The effect of health care worker training on the use of intermittent preventive treatment for malaria in pregnancy in rural western Kenya.
BACKGROUND
In 1998, Kenya adopted intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) for malaria prevention during pregnancy. We conducted a survey in 2002 among women who had recently delivered in the rural neighbouring areas Asembo and Gem and reported coverage of 19% of at least one dose and 7% of two or more doses of SP. Health care workers (HCW) in Asembo were retrained on IPTp in 2003.


OBJECTIVE
To evaluate if IPTp coverage increased and if the training in Asembo led to better coverage than in Gem, and to identify barriers to the effective implementation of IPTp.


METHODS
Community-based cross-sectional survey among a simple random sample of women who had recently delivered in April 2005, interviews with HCW of antenatal clinics (ANC) in Asembo and Gem.


RESULTS
Of the 724 women interviewed, 626 (86.5%) attended the ANC once and 516 (71.3%) attended two or more times. Overall IPTp coverage was 41% for at least one dose, and 21% for at least two doses of SP. In Asembo, coverage increased from 19% in 2002 to 61% in 2005 for at least one dose and from 7% to 17% for two doses of SP. In Gem, coverage increased from 17% to 28% and 7% to 11%, respectively. Interviews of HCW in both Asembo and Gem revealed confusion about appropriate timing, and lack of direct observation of IPTp.


CONCLUSIONS
Training of HCW and use of simplified IPTp messages may be a key strategy in achieving Roll Back Malaria targets for malaria prevention in pregnancy in Kenya.
Ouma
P O
PO
Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya. pouma@ke.cdc.gov
Van Eijk
A M
AM
Hamel
M J
MJ
Sikuku
E
E
Odhiambo
F
F
Munguti
K
K
Ayisi
J G
JG
Kager
P A
PA
Slutsker
L
L
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D002648:Child; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D019353:Endemic Diseases / Q000517:prevention & control; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000517:prevention & control*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D011739:Pyrimethamine / Q000008:administration & dosage*; D012423:Rural Health; D013413:Sulfadoxine / Q000008:administration & dosage*
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine