4.7 Article

Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys

Journal

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Volume 50, Issue 2, Pages 550-559

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/ije/dyaa233

Keywords

Malaria control; pregnancy; maternal health; sub-Saharan Africa

Funding

  1. UNITAID [2017-13-TIPTOP]
  2. Jhpiego [17-SBA-101]
  3. Spanish Ministry of Science and Innovation [CEX2018-000806-S]
  4. Generalitat de Catalunya
  5. Spanish Ministry of Education and Vocational Training [FPU15/03548]

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The coverage of IPTp3+ in the surveyed districts in four sub-Saharan countries was generally low, falling short of universal coverage. However, one district in Mozambique showed significantly higher IPTp3+ coverage compared to other areas and the 2018 national average, indicating a need for further investigation into the reasons behind this discrepancy.
Background: Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, base-line information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods: Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results: A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions: The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.

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