Jiang Yongsheng, Liang Di, Zhao Jinkou, Prasad Shailendra, Ndiop Medoune, Thiam Serigne Amdy, Diallo Ibrahima, Sene Doudou, Mpembeni Rose, Huang Jiayan
School of Public Health, Global Health Institute, Fudan University, Shanghai, 200032, China.
Programmatic Monitoring Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, 1218, Switzerland.
Infect Dis Poverty. 2025 Jul 20;14(1):71. doi: 10.1186/s40249-025-01341-5.
Despite the World Health Organization's recommendations, the uptake of Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in Senegal remains suboptimal, with disparities observed between urban and rural areas. More remains to be known about how malaria service readiness would affect the utilization of IPTp-SP.
Data were obtained from seven annual rounds of Demographic and Health Surveys (DHS) and Service Provision Assessments (SPA) in Senegal from 2012 to 2019. Using sample domain linkage to link the databases at the regional level. A malaria service readiness index was calculated to quantify the malaria service delivery capacity within the service environment where women reside. The Heckman selection model was utilized to analyze the relationship between malaria service readiness and IPTp-SP utilization.
From 2012 to 2019, the average number of IPTp-SP doses received in Senegal was 1.66 (95% CI: 1.65-1.68), higher in urban areas [1.73 (95% CI: 1.71-1.75)] than rural areas [1.63 (95% CI: 1.62-1.65)]. Each one-point increase in malaria service readiness led to a rise of 0.251 doses in IPTp-SP. The significant interaction (Coef. = - 0.523, P < 0.001) indicated that women in rural areas received fewer doses of IPTp-SP (0.089) than in urban areas (0.612) for every unit increase in malaria service readiness.
Linking household and health facility surveys revealed significant room for improvement in malaria service readiness and IPTp-SP utilization in rural areas in Senegal. For better IPTp-SP coverage, differential strategies are required for urban and rural settings. Urban areas need to enhance malaria service readiness, while rural areas should focus on improving service readiness alongside infrastructure and community engagement to bridge the urban-rural disparities.
尽管世界卫生组织提出了相关建议，但塞内加尔孕期使用磺胺多辛-乙胺嘧啶进行间歇性预防治疗（IPTp-SP）的情况仍不理想，城乡之间存在差异。关于疟疾服务准备情况如何影响IPTp-SP的使用，仍有更多内容有待了解。
数据来自2012年至2019年塞内加尔七轮年度人口与健康调查（DHS）和服务提供评估（SPA）。利用样本域链接在区域层面将数据库进行关联。计算疟疾服务准备指数，以量化妇女居住的服务环境中的疟疾服务提供能力。采用赫克曼选择模型分析疟疾服务准备情况与IPTp-SP使用之间的关系。
2012年至2019年，塞内加尔接受IPTp-SP剂量的平均数为1.66（95%置信区间：1.65 - 1.68），城市地区[1.73（95%置信区间：1.71 - 1.75）]高于农村地区[1.63（95%置信区间：1.62 - 1.65）]。疟疾服务准备情况每提高1分，IPTp-SP剂量增加0.251剂。显著的交互作用（系数 = -0.523，P < 0.001）表明，疟疾服务准备情况每提高一个单位，农村地区妇女接受的IPTp-SP剂量（0.089）比城市地区妇女（0.612）少。
将家庭调查与卫生设施调查相结合发现，塞内加尔农村地区的疟疾服务准备情况和IPTp-SP使用情况有很大的改善空间。为了实现更好的IPTp-SP覆盖，城乡地区需要采取不同的策略。城市地区需要提高疟疾服务准备情况，而农村地区应在改善基础设施和社区参与的同时，着重提高服务准备情况，以缩小城乡差距。
