Economic and Other Contextual Determinants of the Desirability and Viability of Intermittent Prevent

1
Economic and Other Contextual Determinants of the
Desirability and Viability of Intermittent
Preventive Treatment of Malaria during Pregnancy
in Tanzania Godfrey M. Mubyazi., Ø.Olsen,.,
K.S. Hansen., I.C. Bygbjerg., P.Magnussen., J.
Byskov., L.E.G Mboera Paul Bloch

• What literature says about Potential Barriers to
  ANC service Delivery and Use in poor countries
  (ctd..)
• Travel barriers to and from health care
  facilities
• Client drug demand-driven health workers
  prescription and drug dispensing
• Understaffing and shortage of working tools in
  health facilities
• Hard working conditions demoralizing health
  workers
• Trust in traditional health practices e.g.
  T-birth attendants
• Late attendance to ANC clinics compromising
  completion rate of drug dosage (e.g. for IPTp)
• Fear of being tested for HIV by attending ANC
  clinics
• Perceived poor quality of care at health
  facilities by pregnant women and the society
  around them
• Rationale of the present research on malaria
  IPTp in TZ
• According to WHO, interventions deemed
  efficacious within clinical trials may not be
  feasible in real world contexts. Other experts
  contend that non-biomedical determinants of the
  malaria epidemiology have received little
  attention in malaria control programmes although
  they are imperative to complement biomedical
  evidence. Conceptually, the present PhD study
  focuses on economic factors in a way they may not
  be acting in isolation of social, geographical
  and health system contexts influencing the
  behaviour of antimalarial service users and
  providers.
• Study Methods The PhD study is exploratory
  analytical in design. It applies qualitative and
  quantitative techniques - (i) Separate
  semistructured interview tools targeting pregnant
  women while leaving public/other ANC clinics
  after service and health staff working at such
  clinics (ii) Focus group discussions with
  mothers/caretakers of infants aged 1-2 years and
  pregnant women (both groups traced at community
  level) and with members of district health
  management team (iii) Individual indepth
  interviews with financial accounts officers and
  planners and national level policymakers and
  malaria control managers (iv) documentary review
  on malaria related budget/accounts and
  IPTp-policy aspects at health facility and
  district level (v) researchers observation of
  ANC service environments.
• Results Findings from the pilot study are being
  analysed while the actual study will follow the
  MIM Conference in later in this November.
• Acknowledgements GMP for Funding the PhD study
  Godfreys participation at the MIM Conference
  Carol Aldous, Heather Naylor GMP Prof. B
  Greenwoods Office in London at large
  CEEMI-NIMR-TZ for communication and coordination
  MIM Conference Organizers for invitation Dr P
  Bloch colleagues for supervising Godfreys PhD
  DBL-IHRD Copenhagen University for registering
  Godfreys PhD study. Dr Catherine Goodman of
  LSHTM for suggesting some literature for review
  for Godfreys PhD study. MoH/MRCC-TZ for study
  Ethics Clearance.

The Global Malaria Epidemiological
Situation Globally malaria causes about 500
million cases and 1-2 million deaths each year,
pregnant women and children under five years
being most vulnerable. Of all the cases,
Sub-Saharan Africa (SSA) contributes about 90.
Reports by WHO and other malaria exerts show that
malaria during pregnancy may cause impaired fatal
growth, miscarriage, premature birth,
inter-uterine growth restrictions, cerebral
problems and low birth-weight, all of which exist
in endemic countries. Malaria and its burden
on socio-economic development Evidence from a
number of studies supports the hypothetical
contention that in SSA the cost of time,
financial, and other materials for preventing and
treating malaria is enormous, and malaria plays a
significant role in the poverty cycle
concurrently with other problems related to HIV
and TB. In TZ malaria consumes about 3.4 of the
GDP and about 120 billion shillings per year.
Demographic and Health Survey 2004-2005 and other
literature indicates malaria as one of the
leading causes of maternal morbidity and
mortality in TZ. Intermittent Preventive
Treatment of Malaria (IPTm) in TZ Use of SP for
IPT in pregnancy (IPTp) has shown to be safe,
efficacious and cost-effective in countries close
to TZ. In line with WHOs advice, the Government
recommended IPT as part of focused Antenatal Care
(ANC) package. The national guidelines require
health workers at ANC clinics to administer
through the Direct Observation Therapy system a
single dose of 3 tablets of sulfadoxine-pyrimetham
ine (SP) to each pregnant woman contacting ANC
clinics during the 2nd and early 3rd trimesters.
Current critical debate about the use of SP for
IPTm Increasing evidence on rapid P.falciparum
resistance to SP in East and Central Africa has
opened research and policy debate about the
usefulness of SP. Sceptics also argue that
knowledge of the benefits of IPT may be low in
SSA settings where health information is
imperfectly accessible. Meanwhile, with SSA
countries recommending artemisinin-based
combination therapies (ACT), scientists doubt
about the feasibility of ACT in terms of cost and
compliance with the drug among service providers
and drug users if it is recommended for IPT (b)
its possible influence on health staff attitudes
and behaviours in relation to SP that may remain
the drug for IPT after ACT has been recommended
as the 1st line for uncomplicated malaria. PhD
study supported by The Gates Malaria Partnership
(GMP) in Tanzania A study is underway towards
analysing cost and quality of ANC related- and
other contextual determinants of the desirability
and viability of of IPTp in two district settings
located in different regions. What literature
says about Potential Barriers to ANC service
Delivery and Use in poor countries User fees in
countries health system where exemption
mechanisms poorly implemented Financial poverty
among women from poor socio-economic and male
dominated households/families