Predictors of the use of interventions to prevent malaria in pregnancy in Cameroon

  • Malaria Journal, Volume 16, No. 1, Year 2017

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Study Justification:
– Malaria in pregnancy is common in sub-Saharan Africa and contributes to perinatal morbidity and mortality.
– Interventions such as insecticide-treated bed nets and preventive therapy with sulfadoxine-pyrimethamine are effective but underutilized.
– Factors associated with bed net ownership, bed net usage, and use of malaria prophylaxis medications during pregnancy in Cameroon were investigated.
Study Highlights:
– Nearly half of the surveyed women in Cameroon had a recent pregnancy.
– Bed net ownership and usage rates were low (33.7% and 16.9% respectively).
– 61.6% of women used medication for malaria prophylaxis during pregnancy.
– Bed net ownership and usage were associated with maternal literacy and the presence of children under age 5 in the home.
– Use of malaria prophylaxis medication was associated with healthcare access, higher maternal education, and maternal literacy.
Study Recommendations:
– Ensure universal provision of bed nets to improve bed net ownership and usage rates.
– Promote consistent antenatal care to increase the use of malaria prophylaxis medications during pregnancy.
– Focus on educating girls to improve birth outcomes attributable to malaria infection.
Key Role Players:
– Ministry of Health: Responsible for implementing and coordinating interventions to prevent malaria in pregnancy.
– Healthcare Providers: Involved in providing antenatal care and educating pregnant women about malaria prevention.
– Non-Governmental Organizations: Support the implementation of interventions and provide resources for malaria prevention.
– Community Leaders: Play a role in raising awareness and promoting the use of interventions among community members.
Cost Items for Planning Recommendations:
– Bed Nets: Budget for the procurement and distribution of bed nets to ensure universal provision.
– Antenatal Care Services: Allocate funds for improving access to antenatal care and training healthcare providers.
– Education Programs: Invest in educational initiatives targeting girls to improve literacy and knowledge about malaria prevention.
– Monitoring and Evaluation: Set aside resources for monitoring the implementation and impact of interventions.
Note: The actual cost of implementing these recommendations will depend on various factors and would require a detailed budget analysis.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it is based on national data from the 2011 Cameroon Demographic Health Survey, which provides a large sample size and representative data. However, the abstract does not provide specific details about the methodology used in the survey or the statistical analysis conducted. To improve the evidence, the abstract could include more information about the survey design, sampling techniques, and statistical methods used. Additionally, it would be helpful to provide information about the reliability and validity of the data collected.

Background: Malaria in pregnancy is common in sub-Saharan Africa where it contributes to perinatal morbidity and mortality. Use of insecticide-treated bed nets and intermittent preventive therapy with sulfadoxine-pyrimethamine during pregnancy are effective but underutilized interventions to prevent infection. Factors associated with bed net ownership and usage, and use of prophylaxis among recently pregnant women in Cameroon were investigated. Methods: National data from the 2011 Cameroon Demographic Health Survey was used to identify women with a pregnancy within the previous 5 years. Logistic regression models were created to assess for independent predictors of reported bed net ownership, bed net usage, and the use of malaria prophylaxis medications during pregnancy. Results: Nearly one in two women surveyed had a recent pregnancy (n = 7647). In this group, bed net ownership and usage rates were low (33.7 and 16.9%, respectively); 61.6% used medication for malaria prophylaxis during pregnancy. Bed net ownership and usage were associated with maternal literacy (aOR 1.4 for net usage, 95% CI 1.1-1.8) and the presence of children under age 5 in the home (aOR 2.3 for net usage, 95% CI 1.6-3.3). The use of malaria prophylaxis medication was associated with measures of healthcare access (aOR 17.8, 95% CI 13-24.5 for ≥4 antenatal care visits), higher maternal education (aOR 1.5, 95% CI 1.1-2.1) and maternal literacy (aOR 1.4, 95% CI 1.1-1.7). Conclusions: Women in Cameroon and their antenatal providers missed many opportunities to prevent malaria in pregnancy. Efforts toward ensuring universal bed net provision, consistent antenatal care and the education of girls are likely to improve birth outcomes attributable to malaria infection.

Surveys were collected in Cameroon between January and August of 2011 as part of the cross-sectional National Demographic Health Survey (DHS) [22]. These recurring household level surveys have been carried out using previously described methods and survey data was weighted to make it nationally representative [22–24]. Data was collected from 15,426 eligible women who were interviewed using two-stage stratified sampling techniques. This study captures responses from the subset of 7647 women who reported a birth in the previous 5 years. Surveys included detailed questions about socio-demographics, pregnancy history, access to antenatal care services, site of delivery and the use of interventions to prevent malaria during the most recent pregnancy. Blood was collected from a subset of women for rapid HIV testing. DHS data has been cleaned, is devoid of personal identifiers and datasets are publicly available to researchers upon request. Sociodemographics included age, partner’s age, education, literacy (ability to read a written phrase in the language of choice), partner’s education, marital status, polygamy, religion, urban/rural residence (rural defined as a population density <20,000 people), region of the country (10 official regions plus separate categories for the two largest urban areas; Douala and Yaoundé i.e., 12 regional categories), ownership of a means of transportation (bicycle, motorcycle or car), parity, number of children 1 dose, at least 2 vs >2 doses, at least 3 vs >3 doses). Separate univariate (UV) and multi-variable (MV) models were fit for each outcome. All variables in Table 1 were considered for the MV models and variables were selected based on statistical significance in the univariate models (p < 0.05), review of existing literature and collinearity considerations. The same set of independent variables was used in all MV models. Sensitivity analyses were performed by fitting various MV models with and without the variables that showed collinearity. Since region of residence and urban/rural residence were highly collinear with the wealth variable, they were excluded from the MV models. The timing of the initial ANC visit, provider type and facility type were also excluded from MV models due to collinearity with one another. Missing data is presented in the tables but data points were generally complete. UV and MV odds ratios with 95% confidence intervals are presented in the tables and UV and MV odds ratios are shown in a figure. All analyses were performed with SAS 9.4 (Cary, NC) and results were adjusted for weighting, clustering and stratification using the SAS/STAT® “SURVEY” procedures. Characteristics of women with pregnancy in the past 5 years (n = 7647) Data adjusted for weighting, clustering and stratification a Numbers in parenthesis show the denominator for each variable due to missing data b More than one response allowed

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Based on the information provided, here are some potential innovations that could be used to improve access to maternal health in Cameroon:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or text messaging services to provide pregnant women with information about malaria prevention, antenatal care, and the importance of bed net usage. These tools can also send reminders for clinic visits and medication intake.

2. Community Health Workers: Train and deploy community health workers to educate pregnant women and their families about the importance of bed net usage, antenatal care, and malaria prophylaxis. These workers can also distribute bed nets and provide support for accessing healthcare services.

3. Telemedicine: Establish telemedicine services to connect pregnant women in remote areas with healthcare providers. This can enable remote consultations, monitoring of pregnancy progress, and timely access to medical advice.

4. Public-Private Partnerships: Collaborate with private sector organizations to increase the availability and affordability of bed nets, malaria prophylaxis medications, and other essential maternal health supplies. This can help improve access for women in low-income communities.

5. Health Education Campaigns: Launch targeted health education campaigns to raise awareness about the importance of maternal health and malaria prevention. These campaigns can use various media channels, including radio, television, and social media, to reach a wide audience.

6. Integration of Services: Integrate maternal health services with existing healthcare infrastructure, such as antenatal care clinics and primary healthcare centers. This can ensure that pregnant women receive comprehensive care, including malaria prevention interventions, during their visits.

7. Empowering Women: Promote women’s empowerment and education to improve their decision-making power regarding their own health and the health of their families. This can include initiatives to increase female literacy rates and provide opportunities for women to participate in income-generating activities.

These innovations have the potential to address the barriers identified in the study and improve access to maternal health services, ultimately leading to better birth outcomes and reduced malaria-related morbidity and mortality.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health in Cameroon is as follows:

1. Ensure universal provision of bed nets: The study found that bed net ownership and usage rates were low. To address this, it is recommended to implement a comprehensive program to provide bed nets to all pregnant women in Cameroon. This can be done through partnerships with international organizations, government initiatives, and community-based distribution programs.

2. Increase access to antenatal care: The use of malaria prophylaxis medication during pregnancy was associated with measures of healthcare access, such as having at least 4 antenatal care visits. To improve access, efforts should be made to increase the number of antenatal care visits for pregnant women in Cameroon. This can be achieved through awareness campaigns, improving transportation infrastructure, and ensuring the availability of healthcare facilities in rural areas.

3. Promote maternal education and literacy: The study found that bed net ownership, bed net usage, and the use of malaria prophylaxis medication were associated with maternal literacy and education. To address this, it is important to prioritize education for girls and women in Cameroon. This can be done through initiatives that promote girls’ education, adult literacy programs, and community-based education campaigns.

By implementing these recommendations, it is likely that access to maternal health, specifically in relation to preventing malaria in pregnancy, will be improved in Cameroon.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase availability and distribution of insecticide-treated bed nets: Since bed net ownership and usage rates were low in Cameroon, efforts should be made to ensure that pregnant women have access to bed nets. This can be achieved through targeted distribution programs, partnerships with local communities, and education campaigns to promote the importance of bed net usage.

2. Improve access to antenatal care services: The study found that the use of malaria prophylaxis medication during pregnancy was associated with measures of healthcare access, such as the number of antenatal care visits. Therefore, efforts should be made to improve access to antenatal care services, including increasing the number of clinics and healthcare providers, especially in rural areas.

3. Enhance maternal education and literacy: The study found that maternal literacy was associated with both bed net usage and the use of malaria prophylaxis medication. Therefore, promoting education and literacy among women can help improve their understanding of the importance of preventive measures during pregnancy.

4. Strengthen healthcare infrastructure: The study highlighted the need for consistent antenatal care and universal bed net provision. To achieve this, investments should be made to strengthen healthcare infrastructure, including training healthcare providers, ensuring the availability of necessary medications and supplies, and improving the quality of care provided during pregnancy.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as bed net ownership and usage rates, utilization of antenatal care services, and the use of malaria prophylaxis medication during pregnancy.

2. Collect baseline data: Gather data on the current status of the indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Develop a simulation model: Create a mathematical or statistical model that simulates the impact of the recommendations on the selected indicators. The model should take into account factors such as population size, demographic characteristics, and the implementation of the recommendations.

4. Input the recommended interventions: Incorporate the recommended interventions into the simulation model. This can be done by adjusting the relevant parameters or variables in the model based on the expected impact of the interventions.

5. Run the simulation: Execute the simulation model to generate projections of the indicators under different scenarios. This can help estimate the potential impact of the recommendations on improving access to maternal health.

6. Analyze the results: Analyze the simulation results to assess the potential effectiveness of the recommendations. This can involve comparing the projected indicators under different scenarios and identifying the most promising interventions.

7. Refine and validate the model: Continuously refine and validate the simulation model based on feedback, additional data, and real-world observations. This will help improve the accuracy and reliability of the model for future simulations.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data.


Statistics:
Citations: 13
Identifiers:
DOI: 10.1186/s12936-017-1786-z
Research Areas:
Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Cameroon
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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