尼日利亚妊娠期间歇性预防治疗疟疾的服务提供不佳：提供者因素的影响。
Sub-optimal delivery of intermittent preventive treatment for malaria in pregnancy in Nigeria: influence of provider factors.
机构信息
Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
出版信息
Malar J. 2012 Sep 7;11:317. doi: 10.1186/1475-2875-11-317.
BACKGROUND
The level of access to intermittent preventive treatment for malaria in pregnancy (IPTp) in Nigeria is still low despite relatively high antenatal care coverage in the study area. This paper presents information on provider factors that affect the delivery of IPTp in Nigeria.
METHODS
Data were collected from heads of maternal health units of 28 public and six private health facilities offering antenatal care (ANC) services in two districts in Enugu State, south-east Nigeria. Provider knowledge of guidelines for IPTp was assessed with regard to four components: the drug used for IPTp, time of first dose administration, of second dose administration, and the strategy for sulphadoxine-pyrimethamine (SP) administration (directly observed treatment, DOT). Provider practices regarding IPTp and facility-related factors that may explain observations such as availability of SP and water were also examined.
RESULTS
Only five (14.7%) of all 34 providers had correct knowledge of all four recommendations for provision of IPTp. None of them was a private provider. DOT strategy was practiced in only one and six private and public providers respectively. Overall, 22 providers supplied women with SP in the facility and women were allowed to take it at home. The most common reason for doing so amongst public providers was that women were required to come for antenatal care on empty stomachs to enhance the validity of manual fundal height estimation. Two private providers did not think it was necessary to use the DOT strategy because they assumed that women would take their drugs at home. Availability of SP and water in the facility, and concerns about side effects were not considered impediments to delivery of IPTp.
CONCLUSION
There was low level of knowledge of the guidelines for implementation of IPTp by all providers, especially those in the private sector. This had negative effects such as non-practice of DOT strategy by most of the providers, which can lead to low levels of adherence to IPTp and ineffectiveness of IPTp. Capacity development and regular supportive supervisory visits by programme managers could help improve the provision of IPTp.
背景
尽管研究地区的产前保健覆盖率相对较高，但尼日利亚间歇性预防治疗疟疾（IPTp）的可及性仍较低。本文介绍了影响尼日利亚提供 IPTp 的提供者因素的信息。
方法
数据来自尼日利亚东南部埃努古州两个区的 28 家公立和 6 家私营医疗保健机构的孕产妇保健单位负责人。使用四个方面评估提供者对 IPTp 指南的了解程度：用于 IPTp 的药物、首次剂量给药时间、第二次剂量给药时间以及磺胺多辛-乙胺嘧啶（SP）给药策略（直接观察治疗、DOT）。还检查了提供者有关 IPTp 的实践和可能解释观察结果的设施相关因素，例如 SP 和水的可用性。
结果
在所有 34 名提供者中，仅有 5 名（14.7％）对提供 IPTp 的所有四项建议均有正确的了解。他们中没有一个是私营提供者。DOT 策略仅在一家私营和六家公营提供者中实施。总体而言，22 名提供者在设施中向妇女提供 SP，并且允许妇女在家中服用该药。在公营提供者中，这样做的最常见原因是妇女需要空腹来进行产前保健，以增强手动宫底高度估计的有效性。有两名私营提供者认为没有必要使用 DOT 策略，因为他们认为妇女会在家中服用药物。设施中 SP 和水的可用性以及对副作用的担忧并未被认为是提供 IPTp 的障碍。
结论
所有提供者，尤其是私营部门的提供者，对实施 IPTp 的指南的了解程度都很低。这产生了负面影响，例如大多数提供者不实施 DOT 策略，这可能导致 IPTp 的接受程度低和 IPTp 的效果不佳。方案管理人员的能力建设和定期支持性监督访问可以帮助改善 IPTp 的提供。
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