CHW referrals conducted within a C-IPTp program increase IPTp uptake without disrupting ANC attendance and that CHWs applied the referral process equally. This strengthens the evidence base for C-IPTp scale-up, which could have a large impact in sub-Saharan Africa in mitigating existing health systems issues.