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Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-saharan Africa: a systematic review and meta-analysis.
MedLine Citation:
PMID:  23935459     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women.
METHODS AND RESULTS: We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations.
CONCLUSIONS: Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary.
Jenny Hill; Jenna Hoyt; Anna Maria van Eijk; Lauren D'Mello-Guyett; Feiko O Ter Kuile; Rick Steketee; Helen Smith; Jayne Webster
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Publication Detail:
Type:  Journal Article     Date:  2013-07-23
Journal Detail:
Title:  PLoS medicine     Volume:  10     ISSN:  1549-1676     ISO Abbreviation:  PLoS Med.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-08-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101231360     Medline TA:  PLoS Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1001488     Citation Subset:  IM    
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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