Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

• Published in: Malaria journal 2020-11, Vol.19 (1), p.1-394, Article 394
• Main Authors: Okedo-Alex, Ijeoma Nkem, Akamike, Ifeyinwa Chizoba, Alo, Chihurumnanya Nwachi, Agu, Adaoha Pearl, Nzeh, Chinyere Benedicta, Ndukwe, Chinwendu Daniel, Okoro, Odii Ogonna, Abateneh, Dejene Derseh, Uneke, Chigozie Jesse
• Format: Article
• Language: English
• Subjects: Antimalarial agents; Antimalarials; Community; Community involvement; Community-directed distribution; Data collection; Disease transmission; Distribution; Dosage and administration; Drug dosages; Effectiveness; Evaluation; Fever; Health aspects; Health behavior; Health facilities; Human diseases; Insecticides; Intervention; Malaria; Medical sciences; Mortality; Population; Pregnancy; Pregnant women; Prenatal care; Prevention; Public health administration; Pyrimethamine; Questionnaires; Rural areas; Satisfaction; Sulfadoxine; Sulfadoxine-pyrimethamine; Surveying; Union leadership; Uptake; Vector-borne diseases; Women; Womens health
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-020-03468-2

Background Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. Methods This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20. Results During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of [greater than or equai to] 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%). Conclusion Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement. Keywords: Malaria, Pregnancy, Sulfadoxine-pyrimethamine, Effectiveness, Community-directed distribution, Satisfaction, Nigeria