title: Systemic constraints continue to limit coverage of intermittent preventive treatment for malaria in pregnancy in southeast Tanzania.
abstract: BACKGROUND
  Factors limiting coverage of intermittent preventive treatment for malaria in pregnancy (IPTp) in Tanzania were explored from the perspective of health workers, in order to make recommendations to improve service delivery. Recent data estimates coverage of the recommended two doses of IPTp at 26.3%, far short of the national target of 80%.
  
  
  METHODS
  Semistructured interviews were conducted with 13 health workers and 2 health managers during June 2011 in Ikwiriri, southeast Tanzania.
  
  
  RESULTS
  Delivery of sulfadoxine-pyrimethamine (SP) was severely constrained by drug shortages and widespread stock-outs, indicative of ongoing difficulties in the wider health system. While SP was well known and attitudes towards IPTp were positive, health workers were often not informed of up-to-date dosing schedules, limiting coverage. Recent literature suggests this could be due to inconsistent and conflicting national guidelines. In addition, it was found that two pills, instead of the recommended three pills, per dose of IPTp were frequently given to pregnant women, a finding previously unreported.
  
  
  CONCLUSIONS
  To maximize IPTp coverage, sufficient and consistent supplies of SP to both public and private health facilities are a necessity, combined with effective communication of revised dosing schedules. Further research is warranted to investigate the aberrant administration of two pills per dose, as it may exacerbate drug resistance.
authors.affiliation: Ifakara Health Institute, Rufiji Health Demographic Surveillance System, Folk Development College, Ikwiriri, PO Box 40, Tanzania.
authors.forename: Kirstie J
authors.initials: KJ
authors.lastname: Graham
authors.forename: Maryam M
authors.initials: MM
authors.lastname: Ba-Break
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000592:standards*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011295:Prenatal Care / Q000592:standards*; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000627:therapeutic use; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000627:therapeutic use; D013636:Tanzania
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
keywords: Health service delivery; Health workers; Intermittent preventive treatment; Malaria; Pregnancy; Tanzania