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Prevention of Malaria in Pregnancy with Intermittent Preventive Treatment and Insecticide Treated Nets in Mali: A Quantitative Health Systems Effectiveness Analysis

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  • Jayne Webster
  • Kassoum Kayentao
  • Jane Bruce
  • Sory I Diawara
  • Amadou Abathina
  • Alhassane Ag Haiballa
  • Ogobara K Doumbo
  • Jenny Hill

Abstract

Introduction: The objectives of the study were to evaluate the health system effectiveness of ANC for the delivery of a dose of IPTp and an ITN to women attending ANC during eligible gestation, and to identify the predictors of systems effectiveness. Methods: A cross sectional study was undertaken in 10 health facilities including structured non-participant observations of the ANC process for 780 pregnant women followed by exit interviews. The proportion of pregnant women receiving a dose of IPTp-SP and an ITN was assessed. Predictors of each ineffective intermediate process were identified using multivariable logistic regression. Results: Overall, 0% and 24.5% of pregnant women of eligible gestation on the first visit to ANC received a dose of IPTp-SP by DOT at the district and community levels respectively. Ineffective intermediate processes were ‘given IPTp-SP at the ANC’ 63.9% and 74.0% (95% CI 62.0, 83.3), and ‘given IPTp-SP by DOT’ 0% and 34.3% (95% CI 10.5, 69.8), at district and community levels, respectively. Delivery of ITNs was effective where they were in stock; however stock-outs were a problem. Predictors of receiving IPTp-SP at the district level were 4 to 6 months gestation, not reporting symptoms of malaria at ANC visit and the amount of money spent during the visit. At the community level, the predictors were 4 to 6 months gestation, maternal education below primary level, routine ANC visit (not for an illness), palpation of the abdomen, and expenditure of money in ANC. Conclusion: In Segou District, the delivery of IPTp-SP was ineffective; whilst ITN delivery was effective if ITNs were in stock. Predictors of receiving IPTp-SP at the district and community levels included gestational age, the amount of expenditure during the ANC visit and no illness.

Suggested Citation

  • Jayne Webster & Kassoum Kayentao & Jane Bruce & Sory I Diawara & Amadou Abathina & Alhassane Ag Haiballa & Ogobara K Doumbo & Jenny Hill, 2013. "Prevention of Malaria in Pregnancy with Intermittent Preventive Treatment and Insecticide Treated Nets in Mali: A Quantitative Health Systems Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-15, June.
    • Handle: RePEc:plo:pone00:0067520
    DOI: 10.1371/journal.pone.0067520
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    3. Abdisalan M Noor & Abdinasir A Amin & Willis S Akhwale & Robert W Snow, 2007. "Increasing Coverage and Decreasing Inequity in Insecticide-Treated Bed Net Use among Rural Kenyan Children," PLOS Medicine, Public Library of Science, vol. 4(8), pages 1-8, August.
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