Effectiveness of antenatal care delivery of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine in the context of an integrated strategy with seasonal malaria chemoprevention in Mali and Burkina Faso

Background To improve uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP), a cluster-randomised implementation trial of ‘integrated IPTp-SP delivery’ through seasonal malaria chemoprevention (SMC) alongside antenatal care (ANC) was conducted in Mali and Burkina Faso. This nested study assessed ANC provider acceptability and feasibility of the integrated strategy and whether the training they received as part of the intervention (‘enhanced facilities’) improved IPTp-SP delivery effectiveness. 

Methods A cross-sectional survey was conducted in 20 trial facilities in each country (10 intervention/10 control) from November 2023 to January 2024, involving ANC exit interviews with pregnant women, facility audits and structured interviews with ANC providers. The primary outcome was the proportion of eligible pregnant women receiving IPTp-SP by directly observed therapy (DOT). Predictors of receiving IPTp-SP by DOT were estimated using mixed model logistic regression. ANC provider attitudes towards the integrated strategy were assessed using Likert scales. 

Results In Mali, 240 and 297 of 703women interviewed were eligible for SP in the intervention and control facilities, respectively, and 323 and 334 of 709women, respectively, interviewed in Burkina Faso. Delivery effectiveness of IPTp-SP was higher in the enhanced facilities in both Mali (79.2% (95% CI 74.0% to 84.3%) vs 68.7% (95% CI 63.4% to 73.9%), p=0.006) and Burkina Faso (52.3% (95% CI 46.9% to 57.8%) vs 28.7% (95% CI 23.9% to 33.6%), p<0.0001). Predictors of receiving IPTp-SP by DOT included attending a routine ANC visit in Mali, and gestational age, multiparity and a routine ANC visit in Burkina Faso. ANC providers interviewed in Mali (44) and Burkina Faso (41) thought that IPTp-SP delivery through SMC increased ANC attendance and reduced malaria cases, and that it was feasible and acceptable. 

Conclusions ANC provider training improved IPTp-SP delivery effectiveness, showing greater impact in Mali than in Burkina Faso. ANC providers found the integrated IPTp-SP strategy through ANC and SMC acceptable and feasible.