A New Approach to Deliver Malaria Preventions to Pregnant Women at a Community Level in Uganda
Status:
Completed
Trial end date:
2007-06-01
Target enrollment:
Participant gender:
Summary
SUMMARY
Background: Malaria is the leading cause of morbidity and mortality among pregnant women in
Uganda. Although effective tools for prevention and control of malaria exist, their delivery
presents a problem. Intermittent presumptive treatment (IPT) with sulfadoxine-pyrimethamine
(SP) is effective, yet >60% of women in Uganda do not get it as < 40%, attend antenatal care.
Effective ways of delivering IPT with SP to pregnant women at a community level need to be
developed. This study assessed whether community based resource persons like traditional
birth attendants (TBAs), community reproductive health workers (CRHWs), adolescent peer
mobilizers (APMs) and drug-shop owners (DSV) can distribute IPT with SP to pregnant women.
Objectives: The objectives of this study were:
- To assess community based approaches for delivering malaria prevention to pregnant women
in Uganda;
- To assess community perceptions, beliefs and practices associated with malaria treatment
and prevention in pregnancy;
- To assess whether community based resource persons can deliver IPT to pregnant women and
reach those most at risk;
- To assess the impact of IPT on anaemia and pregnancy outcome;
- To estimate cost-effectiveness of the approaches and assess the acceptability and
sustainability of the approaches.
Methods: The study was conducted in 5 sub-counties of the Mukono district, situated on the
shores of L. Victoria in Central Uganda. The district is hyper-endemic for malaria. 25
parishes with a total population of 75,000 people were used to test the new approaches. Phase
1 obtained qualitative data on community perceptions, beliefs and practices associated with
malaria prevention in pregnancy. Phase 2 was an intervention study that assessed distribution
of IPT to pregnant women by TBAs, CRHWs, APMs and DSVs compared with health units. Pregnant
women of all parities were enrolled. Key resource persons in each parish were identified to
sensitise the communities on the intervention. Data was collected regarding: timing of the
first dose of SP, proportion of women who complete two doses of SP, birth weight of babies,
proportion of low birth-weight babies, and proportion of adolescent pregnancies. The third
phase of the study evaluated the sustainability of the approaches.
Work Plan: The first phase of the study took two months. The second phase took 14-16 months.
Data analysis was expected to take 12 months.
Phase:
N/A
Details
Lead Sponsor:
Gates Malaria Partnership London School of Hygiene and Tropical Medicine
Collaborators:
DBL -Institute for Health Research and Development Ministry of Health, Uganda
Treatments:
Fanasil, pyrimethamine drug combination Pyrimethamine Sulfadoxine