Bottlenecks for high coverage of intermittent preventive treatment in pregnancy: the case of adolescent pregnancies in rural Burkina Faso.
BACKGROUND
While IPTp-SP is currently being scaled up in sub-Saharan Africa (SSA), the coverage with the required>or=2 doses of SP remains considerably short of the Roll Back Malaria (RBM) goal of 80%, not to mention of the recently advocated universal coverage.


METHODS
The study triangulates quantitative data from a health center randomized community-based trial on IPTp-SP effectiveness and the additional benefit of a promotional campaign with qualitative data from focused ethnography.


RESULTS
In rural Burkina Faso, despite the significantly higher risk of malaria infection among adolescent primigravidae (PG) (OR 2.44 95%CI 1.81-3.28, p<0.001), making them primary target beneficiaries of IPTp-SP, adolescents adhered to the required three or more ANC visits significantly less (PG: 46.6%; SG 43.7%) than adults (PG: 61.9%; SG 54.9%) and had lower SP uptake during the malaria transmission season, further showing the difficulty of reaching this age group. Adolescents' structural constraints (such as their social position and household labor requirements) and needs (such as anonymity in the health encounter) leave them highly vulnerable during their pregnancies and, especially, during the high malaria transmission season.


CONCLUSIONS
Our study shows that adolescents need to be targeted specifically, prior to their first pregnancy and with measures adapted to their social context, addressing their structural constraints and needs and going beyond standard health promotion campaigns. Unless such specific measures are taken, adolescents' social vulnerability will present a serious bottleneck for the effectiveness of IPTi-SP.
Grietens
Koen Peeters
KP
Prince Leopold Institute for Tropical Medicine, Antwerp, Belgium. kpeeters@itg.be
Gies
Sabine
S
Coulibaly
Sheick Oumar
SO
Ky
Clotilde
C
Somda
Judith
J
Toomer
Elizabeth
E
Muela Ribera
Joan
J
D'Alessandro
Umberto
U
D000293:Adolescent; D017677:Age Distribution; D001294:Attitude to Health / Q000208:ethnology; D002050:Burkina Faso / Q000208:ethnology; D004338:Drug Combinations; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011739:Pyrimethamine / Q000494:pharmacology; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012752:Shame; D013413:Sulfadoxine / Q000494:pharmacology; D055815:Young Adult
D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine