Behavior Profile: Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp)
1. Reduce malaria mortality by one-third from 2015 levels in PMI-supported countries, achieving a greater than 80 percent reduction from PMI’s original 2000 baseline levels. 2. Reduce malaria morbidity in PMI-supported countries by 40 percent from 2015 levels.
Pregnant women complete a full course of IPTp
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

BEHAVIOR AND STEPS

What steps are needed to practice this behavior?

Pregnant women complete a full course of IPTp

  1. Decide to seek ANC care early before the end of the first trimester
  2. Demand IPTp at each ANC visit, beginning in second trimester
  3. Adhere to provider instructions at each visit, including when to return for the next visit

FACTORS

What factors may prevent or support practice of this behavior?
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, and what actions must they take?
Institutional
Policymakers: Incorporate IPTp into broader reproductive health programs in collaboration with MIP point of contact and reproductive health staff.
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.
Logistics Personnel: Procure sufficient stock of SP or other IPTp commodity supplies.
Providers: Counsel about protective benefits, timing and dosing of IPTp to all pregnant women and their partners.
Providers: Administer SP appropriately during ANC visits.
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

What strategies will best focus our efforts based on this analysis?

Strategy requires Communication Support

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.
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