Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
Malar J. 2018 Aug 24;17(1):309. doi: 10.1186/s12936-018-2426-y.
Malaria in pregnancy has devastating consequences for both the expectant mother and baby. Annually, 88.2 (70%) of the 125.2 million pregnancies in malaria endemic regions occur in the Asia-Pacific region. The control of malaria in pregnancy in most of Asia relies on passive case detection and prevention with long-lasting insecticide-treated nets. Indonesia was the first country in the region to introduce, in 2012, malaria screening at pregnant women's first antenatal care visit to reduce the burden of malaria in pregnancy. The study assessed health providers' acceptability and perceptions on the feasibility of implementing the single screening and treatment (SST) strategy in the context of the national programme in two endemic provinces of Indonesia.
Qualitative data were collected through in-depth interviews with 86 health providers working in provision of antenatal care (midwives, doctors, laboratory staff, pharmacists, and heads of drug stores), heads of health facilities and District Health Office staff in West Sumba and Mimika districts in East Nusa Tenggara and Papua provinces, respectively.
Health providers of all cadres were accepting of SST as a preventive strategy, showing a strong preference for microscopy over rapid diagnostic tests (RDTs) as the method of screening. Implementation of the policy was inconsistent in both sites, with least extensive implementation reported in West Sumba compared to Mimika. SST was predominantly implemented at health centre level using microscopy, whereas implementation at community health posts was said to occur in less than half the selected health facilities. Lack of availability of RDTs was cited as the major factor that prevented provision of SST at health posts, however as village midwives cannot prescribe medicines women who test positive are referred to health centres for anti-malarials. Few midwives had received formal training on SST or related topics.
The study findings indicate that SST was an acceptable strategy among health providers, however implementation was inconsistent with variation across different localities within the same district, across levels of facility, and across different cadres within the same health facility. Implementation should be re-invigorated through reorientation and training of health providers, stable supplies of more sensitive RDTs, and improved data capture and reporting.
妊娠疟疾对母婴都有毁灭性的影响。在疟疾流行地区，每年有 1.252 亿次妊娠中有 88.2%（70%）发生在亚太地区。亚洲大部分地区妊娠疟疾的控制依赖于被动病例检测和长效驱虫蚊帐的预防。印度尼西亚是该地区第一个在 2012 年引入孕妇首次产前保健时进行疟疾筛查的国家，以减轻妊娠疟疾的负担。本研究评估了卫生提供者对在国家方案背景下实施单次筛查和治疗（SST）策略的可接受性和看法，该策略在印度尼西亚两个流行省份实施。
通过对西松巴哇和米米卡区的产前保健提供者（助产士、医生、实验室工作人员、药剂师和药店负责人）、卫生机构负责人和地区卫生办公室工作人员进行深入访谈，收集了定性数据。这两个区分别位于东努沙登加拉省和巴布亚省。
各级卫生工作者都接受 SST 作为一种预防策略，强烈倾向于使用显微镜而不是快速诊断测试（RDT）作为筛查方法。两个地点的政策实施情况不一致，西松巴哇的实施情况不如米米卡广泛。SST 主要在卫生中心一级使用显微镜实施，而在社区卫生所的实施据说不到所选卫生设施的一半。缺乏 RDT 被认为是阻止在卫生所提供 SST 的主要因素，然而，由于乡村助产士不能开处方，检测阳性的妇女被转介到卫生中心接受抗疟治疗。很少有助产士接受过关于 SST 或相关主题的正式培训。
研究结果表明，SST 在卫生提供者中是一种可接受的策略，然而，实施情况不一致，在同一地区的不同地点、不同设施级别和同一卫生设施内的不同职业之间存在差异。应通过重新定向和培训卫生提供者、稳定供应更敏感的 RDT、以及改进数据采集和报告来重新激发实施。
