Bottlenecks for High Coverage of Intermittent Preventive Treatment in Pregnancy: The Case of Adolescent Pregnancies in Rural Burkina Faso
Open Access
- 6 August 2010
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 5 (8), e12013
- https://doi.org/10.1371/journal.pone.0012013
Abstract
While IPTp-SP is currently being scaled up in sub-Saharan Africa (SSA), the coverage with the required ≥2 doses of SP remains considerably short of the Roll Back Malaria (RBM) goal of 80%, not to mention of the recently advocated universal coverage. The study triangulates quantitative data from a health center randomized community-based trial on IPTp-SP effectiveness and the additional benefit of a promotional campaign with qualitative data from focused ethnography. In rural Burkina Faso, despite the significantly higher risk of malaria infection among adolescent primigravidae (PG) (OR 2.44 95%CI 1.81–3.28, p<0.001), making them primary target beneficiaries of IPTp-SP, adolescents adhered to the required three or more ANC visits significantly less (PG: 46.6%; SG 43.7%) than adults (PG: 61.9%; SG 54.9%) and had lower SP uptake during the malaria transmission season, further showing the difficulty of reaching this age group. Adolescents' structural constraints (such as their social position and household labor requirements) and needs (such as anonymity in the health encounter) leave them highly vulnerable during their pregnancies and, especially, during the high malaria transmission season. Our study shows that adolescents need to be targeted specifically, prior to their first pregnancy and with measures adapted to their social context, addressing their structural constraints and needs and going beyond standard health promotion campaigns. Unless such specific measures are taken, adolescents' social vulnerability will present a serious bottleneck for the effectiveness of IPTi-SP.This publication has 27 references indexed in Scilit:
- Rural Gambian women's reliance on health workers to deliver sulphadoxine – pyrimethamine as recommended intermittent preventive treatment for malaria in pregnancyMalaria Journal, 2009
- The right to remain silent: a qualitative study of the medical and social ramifications of pregnancy disclosure for Gambian womenBJOG: An International Journal of Obstetrics and Gynaecology, 2008
- A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina FasoMalaria Journal, 2008
- The tip of the iceberg: Evidence of seasonality in institutional maternal mortality and implications for health resources management in Burkina FasoScandinavian Journal of Public Health, 2008
- Women Bargaining to Seek Healthcare: Norms, Domestic Practices, and Implications in Rural Burkina FasoWorld Development, 2008
- Malaria in Pregnancy: What Can the Social Sciences Contribute?PLoS Medicine, 2007
- Use of intermittent preventive treatment for malaria in pregnancy in a rural area of western Kenya with high coverage of insecticide-treated bed netsTropical Medicine & International Health, 2005
- Implementation of intermittent preventive treatment with sulphadoxine–pyrimethamine for control of malaria in pregnancy in Kisumu, western KenyaTropical Medicine & International Health, 2004
- Research report. The use of formal and informal services for antenatal care and malaria treatment in rural UgandaHealth Policy and Planning, 1998
- Seasonal variations of household costs of illness in Burkina FasoSocial Science & Medicine (1982), 1996