Coverage of Malaria Interventions During Antenatal Care in Mali

Malaria during pregnancy remains a major public health problem
in endemic areas of the African region where approximately 25-30
million of pregnant women are at risk of Plasmodium falciparum
infection and its adverse effects during pregnancy...


Introduction
Malaria during pregnancy remains a major public health problem in endemic areas of the African region where approximately 25-30 million of pregnant women are at risk of Plasmodium falciparum infection and its adverse effects during pregnancy [1,2]. In order to reduce the burden of malaria during pregnancy, the World Health Organization (WHO) currently recommends Intermittent Prevetive Treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) and Insecticide Treated mosquito Net (ITN) use in areas of stable (high) transmission of P. falciparum [1]. Antenatal care (ANC) from trained health care professionals is essential in order to anticipate adverse issues and complications to ensure a safe DOI: 10.26717/BJSTR.2020.30.004938 23320 birth. ANC visits provide a forum for delivery of key maternal health interventions including those designed to prevent malaria. Over the past five years, coverage of key interventions against malaria during pregnancy has improved significantly in some African countries but is still low in majority of sub-Saharan Africa countries [3].
Findings from national household surveys showed that, on average, 17% of pregnant women slept under ITNs and 25% of those receiving at least one dose of IPTp-SP [4]. The main barriers to understanding the reasons for low coverage of interventions include health system failures, lack of effective monitoring in data collection, inadequate use of data for program management at local level. Studies examining factors affecting the delivery, access and use of interventions to prevent malaria during pregnancy in sub-Saharan Africa have identified education, knowledge and perception of malaria, socio-economic status, number and timing of ANCs, number of pregnancies, health system problems as factors influencing coverage of interventions as well as access to antenatal care services [5][6][7][8]. In Mali, malaria affects more than 600,000 births per year, of which 19.3%, 13.5%, and 54.0%, respectively, result in placental malaria, low birth weight (LB) and maternal anemia.
Review of DHS data in Africa on malaria interventions coverage during pregnancy among pregnant women suggests that there are inadequacies in antenatal care services informing about missed opportunities for intervention delivery of service against malaria in pregnancy. Literature review shows that often the reasons for low coverage are in fact simple misunderstandings that are not difficult to resolve once they are identified, but they vary from country to country, from district to district health [9]. The aim of this study was to assess malaria interventions coverage to control malaria in pregnancy during household survey in Mali in 2015.

Material and Method
The Data entry was done with CSPro software and analyzed on Stata version 14. Bivariate analysis allowed us to determine the distribution of parameters within the study popluation and the relationship between the outcome variable (IPTp2+) with some predictive factors, and multivariate logistic regression was used to determine the factors associated with SP delivery. Age and parity were categorized as follows: age (<20, 20-34, ≥35) years; parity: primiparae, secundiparae and multiparae (≥3 pregnancies).
Complete ANC attendance was considered to be at least four ANC visits during pregnancy (yes/no). The outcome variable is binary and is defined as at least complete two or more doses of SP administered during the pregnancy (IPTp2+) (yes/no).

Results
The moajority of study population was aged from 20 to 34 years (55%) with a median age of 27  years. The majority of women were married (91.3%); and 72% did not have formal education. Fourteen percent were educated to primary level and only 15% had at least a secondary level. More than half of women were multiparous (52%) only 11% was secundiparous and 37% primiparous. We noted that 90.4% of women slept under ITN last night prior the survey and 73.8% were residents of rural areas and 36.8% lived in households in the lowest wealth tercile (Table 1).
Among 2376 interviewed women, 94.6% reported attending ANC at least once during their most recent pregnancy in the past 2 years.
The number of ANC visits varied from 1-5 with a median of 1 visit.
Among ANC attendees, 43.4% had their first visit in the second trimester. Approximately 5% of the ANC attendees completed at least 3 visits.   (Figure 1). First ANC visit was more frequent in urban women (94.1%) and rural women (94.8%) than other 2 and + ANC visits ( Figure 1). In multivariate analysis, marital status (married) (p=0.031) wealth index (P <0.005), primary education level (P <10-4) and rural residency (p=0.019) remained significant independent factors associated with SP uptake (Table 4).   pregnancy. These factors were found to be important in a study by Adrew [20].
In Papua New Guinea. We identified foctors associated with SP uptake in multivariate analysis, among those, marital status, wealth index, primary education level and rural residency remained significantly independent factors. Many studies confirmed this finding [21][22][23][24], to increase the level of uptake of IPTp2, appropriate measures should be implemented such as health education and focusing intervention on marginalized population (less wealthy, less educated). Pregnant women's perceptions about side effects of SP and access to health services may be limiting factors.