Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study

BACKGROUND: Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women’s compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria. METHODS: A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15–49 years recruited through multistage sampling. Binary logistic regression was used to determine the factors associated with the use of SP-IPTp in the study population. RESULTS: Use of SP-IPTp was self-reported by 41 % of the total respondents. Lack of autonomy in the households to receive sulfadoxine-pyrimethamine (SP) during ANC was the main barrier to use of IPTp (83 %). Other barriers were stock-outs of free SP (33 %) and poor supervision of SP ingestion by directly observed treatment among those who obtained SP from ANC clinics (36/110 = 33 %). In the multivariate logistic regression, the odds of using SP-IPTp was increased by the knowledge of the use of insecticide treated nets (ITNs) (OR = 2.13, 95 % CI: 1.70–3.73) and SP (OR = 22.13, 95 % CI: 8.10–43.20) for the prevention of MIP. Use of ITNs also increased the odds of using SP-IPTp (OR = 2.38, 95 % CI: 1.24–12.31). CONCLUSIONS: Use of SP-IPTp was low and was associated with knowledge of the use of ITNs and SP as well as the use of ITNs for the prevention of MIP. There is a need to strengthen PHC systems and address barriers to the usage of SP-IPTp in order to reduce the burden of MIP. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0883-2) contains supplementary material, which is available to authorized users

Additional file 1: of Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study

Sampling of the study participants in the PHC facilities. (DOCX 14 kb

Additional file 2: of Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study

Questionnaire used for the study. (DOCX 23 kb

Does an innovative paper-based health information system (PHISICC) improve data quality and use in primary healthcare? Protocol of a multicountry, cluster randomised controlled trial in sub-Saharan African rural settings

IntroductionFront-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems.Methods and analysisStudy areas are in rural zones of Côte d’Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes’ data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects.Ethics and disseminationEthics committees in Côte d’Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS.Trial registration numberPACTR201904664660639; Pre-results.</jats:sec

Does an Innovative Paper-Based Health Information System (PHISICC) Improve Data Quality and use in Primary Health Care? Protocol of a Multi-Country, Cluster Randomised Controlled trial in Sub-Saharan African Rural Settings.

Abstract BackgroundFrontline health workers in remote, rural health facilities are the first contact of the formal health sector and are confronted with the need to make life-saving clinical and public health decisions. Appropriate health information systems (HIS) provide data to support the collection and use of data, thus facilitating decision-making. However, HIS focus on reporting and are unfit to support critical decisions at the peripheral level. Since data tools are paper-based in most primary health care settings, we have produced an innovative paper-based HIS (PHISICC), embracing all health care areas in primary health care, using a Human Centred Design, co-creation approach. The PHISICC tools aid decision-making, include recording and reporting and substitute the regular HIS tools. We are carrying out a cluster-randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems, on data use and quality, quality of health care and health worker perceptions, in remote, rural settings.MethodsWe have selected study areas in rural zones of Côte d’Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools (35 per arm). We have selected three villages in the catchment area of each health facility to carry out surveys in 10 households each. Outcomes of interest include data quality and use, coverage of health services, health workers perceptions and other process and explanatory variables. DiscussionWe strive to contribute to producing robust evidence on health systems interventions, affecting people in remote, rural settings where the most vulnerable live. The PHISICC tools focus on decision-making rather than data and are meant to support health workers decisions as well as reporting to the higher levels of the system. Robust evidence on HIS can better find its way to high quality systematic reviews and guidance development to inform policy and practice.Trial registration: Pan African Clinical Trials Registry - PACTR201904664660639. Registered 01/04/2019, https://pactr.samrc.ac.za/Search.aspx.</jats:p