A New Approach to Deliver Malaria Preventions to Pregnant Women at a Community Level in Uganda
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 2,150
- 试验地点
- 2
- 主要终点
- Proportion of scheduled visits completed by each delivery approach.
研究概览
简要总结
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.
详细描述
OBJECTIVES OF THE STUDY: The objectives of this study were:
- To assess new 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 TBAs, CRHWs, APMs and DSVs can administer IPT with SP to pregnant women at a community level;
- To assess whether TBAs, CRHWs, APMs and DSVs can reach women at most risk of malaria in pregnancy;
- To evaluate the impact of community based distribution of IPT with SP on anaemia in pregnancy and birth outcome;
- To assess the acceptability and sustainability of delivering IPT with SP to pregnant women at a community level;
- To estimate the cost-effectiveness of the new community based approaches for delivering malaria prevention interventions to pregnant women.
The study was conducted in the Mukono district, Central Region, Uganda. The district is situated 50-150kms east of Kampala. The district has an estimated population size of 1,128,500. The district lies at altitudes from 1,158m to 1,219m and is bordered by Kayunga district in the North and Lake Victoria in the South. It has high temperatures and heavy rainfall during the months of March to May and October to November. The district is divided into 6 counties, 28 sub-counties and 145 parishes. A sub-county usually has a population of about 30,000 people while a parish has approximately 3,000 people. The Baganda are the majority tribe in the district. Other tribes include: Basoga, Badama, Banyole, Banyarwanda, Barundi, Balulu, Lugbar and Jaluos. There is a high fertility rate, of 7.2 births per woman and an annual population growth rate of 2.3%. The district is hyper- to holoendemic for malaria. The population is served by 4 hospitals, 5 health centres IV, 23 health centres III and 25 health centres II. There are numerous drug-shops, TBAs, private midwives and CHRWs who provide health care in the district. Drug shops are licensed and registered at the District Health Office.
Five rural sub-counties from the lake- shore region with the same level of malaria transmission were selected. Within each sub-county, 5 parishes were selected based on: availability of a health centre II, III or IV, and trained TBAs, DSVs, CRHWs and APMs.
Study Population: The study population included all the pregnant women who live in the study area.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Pregnant women of all parities and gestational week 16
排除标准
- •Pregnant women with a history of allergy to sulphonamide containing drugs
结局指标
主要结局
Proportion of scheduled visits completed by each delivery approach.
The costs per anaemic pregnant woman avoided.
Birth weight of babies.
Proportion of women who complete two doses of SP.
Timing of the first dose of SP.
Proportion of low birth-weight babies.
Maternal haemoglobin and malaria parasite counts.
Proportion of adolescent pregnancies participating in the study.
The costs per low birth weight of babies avoided.
Proportion of pregnant women who agree to take part in the study.
Mothers' perceptions on the four different SP delivery outlets
次要结局
未报告次要终点
研究者
Brian Greenwood
Professor
London School of Hygiene and Tropical Medicine