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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Preventing malaria in pregnancy through community-directed interventions: Evidence from Akwa Ibom State, Nigeria
Malaria Journal, Volume 10, Article 227, Year 2011
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Description
Background: Despite massive anti-malaria campaigns across the subcontinent, effective access to intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) among pregnant women remain low in large parts of sub-Saharan Africa. The slow uptake of malaria prevention products appears to reflect lack of knowledge and resistance to behavioural change, as well as poor access to resources, and limited support of programmes by local communities and authorities. Methods. A recent community-based programme in Akwa Ibom State, Nigeria, is analysed to determine the degree to which community-directed interventions can improve access to malaria prevention in pregnancy. Six local government areas in Southern Nigeria were selected for a malaria in pregnancy prevention intervention. Three of these local government areas were selected for a complementary community-directed intervention (CDI) programme. Under the CDI programme, volunteer community-directed distributors (CDDs) were appointed by each village and kindred in the treatment areas and trained to deliver ITNs and IPTp drugs as well as basic counseling services to pregnant women. Findings. Relative to women in the control area, an additional 7.4 percent of women slept under a net during pregnancy in the treatment areas (95% CI [0.035, 0.115], p-value < 0.01), and an additional 8.5 percent of women slept under an ITN after delivery and prior to the interview (95% CI [0.045, 0.122], p-value < 0.001). The effects of the CDI programme were largest for IPTp adherence, increasing the fraction of pregnant women taking at least two SP doses during pregnancy by 35.3 percentage points [95% CI: 0.280, 0.425], p-value < 0.001) relative to the control group. No effects on antenatal care attendance were found. Conclusion: The presented results suggest that the inclusion of community-based programmes can substantially increase effective access to malaria prevention, and also increase access to formal health care access in general, and antenatal care attendance in particular in combination with supply side interventions. Given the relatively modest financial commitments they require, community-directed programmes appear to be a cost-effective way to improve malaria prevention; the participatory approach underlying CDI programmes also promises to strengthen ties between the formal health sector and local communities. © 2011 Okeibunor et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Okeibunor, Joseph Chukwudi
Nigeria, Naukka
University of Nigeria
United States, Baltimore
Jhpiego Corporation
United States, Boston
Harvard T.h. Chan School of Public Health
Orji, Bright Chukwudi
United States, Baltimore
Jhpiego Corporation
Brieger, William R.
United States, Baltimore
Jhpiego Corporation
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Ishola, Gbenga P.
United States, Baltimore
Jhpiego Corporation
Otolorin, Emmanuel
United States, Baltimore
Jhpiego Corporation
Rawlins, Barbara J.
United States, Baltimore
Jhpiego Corporation
Ndekhedehe, Enobong U.
Nigeria
Community Partners for Development
Onyeneho, Nkechi Genevieve
Nigeria, Naukka
University of Nigeria
Fink, Günther
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 72
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1186/1475-2875-10-227
e-ISSN:
14752875
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Study Locations
Nigeria
Participants Gender
Female