Malaria Branch, U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
PMI Boresha Afya, Jhpiego, Dar Es Salaam, Tanzania.
Malar J. 2023 Feb 24;22(1):66. doi: 10.1186/s12936-023-04480-y.
Measurement of malaria prevalence is conventionally estimated through infrequent cross-sectional household surveys that do not provide continuous information regarding malaria parasitaemia. Recent studies have suggested that malaria parasitaemia prevalence among women attending antenatal care (ANC) correlates with prevalence among children under 5 years old and that pregnant women could be a sentinel population for tracking malaria prevalence. In mainland Tanzania, 97% of women are tested for malaria parasitaemia during first ANC visits. However, acceptability among pregnant women and healthcare providers of collecting malaria risk factor data during ANC visits is limited.
A tablet-based questionnaire including 15 questions on insecticide-treated net ownership and use and care-seeking for febrile children was introduced at 40 healthcare facilities in Geita Region, Tanzania. Facilities were randomly selected from among those with 15-120 first ANC visits per month. To assess perspectives regarding introduction of the questionnaire, 21 semi-structured interviews were held with providers and facility in-charges at 12 facilities. Thirty pregnant and recently delivered women participated in focus group discussions at seven facilities to assess the acceptability of spending additional time answering questions about malaria risk.
All pregnant women reported that introduction of ANC surveillance and spending 10 more minutes with providers answering questions about their health would be neutral or beneficial. They perceived being asked about their health as standard of care. Providers and in-charges reported that introduction of ANC surveillance was within their scope of practice. Nine of 21 indicated it could potentially benefit women's health. Six providers expressed concern about staffing shortages and need for reimbursement for extra time and noted that data management occurs after hours.
Pregnant women and providers generally perceived ANC surveillance for malaria as acceptable and positive. Pregnant and recently delivered women saw this as a reasonable and even helpful intervention. To be seen as a part of standard practice, efforts are needed to ensure providers perceive a benefit for ANC clients and that staffing concerns are addressed. In addition, staff should receive feedback related to data submissions regarding malaria prevalence and risk factors among women at their facility, with actions to take.
疟疾发病率的传统测量方法是通过不频繁的横断面家庭调查进行的，这些调查无法提供关于疟疾寄生虫血症的连续信息。最近的研究表明，在产前保健（ANC）就诊的妇女中的疟疾寄生虫血症患病率与 5 岁以下儿童的患病率相关，孕妇可能是监测疟疾患病率的哨点人群。在坦桑尼亚大陆，97%的孕妇在第一次 ANC 就诊时接受疟疾寄生虫血症检测。然而，在 ANC 就诊期间收集疟疾危险因素数据在孕妇和医疗保健提供者中接受程度有限。
在坦桑尼亚盖塔地区的 40 个医疗保健机构引入了一个基于平板电脑的问卷，其中包括 15 个关于驱虫蚊帐拥有和使用以及发热儿童求医的问题。这些设施是从每月有 15-120 次首次 ANC 就诊的设施中随机选择的。为了评估引入问卷的观点，在 12 个设施中对提供者和设施负责人进行了 21 次半结构访谈。在七个设施中，30 名孕妇和最近分娩的妇女参加了焦点小组讨论，以评估花额外时间回答有关疟疾风险的问题的可接受性。
所有孕妇都表示，引入 ANC 监测并与提供者多花 10 分钟回答有关她们健康的问题将是中性或有益的。她们认为被问及自己的健康是护理标准。提供者和负责人报告说，引入 ANC 监测在他们的实践范围内。21 人中的 9 人表示，这可能对妇女的健康有益。6 名提供者对人员短缺表示担忧，并需要额外时间的报销，并指出数据管理是在下班后进行的。
孕妇和提供者普遍认为 ANC 监测疟疾是可以接受和积极的。孕妇和最近分娩的妇女认为这是一种合理的、甚至是有帮助的干预措施。为了被视为标准实践的一部分，需要努力确保提供者认为 ANC 客户有受益，并且解决人员配备问题。此外，工作人员应收到与他们所在机构的妇女疟疾患病率和危险因素相关的数据提交反馈，并采取相应的行动。
