School of Public Health, Global Health Institute, Fudan University, Shanghai, China.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
J Glob Health. 2024 Jun 28;14:04112. doi: 10.7189/jogh.14.04112.
Malaria infection during pregnancy is associated with an increased risk of maternal death, as well as adverse birth outcomes. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is known to improve pregnancy outcomes. However, the coverage of IPTp-SP in antenatal care (ANC) in sub-Saharan Africa remains well below the target. This study aims to estimate to what extent malaria service readiness affects the uptake of IPTp-SP during ANC visits in sub-Saharan African countries.
This study included 3267 pregnant women attending ANC for the first time and 2797 pregnant women who had attended ANC more than a month ago in six sub-Saharan African countries. The readiness of malaria services at each institution includes four indicators: the presence of IPTp-SP guidelines, SP availability, integration of IPTp-SP service into ANC, and provider training on IPTp-SP. The outcome variable indicates whether a pregnant woman received IPTp-SP at her current ANC visit. A modified Poisson regression model estimated the associations between malaria service readiness and IPTp-SP uptake for women eligible for the first and subsequent doses.
For women eligible for their first dose, visiting an institution with available SP was associated with an increased probability of receiving IPTp-SP (risk ratio (RR) = 1.43; 95% confidence interval (CI) = 1.22 to 1.67, P < 0.001). For women who were eligible for their next dose, the availability of SP (RR = 1.17; 95% CI = 1.04 to 1.32, P = 0.008) and integration of IPTp-SP service into ANC (RR = 1.82; 95% CI = 1.21 to 2.74, P = 0.004) in the institution were associated with increased likelihood of IPTp-SP uptake. Counterfactual predictions indicated that enhanced provider training could boost IPTp-SP uptake in high-uptake countries, while better SP availability and IPTp-SP integration into ANC would significantly impact low-uptake countries.
For better IPTp-SP coverage, strategies should be customised. High uptake countries should focus on provider training, while low uptake ones should ensure IPTp-SP availability and service integration.
疟疾感染会增加孕妇死亡的风险，还会导致不良的妊娠结局。在撒哈拉以南非洲地区，孕妇接受磺胺多辛-乙胺嘧啶（SP）间歇性预防治疗（IPTp-SP）可以改善妊娠结局。然而，在撒哈拉以南非洲地区，产前护理（ANC）中的 IPTp-SP 覆盖率远低于目标。本研究旨在评估疟疾服务准备情况在多大程度上影响撒哈拉以南非洲国家 ANC 就诊时接受 IPTp-SP 的情况。
本研究纳入了 3267 名首次接受 ANC 的孕妇和 2797 名在撒哈拉以南非洲地区六个国家接受 ANC 超过一个月的孕妇。每个机构的疟疾服务准备情况包括四个指标：IPTp-SP 指南的存在、SP 的供应情况、将 IPTp-SP 服务纳入 ANC 以及提供者接受 IPTp-SP 培训。结果变量表示孕妇在当前 ANC 就诊时是否接受了 IPTp-SP。使用修正泊松回归模型估计了疟疾服务准备情况与首次和后续剂量的 IPTp-SP 接受率之间的关联。
对于有资格接受第一剂的女性，到 SP 供应的机构就诊会增加接受 IPTp-SP 的可能性（风险比（RR）=1.43；95%置信区间（CI）=1.22 至 1.67，P<0.001）。对于有资格接受下一剂的女性，机构中 SP 的供应情况（RR=1.17；95%CI=1.04 至 1.32，P=0.008）和将 IPTp-SP 服务纳入 ANC（RR=1.82；95%CI=1.21 至 2.74，P=0.004）与接受 IPTp-SP 的可能性增加相关。反事实预测表明，加强提供者培训可以提高高接受率国家的 IPTp-SP 接种率，而更好地供应 SP 和将 IPTp-SP 纳入 ANC 将对低接受率国家产生重大影响。
为了提高 IPTp-SP 的覆盖率，应制定有针对性的策略。高接受率国家应注重提供者培训，而低接受率国家应确保 IPTp-SP 的供应和服务整合。
