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Free Content Community-based distribution of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy improved coverage but reduced antenatal attendance in southern Malawi

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Summary Objective  To evaluate the impact of a 2-year programme for community-based delivery of sulfadoxine-pyremethamine (SP) on intermittent preventive treatment during pregnancy coverage, antenatal clinic attendance and pregnancy outcome. Methods  Fourteen intervention and 12 control villages in the catchment areas of Chikwawa and Ngabu Government Hospitals, southern Malawi, were selected. Village-based community health workers were trained in information, education and counselling on malaria control in pregnancy and the importance of attending antenatal clinics and promoted these messages to pregnant women. In the intervention group community health workers also distributed SP to pregnant women. Results  In the control area, coverage of intermittent preventive treatment during pregnancy (>2 doses) was low before (44.1%) and during the intervention (46.1%). In the intervention area, coverage increased from 41.5% to 82.9% ( < 0.01). Antenatal clinic attendance (>2 visits) was maintained in control villages at above 90%, but fell in intervention villages from 87.3% to 51.5% ( < 0.01). Post-natal malaria parasitaemia prevalence fell in women from both study areas during the intervention phase ( < 0.05). Increasing the coverage of intermittent preventive treatment during pregnancy to >40% did not significantly improve maternal haemoglobin or reduce low birthweight prevalence. Conclusions  Better coverage of community-based intermittent preventive treatment during pregnancy can lower attendance at antenatal clinics; thus its effect on pregnancy outcome and antenatal attendance need to be monitored.


Evaluer l’impact d’une intervention basée sur la communauté de 2 années de distribution de sulfadoxine-pyriméthamine sur la couverture du traitement préventif intermittent pendant la grossesse, la fréquentation des cliniques prénatales et le résultat de la grossesse. Méthodes: 

14 villages d’interventions et 12 villages contrôles dans les hôpitaux gouvernementaux des zones de captage de Chikwawa et Ngabu dans le sud du Malawi ont été sélectionnés. Des agents de santé communautaires ont été formés à l’information, à l’éducation, aux conseils sur le contrôle de la malaria pendant la grossesse, à l’importance de visiter les cliniques prénatales et à la promotion de ces messages chez les femmes enceintes. Dans le groupe d’intervention les agents de santé communautaires ont également distribué le sulfadoxine-pyriméthamine aux femmes enceintes. Résultats: 

Dans la zone contrôle, la couverture du traitement préventif intermittent pendant la grossesse (> 2 doses) était faible avant (44,1%) et au cours de l’intervention (46,1%). Dans la zone d’intervention, la couverture est passée de 41,5%à 82,9% (P < 0,01). La fréquentation des cliniques prénatales (> 2 visites) a été maintenue dans les villages contrôles au-dessus de 90%, mais a diminué dans les villages d’intervention de 87,3%à 51,5% (P < 0,01). La prévalence de parasitémie post malariale a diminué chez les femmes dans les deux zones d’étude au cours de la phase d’intervention (P < 0,05). L’augmentation de la couverture du traitement préventif intermittent pendant la grossesse à > 40% n’a pas amélioré sensiblement l’hémoglobine maternelle ni réduit la prévalence du faible poids à la naissance. Conclusions: 

Une meilleure couverture du traitement préventif intermittent basé sur la communauté pendant la grossesse peut réduire la fréquentation des cliniques prénatales. Dès lors, son effet sur le résultat de la grossesse et les visites prénatales doit être surveillé.

Keywords: Malawi; anaemia; anemia; antenatal attendance; anémie; birthweight; embarazo; grossesse; malaria; naissance; peso al nacer; pregnancy; sulfadoxina-pirimetamina; sulfadoxine-pyrimethamine; sulfadoxine-pyriméthamine

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2008.02197.x

Affiliations: 1:  Malaria Alert Centre, College of Medicine, Blantyre, Malawi 2:  Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK 3:  Baylor College of Medicine, Children’s Clinical Centre of Excellence, Lilongwe, Malawi 4:  Epidemiology and Control of Parasitic Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium

Publication date: February 1, 2009

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