Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 6;110(3_Suppl):56-65.
doi: 10.4269/ajtmh.23-0399. Print 2024 Mar 5.

Understanding Antenatal Care Service Quality for Malaria in Pregnancy through Supportive Supervision Data in Tanzania

Goodluck Elias Tesha  1 , Stella Makwaruzi  1 , Rachel Haws  2 , Jadmin Mostel  3 , Abdallah Lusasi  4 , Samwel Lazaro  4 , Sijenunu Mwaikambo  4 , Frank Chacky  4 , Erik Reaves  5 , Chonge Kitojo  6 , Naomi Serbantez  6 , Gladys Tetteh  3 , Katherine Wolf  3 , Lolade Oseni  3
Affiliations

Understanding Antenatal Care Service Quality for Malaria in Pregnancy through Supportive Supervision Data in Tanzania

Goodluck Elias Tesha et al. Am J Trop Med Hyg. .

Abstract

Malaria in pregnancy (MiP) is associated with maternal anemia, spontaneous abortion, and infant and maternal death. In Tanzania, MiP service data are collected through routine Malaria Services and Data Quality Improvement (MSDQI) supportive supervision rounds at antenatal care (ANC) facilities. Using structured assessment tools, the U.S. President's Malaria Initiative Impact Malaria Project reviewed two annual rounds of MSDQI data (492 facilities in 2021 and 522 facilities in 2022), including ANC records and client satisfaction interviews. We assessed coverage of key MiP care components, used logistic regression to analyze uptake of the recommended three or more doses of intermittent preventive treatment in pregnancy (IPTp3+), and assessed client satisfaction. Coverage of most MiP care components exceeded 80%; however, only 38% of women received all components. Odds of receiving IPTp3+ were much lower among late ANC initiators than among those who initiated ANC during their first trimester (odds ratio [OR], 0.46; 95% CI, 0.38-0.57). Uptake of IPTp3+ increased almost exponentially by number of ANC visits. Women with seven visits were 30 times more likely than those with three visits to receive IPTp3+ (OR, 30.71; 95% CI, 11.33-83.22). Just 54% of clients had anemia screening and only 46% received IPTp3+. Client satisfaction with services and provider communication was high (98% and 97%, respectively); only 8% of client visits exceeded 3 hours. Increased ANC visits could boost IPTp3+ coverage. Routine MSDQI supportive supervision data are useful to assess quality of care, identify service delivery gaps, and guide policies to improve quality of MiP services.

PubMed Disclaimer

Conflict of interest statement

Disclosure: This study analyzed secondary data and received a nonresearch determination from the Institutional Review Board (IRB) of the Johns Hopkins Bloomberg School of Public Health (Baltimore, MD; IRB No. 23914) and clearance from the Population Services International Research Ethics Board. In Tanzania, no ethical approval was required because secondary aggregated data were used for the analysis. Permission to conduct the study was sought from all district authorities. Oral consent to participate in the client satisfaction survey was sought during the MSDQI supervisory process from all participating clients. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. President’s Malaria Initiative, the United States Agency for International Development, the U.S. CDC, or other employing organizations or sources of funding.

Figures

Figure 1.
Figure 1.
Coverage of MiP care components (ANC register review). Round 1, 492 facilities; round 2, 522 facilities; total, 562 discrete facilities. ANC = antenatal care; Hb = hemoglobin; IPTp = intermittent preventive treatment in pregnancy; Any IPTp = one or more doses of intermittent preventive treatment in pregnancy; IPTp3+ three or more doses of intermittent preventive treatment in pregnancy; ITN = insecticide-treated net; MiP = malaria in pregnancy; mRDT = malaria rapid diagnostic test.
Figure 2.
Figure 2.
Uptake of three or more doses of intermittent preventive treatment in pregnancy (IPTp3+) by gestational age at first antenatal care (ANC) visit (frequency analysis). Round 1, n = 4,031; round 2, n = 4,711.
See this image and copyright information in PMC

References

    1. Desai M. et al., 2016. Impact of sulfadoxine-pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis 62: 323–333. - PMC - PubMed
    1. World Health Organization , 2021. World Malaria Report 2021. Geneva, Switzerland: WHO.
    1. World Health Organization , 2014. Consultation on Improving Measurement of the Quality of Maternal, Newborn and Child Care in Health Facilities. World Health Organization, Geneva, Switzerland. 150741–150748.
    1. Tanzania Ministry of Health , 2020. National Malaria Strategic Plan 2021–2025: Transitioning to Malaria Elimination in Phases. Dar es Salaam, Tanzania: Tanzania Ministry of Health.
    1. Tunçalp Ö, Pena-Rosas J, Lawrie T, Bucagu M, Oladapo O, Portela A, Metin Gülmezoglu A, 2017. WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival. BJOG 124: 860–862. - PubMed