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. 2023 Dec 26;110(3_Suppl):42-49.
doi: 10.4269/ajtmh.23-0206. Print 2024 Mar 5.

Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries

Katherine Wolf  1 , Jadmin Mostel  2 , Lolade Oseni  1 , Patricia Gomez  1 , Tabitha Kibuka  2 , Courtney Emerson  3 , Julie R Gutman  3 , Ashley Malpass  4 , Susan Youll  4 , Jean Yves Mukamba  5 , Eric Tchinda Meli  5 , Dorothy Achu  6 , Paul Tjek  6 , Jean Louis Assa  7 , Mamadou Silue  7 , Méa Antoine Tanoh  8 , Colette Kokrasset-Yah  8 , Felicia Babanawo  9 , Amos Asiedu  9 , Mildred Komey  10 , Paul Boateng  10 , Maureen Mabiria  11 , Augustine Ngindu  11 , Peter Njiru  12 , Ahmeddin Hassan Omar  12 , Fatoumata A Sidibe  13 , Chebou Diallo  13 , Beh Kamate  13 , Aissata Kone  14 , Sanoussi Elisha  15 , Arouna Djibrilla Maiga  15 , Alzouma Ibrahim Mayaki  16 , Fati Tidjani Issa Gana  16 , Gladys Tetteh  1
Affiliations

Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries

Katherine Wolf et al. Am J Trop Med Hyg. .

Abstract

Malaria in pregnancy (MiP) intervention coverage, especially intermittent preventive treatment in pregnancy (IPTp), lags behind other global malaria indicators. In 2020, across Africa, only 32% of eligible pregnant women received at least three IPTp doses, despite high antenatal care attendance. We conducted a secondary analysis of data collected during Outreach Training and Supportive Supervision visits from 2019 to 2020 to assess quality of care and explore factors contributing to providers' competence in providing IPTp, insecticide-treated nets, malaria case management, and respectful maternity care. Data were collected during observations of provider-patient interactions in six countries (Cameroon, Cote d'Ivoire, Ghana, Kenya, Mali, and Niger). Competency scores (i.e., composite scores of supervisory checklist observations) were calculated across three domains: MiP prevention, MiP treatment, and respectful maternity care. Scores are used to understand drivers of competency, rather than to assess individual health worker performance. Country-specific multilinear regressions were used to assess how competency score was influenced by commodity availability, training, provider gender and cadre, job aid availability, and facility type. Average competency scores varied across countries: prevention (44-90%), treatment (78-90%), and respectful maternity care (53-93%). The relative association of each factor with competency score varied. Commodity availability, training, and access to job aids correlated positively with competency in multiple countries. To improve MiP service quality, equitable access to training opportunities for different cadres, targeted training, and access to job aids and guidelines should be available for providers. Collection and analysis of routine supervision data can support tailored actions to improve quality MiP services.

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Conflict of interest statement

Disclosures: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the U.S. Agency for International Development. The data analyzed from this study were collected as part of routine quality improvement activities, specifically OTSS+ visits, that are conducted by the national malaria programs and regional and district health authorities in the targeted countries. No patient or health worker identifying information was collected during these OTSS+ visits. Identifying information for the health facilities was removed during the data cleaning process and is not included in the final database. The study obtained a nonresearch determination from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB), Baltimore, MD (IRB No. 00017407), and the Population Services International Research Ethics Board.

Figures

Figure 1.
Figure 1.
Distribution of malaria in pregnancy (MiP) prevention competency, MiP treatment competency, and respectful maternal care (RMC) competency scores. From bottom to top of each range: minimum value, first quartile value, median value, third quartile value, and maximum value. CDI = Cote d’Ivoire.
Figure 2.
Figure 2.
Directly observed therapy (DOT) supplies in stock on day of observation. *Ghana only asks: Is clean water available for DOT of sulfadoxine–pyrimethamine (SP) at the antenatal care unit? CDI = Cote d’Ivoire.
See this image and copyright information in PMC

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