Intermittent preventive treatment of malaria in pregnancy: the effect of new delivery approaches on access and compliance rates in Uganda.
OBJECTIVE
To assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer intermittent preventive treatment (IPT) with sulfadoxine-pyremethamine to pregnant women, and reach those most at risk of malaria and increase access and compliance to it.


METHODS
The study was designed to assess new approaches of delivering IPT through these groups and compare it with IPT at health units. The primary outcome measures were: the proportion of adolescents and primigravidae accessed; gestational age at recruitment and the proportion of women who completed two doses of sulfadoxine-pyremethamine.


RESULTS
Two thousand seven hundred and eighty-five pregnant women (78% of those in the study area) participated. With new approaches, 92.4% of the women received IPT during the second trimester as recommended by the policy, vs. 76.1% at health units, P < 0.0001. Of the women who received two doses of sulfadoxine-pyremethamine, 39.9% were at health units (control) vs. 67.5% through new approaches (P < 0.0001). Women using the new approaches also accessed IPT early: the mean gestational age when receiving the first dose of sulfadoxine-pyremethamine was 21.0 weeks vs. 23.1 weeks at health units (P < 0.0001). However, the health units were used by a higher proportion of primigravidae (23.6% vs. 20.0%, P < 0.04), and this was also the case for adolescents (28.4% vs. 25.0%, P < 0.03). This intervention was acceptable with 89.1% of the women at the new approaches intending to use IPT in future.


CONCLUSIONS
The new approaches increased access to and compliance with IPT. We recommend a review of the policy to allow the provision of IPT through the new approaches.
Mbonye
Anthony K
AK
Reproductive Health Division, Department of Community Health, Ministry of Health, Kampala, Uganda. vpadmn@infocom.co.ug
Magnussen
Pascal
P
Bygbjerg
I B
IB
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration; D004338:Drug Combinations; D005260:Female; D005865:Gestational Age; D020073:Gravidity; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011262:Pregnancy Trimester, Second; D011739:Pyrimethamine / Q000627:therapeutic use*; D012423:Rural Health; D013413:Sulfadoxine / Q000627:therapeutic use*; D014454:Uganda / Q000453:epidemiology
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine