U.S. President's Malaria Initiative, United States Agency for International Development (USAID), Lilongwe, Malawi.
University of Malawi College of Medicine, Malaria Alert Centre, Blantyre, Malawi.
Malar J. 2020 Apr 15;19(1):154. doi: 10.1186/s12936-020-03228-2.
The World Health Organization recommends three or more doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to mitigate the negative effects of malaria in pregnancy (MIP). Many pregnant women in Malawi are not receiving the recommended number of doses. Community delivery of IPTp (cIPTp) is being piloted as a new approach to increase coverage. This survey assessed recently pregnant women's knowledge of MIP and their experiences with community health workers (CHWs) prior to implementing cIPTp.
Data were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16-49 years who had a pregnancy resulting in a live birth in the previous 12 months. Survey questions were primarily open response and utilized review of the woman's health passport whenever possible. Analyses accounted for selection weighting and clustering at the health facility level and explored heterogeneity between districts.
A total of 370 women were interviewed. Women in both districts found their community health workers (CHWs) to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%, p = 0.01); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%, p = 0.02) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0% p = 0.03). Women in Nkhata Bay were more likely to receive 3 + doses of IPTp-SP (IPTp3) (59.2% vs 41.8%, p = 0.0002). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so (adjusted odds ratio = 1.50, 95% confidence interval 0.97-2.32, p-value 0.066).
Women reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+ . Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage.
世界卫生组织建议在妊娠期间使用磺胺多辛-乙胺嘧啶（IPTp-SP）进行三次或更多次间歇性预防治疗，以减轻妊娠疟疾（MIP）的负面影响。马拉维的许多孕妇没有接受推荐的剂量。社区提供的 IPTp（cIPTp）作为一种增加覆盖率的新方法正在进行试点。这项调查评估了最近怀孕的妇女对 MIP 的认识，以及她们在实施 cIPTp 之前与社区卫生工作者（CHW）的接触情况。
数据来自马拉维恩彻乌和恩卡塔湾地区 16-49 岁的最近生育过活产婴儿的妇女，通过家庭调查收集。调查问题主要是开放回答，并尽可能查阅妇女的健康护照。分析考虑了在卫生机构层面的选择权重和聚类，并探讨了两个地区之间的异质性。
共访谈了 370 名妇女。两个地区的妇女都认为社区卫生工作者（CHWs）很有帮助（77.9%），但只有 35.7%的妇女与 CHW 讨论过产前保健，25.8%的妇女在最近一次怀孕时获得了疟疾方面的帮助。与恩彻乌相比，恩卡塔湾地区的妇女更有可能报告从 CHW 那里获得疟疾方面的帮助（42.7%对 21.9%，p=0.01）；恩卡塔湾地区的妇女更有可能将 IPTp-SP 作为预防 MIP 的一种方式（41.0%对 24.8%，p=0.02），并更有可能将蚊子叮咬作为传播疟疾的唯一途径（70.6%对 62.0%，p=0.03）。恩卡塔湾地区的妇女更有可能接受 3+ 剂磺胺多辛-乙胺嘧啶（IPTp3）（59.2%对 41.8%，p=0.0002）。知识充足与接受 IPTp3 的几率增加有关，尽管没有统计学意义（调整后的优势比=1.50，95%置信区间 0.97-2.32，p 值 0.066）。
妇女报告了与 CHW 接触的积极经验，但没有关注 MIP。恩卡塔湾地区的妇女更有可能得到 CHW 的帮助，她们的知识更丰富，更有可能接受 IPTp3+。增加 CHW 对 MIP 危险的关注并实施 cIPTp 有可能增加 IPTp 的覆盖率。
