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Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

  • Okedo-Alex, Ijeoma Nkem1, 2
  • Akamike, Ifeyinwa Chizoba1, 2
  • Alo, Chihurumnanya Nwachi2
  • Agu, Adaoha Pearl1, 2
  • Nzeh, Chinyere Benedicta1
  • Ndukwe, Chinwendu Daniel1
  • Okoro, Odii Ogonna1
  • Abateneh, Dejene Derseh3
  • Uneke, Chigozie Jesse1
  • 1 Ebonyi State University, Abakaliki, Nigeria , Abakaliki (Nigeria)
  • 2 Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria , Abakaliki, Ebonyi State (Nigeria)
  • 3 Kotebe Metropolitan University, Addis Ababa, Ethiopia , Addis Ababa (Ethiopia)
Published Article
Malaria Journal
Springer (Biomed Central Ltd.)
Publication Date
Nov 07, 2020
DOI: 10.1186/s12936-020-03468-2
Springer Nature


BackgroundInnovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria.MethodsThis before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20.ResultsDuring the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%).ConclusionCommunity-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

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