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Open Access Highly Accessed Research

Preventing malaria in pregnancy through community-directed interventions: evidence from Akwa Ibom State, Nigeria

Joseph C Okeibunor123, Bright C Orji2, William Brieger24, Gbenga Ishola2, Emmanuel 'Dipo Otolorin2, Barbara Rawlins2, Enobong U Ndekhedehe5, Nkechi Onyeneho1 and Günther Fink3*

Author Affiliations

1 Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria

2 Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA

3 Harvard School of Public Health; 665 Huntington Avenue, Boston, MA, USA

4 Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

5 Community Partners for Development, Akwa Ibom, Nigeria

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Malaria Journal 2011, 10:227  doi:10.1186/1475-2875-10-227

Published: 5 August 2011

Abstract

Background

Despite massive anti-malaria campaigns across the subcontinent, effective access to intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) among pregnant women remain low in large parts of sub-Saharan Africa. The slow uptake of malaria prevention products appears to reflect lack of knowledge and resistance to behavioural change, as well as poor access to resources, and limited support of programmes by local communities and authorities.

Methods

A recent community-based programme in Akwa Ibom State, Nigeria, is analysed to determine the degree to which community-directed interventions can improve access to malaria prevention in pregnancy. Six local government areas in Southern Nigeria were selected for a malaria in pregnancy prevention intervention. Three of these local government areas were selected for a complementary community-directed intervention (CDI) programme. Under the CDI programme, volunteer community-directed distributors (CDDs) were appointed by each village and kindred in the treatment areas and trained to deliver ITNs and IPTp drugs as well as basic counseling services to pregnant women.

Findings

Relative to women in the control area, an additional 7.4 percent of women slept under a net during pregnancy in the treatment areas (95% CI [0.035, 0.115], p-value < 0.01), and an additional 8.5 percent of women slept under an ITN after delivery and prior to the interview (95% CI [0.045, 0.122], p-value < 0.001). The effects of the CDI programme were largest for IPTp adherence, increasing the fraction of pregnant women taking at least two SP doses during pregnancy by 35.3 percentage points [95% CI: 0.280, 0.425], p-value < 0.001) relative to the control group. No effects on antenatal care attendance were found.

Conclusion

The presented results suggest that the inclusion of community-based programmes can substantially increase effective access to malaria prevention, and also increase access to formal health care access in general, and antenatal care attendance in particular in combination with supply side interventions. Given the relatively modest financial commitments they require, community-directed programmes appear to be a cost-effective way to improve malaria prevention; the participatory approach underlying CDI programmes also promises to strengthen ties between the formal health sector and local communities.