Odjidja Emmanuel N, Duric Predrag
Institute of Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom.
Malariaworld J. 2017 Dec 1;8:20. eCollection 2017.
The intermittent preventive treatment (IPTp) policy of Malawi (2002) stipulates that IPTp is administered during antenatal care as a direct observation therapy (DOT). The policy further recommends that IPT should be administered monthly after 16 weeks of pregnancy until delivery. This study assessed both the demand and supply factors contributing to higher dropout of IPT after the first dose. Optimal number of doses was pegged at a minimum of three in accordance with WHO recommendation.
Data were analysed from the Malawi multiple indicator cluster survey (2015) and the service provision assessment (2014) of 6637 women (aged 15- 49 yrs), 763 facilities and 2105 health workers. The sample was made up of pregnant women, health facilities and workers involved in routine antenatal services across all regions of Malawi. A composite indicator was constructed to report integration of IPTp with ANC services and administration of IPTp-SP as DOT. Multivariate and logistic regression were conducted to determine associations.
Regression analysis found that: 1. Age of women (women 35-49 yrs, AOR 1.98; 95% CI 1.42 - 2.13, number of children as well as the number of ANC visits were associated with optimal uptake of IPTp. 2. Administering IPT as DOT was higher in facilities in rural areas (AOR 1.86; 95% CI 1.54 - 1.92) than in urban areas. 3. Administration of IPTp as DOT was relatively lower in across all facilities with highest being facilities managed by CHAM (72.8%, AOR 1.40; 95% CI 1.22 - 1.54).
Health system bottlenecks were found to present the main cause of low coverage with optimal doses of IPTp. Incorporating these results into strategic policy IPTp formulation could help improve coverage to desired levels. This study could serve as plausible evidence for government and donors when planning malaria in pregnancy interventions, especially in remote parts of Malawi.
马拉维（2002年）的间歇预防性治疗（IPTp）政策规定，IPTp在产前保健期间作为直接观察治疗（DOT）进行。该政策还建议，在怀孕16周后每月进行一次IPT，直至分娩。本研究评估了导致首剂后IPT停药率较高的需求和供应因素。根据世界卫生组织的建议，最佳剂量数设定为至少三剂。
分析了来自马拉维多指标类集调查（2015年）以及6637名妇女（年龄在15 - 49岁）、763个机构和2105名卫生工作者的服务提供评估（2014年）的数据。样本包括马拉维所有地区参与常规产前服务的孕妇、卫生机构和工作人员。构建了一个综合指标来报告IPTp与产前保健服务的整合情况以及IPTp - SP作为DOT的实施情况，并进行多变量和逻辑回归以确定关联。
回归分析发现：1. 妇女年龄（35 - 49岁的妇女，调整后比值比[AOR]为1.98；95%置信区间[CI]为1.42 - 2.13）、子女数量以及产前保健就诊次数与IPTp的最佳接受率相关。2. 在农村地区的机构中，将IPT作为DOT实施的比例（AOR为1.86；95% CI为1.54 - 1.92）高于城市地区。3. 在所有机构中，将IPTp作为DOT实施的比例相对较低，其中由马拉维基督教医学协会（CHAM）管理的机构比例最高（72.8%，AOR为1.40；95% CI为1.22 - 1.54）。
发现卫生系统瓶颈是IPTp最佳剂量覆盖率低的主要原因。将这些结果纳入IPTp战略政策制定中有助于将覆盖率提高到期望水平。本研究可为政府和捐助者在规划孕期疟疾干预措施时，特别是在马拉维偏远地区，提供合理依据。
