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 Country-specific 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: Fansidar/SP is often out of stock or rationed
Service Provider Competencies: Lack of provider knowledge including when to begin IPTp further confuses women and their family
Social
Family and Community Support: Often family members or partners do not consent to multiple ANC visits
Family and Community Support: IPTp is seldom endorsed or promoted by community-based service providers
Internal
Attitudes and Beliefs : Many women fear side effects
Attitudes and Beliefs : Women and families often motivated by idea of treatment more than prevention
Attitudes and Beliefs : Many women are unaware of the protective benefits of IPTp to themselves and their unborn child

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Ensure integration of IPTp with broader reproductive health programs
Logistics Personnel: Ensure SP or other IPTp commodity supply
Providers: Provide clear counseling about protective benefits, timing and dosing of IPTp to pregnant women and their partners

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Partnerships and Networks: Explore delivery of ANC and IPTp in non-formal settings, such as through NGOs and by community health workers, directly in the community where ANC is inaccessible
Policies and Governance: Integrate IPTp into reproductive health programs
Systems, Products and Services
Supply Chain: Strengthen commodities and supply chain for Fansidar/SP or IPTp protocol at all levels to plan for at least 4 doses per expected pregnant woman
Quality Improvement: Disseminate to providers clear IPTp guidelines and information to use in counseling women on benefits
Quality Improvement: Expand and promote services offered during ANC to increase perceived value, including treatment for RTIs
Demand and Use
Communication: Use appropriate communications approaches to reposition value of preventive services to mother and unborn child

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

Demographic and Health Survey, Malaria Indicator Survey

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