Malaria

Intermittent Preventive Treatment of Malaria in Pregnancy

Pregnant women take intermittent preventive treatment of malaria (IPTp) during antenatal care (ANC) visits

Intermittent preventive treatment of malaria in pregnancy reduces incidence of low birth weight by 29%, severe maternal anemia by 38% and neonatal mortality by 31%. This is a periodic behavior that needs to be practiced at every ANC visit.1Investing in Malaria in Pregnancy in Sub-Saharan Africa: Saving Womens and Childrens Lives 

Key Points from Global Research

  • Pregnant women’s knowledge about the protective benefits of IPTp for herself and her unborn child coupled with provider skill on correct timing and dosing can contribute to an increase in this cost-effective and easily administered intervention beginning in the second trimester.

Behavior Profile Sample: Intermittent Preventive Treatment of Malaria in Pregnancy

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating country-specific Behavior Profiles.

Create Behavior Profiles

Improve maternal and child survival
Pregnant women take intermittent preventive treatment of malaria (IPTp) during antenatal care (ANC) visits
Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 3 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit
Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 2 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Decide to seek ANC care early before the end of the first trimester
  2. Obtain IPTp at each ANC visit, beginning in second trimester
  3. Adhere to provider instructions on when to return for the next visit

Click on any box
        to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.  
        of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
Structural
Accessibility: Pregnant women cannot access SP because the SP or related commodities are unavailable
Service Provider Competencies: Pregnant women do not receive SP at each visit because providers do not have the proper technical information to adhere to national MIP guidelines
Social
Family and Community Support: Pregnant women do not seek SP because it is not promoted or encouraged by community-based community health volunteers or agents
Internal
Attitudes and Beliefs: Pregnant women refuse SP because they fear the side effects
Attitudes and Beliefs: Pregnant women do not adhere to provider instructions because they do not understand the difference between drug-based prevention and treatment
Knowledge: Pregnant women do not obtain SP or adhere to provider’s instructions because they are unaware of the benefits of SP for themselves and their unborn children

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Incorporate IPTp into broader reproductive health programs in collaboration with MIP point of contact and reproductive health staff
Providers: Counsel about protective benefits, timing and dosing of IPTp to all pregnant women and their partners
Providers: Administer SP appropriately during ANC visits
Logistics Personnel: Procure sufficient stock of SP or other IPTp commodity supplies
Managers: Conduct regular supportive supervisory visits with facility-based service providers to ensure proper administration of and counseling for IPTp
Managers: Seek innovative ways to provide client-friendly services closer and more convenient to the client
Community
Community Leaders: Create or support structures that promote social accountability to encourage community-based service providers to promote the benefits of IPTp as part of ANC services
Community and Religious Leaders: Engage men and male heads of households to support the decision of pregnant women to seek ANC especially in the absence of community-based service provider support

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Partnerships and Networks: Encourage delivery of ANC and IPTp in non-formal settings, such as through NGOs and by community health workers directly in the community to ensure that ANC is accessible to all women
Policies and Governance: Integrate IPTp into reproductive health programs to ensure that all women accessing these services receive IPTp
Policies and Governance: Create or leverage the power and influence of existing community leaders and members to advocate for accountability at health facilities
Systems, Products and Services
Supply Chain: Strengthen commodities and supply chain for Fansidar/SP or IPTp protocol at all levels to ensure adequate stock for the recommended minimum number of doses per expected pregnant woman
Quality Improvement: Disseminate to providers clear IPTp guidelines and information to use in counseling women on benefits to ensure that all women are receiving recommended IPTp during ANC
Quality Improvement: Expand and promote services offered during ANC to increase women’s perceived value of IPTp
Quality Improvement: Equip health workers with relevant, locally tailored behavior-centered job aids to provide better IPTp services to women
Demand and Use
Communication: Use appropriate communication approaches to promote value of preventative services to mother and unborn child
Communication: Exploit direct-to-consumer digital tools, such as mobile technologies, interactive voice response (IVR), etc. to reach women directly to convey benefits of and value for IPTp as part of routine ANC visits

Global Status of Accelerator Behavior

Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 3 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit

Malaria Indicator Survey, The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program

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