U.S. President's Malaria Initiative Impact Malaria Project, Dar es Salaam, Tanzania.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Trop Med Hyg. 2024 Feb 6;110(3_Suppl):56-65. doi: 10.4269/ajtmh.23-0399. Print 2024 Mar 5.
Malaria in pregnancy (MiP) is associated with maternal anemia, spontaneous abortion, and infant and maternal death. In Tanzania, MiP service data are collected through routine Malaria Services and Data Quality Improvement (MSDQI) supportive supervision rounds at antenatal care (ANC) facilities. Using structured assessment tools, the U.S. President's Malaria Initiative Impact Malaria Project reviewed two annual rounds of MSDQI data (492 facilities in 2021 and 522 facilities in 2022), including ANC records and client satisfaction interviews. We assessed coverage of key MiP care components, used logistic regression to analyze uptake of the recommended three or more doses of intermittent preventive treatment in pregnancy (IPTp3+), and assessed client satisfaction. Coverage of most MiP care components exceeded 80%; however, only 38% of women received all components. Odds of receiving IPTp3+ were much lower among late ANC initiators than among those who initiated ANC during their first trimester (odds ratio [OR], 0.46; 95% CI, 0.38-0.57). Uptake of IPTp3+ increased almost exponentially by number of ANC visits. Women with seven visits were 30 times more likely than those with three visits to receive IPTp3+ (OR, 30.71; 95% CI, 11.33-83.22). Just 54% of clients had anemia screening and only 46% received IPTp3+. Client satisfaction with services and provider communication was high (98% and 97%, respectively); only 8% of client visits exceeded 3 hours. Increased ANC visits could boost IPTp3+ coverage. Routine MSDQI supportive supervision data are useful to assess quality of care, identify service delivery gaps, and guide policies to improve quality of MiP services.
妊娠疟疾（MiP）与母亲贫血、自然流产以及母婴死亡有关。在坦桑尼亚，MiP 服务数据是通过在产前保健（ANC）设施进行的常规疟疾服务和数据质量改进（MSDQI）支持性监督回合收集的。美国疟疾倡议影响疟疾项目使用结构化评估工具，审查了两轮年度 MSDQI 数据（2021 年有 492 个设施，2022 年有 522 个设施），包括 ANC 记录和客户满意度访谈。我们评估了关键 MiP 护理组件的覆盖情况，使用逻辑回归分析了推荐的三剂或更多剂妊娠间歇性预防治疗（IPTp3+）的采用情况，并评估了客户满意度。大多数 MiP 护理组件的覆盖率超过 80%；然而，只有 38%的妇女接受了所有组件。与在孕早期开始 ANC 的妇女相比，晚期 ANC 开始者接受 IPTp3+的可能性要低得多（比值比[OR]，0.46；95%置信区间，0.38-0.57）。随着 ANC 就诊次数的增加，IPTp3+的采用率几乎呈指数增长。接受了 7 次 ANC 就诊的妇女接受 IPTp3+的可能性是接受 3 次 ANC 就诊的妇女的 30 倍（OR，30.71；95%置信区间，11.33-83.22）。只有 54%的患者接受了贫血筛查，只有 46%的患者接受了 IPTp3+。对服务和提供者沟通的客户满意度很高（分别为 98%和 97%）；只有 8%的客户就诊时间超过 3 小时。增加 ANC 就诊次数可以提高 IPTp3+的覆盖率。常规 MSDQI 支持性监督数据可用于评估护理质量，发现服务提供差距，并指导改善 MiP 服务质量的政策。
