Bottlenecks for high coverage of intermittent preventive treatment in pregnancy: the case of adolescent pregnancies in rural Burkina Faso

K Peeters Grietens, S Gies, SO Coulibaly, C Ky, J Somda, E Toomer, J Muela Ribera, U D'Alessandro

    Research output: Contribution to journalA1: Web of Science-article

    Abstract

    BACKGROUND: While IPTp-SP is currently being scaled up in sub-Saharan Africa (SSA), the coverage with the required >/=2 doses of SP remains considerably short of the Roll Back Malaria (RBM) goal of 80%, not to mention of the recently advocated universal coverage. METHODS: The study triangulates quantitative data from a health center randomized community-based trial on IPTp-SP effectiveness and the additional benefit of a promotional campaign with qualitative data from focused ethnography. FINDINGS: In rural Burkina Faso, despite the significantly higher risk of malaria infection among adolescent primigravidae (PG) (OR 2.44 95%CI 1.81-3.28, p<0.001), making them primary target beneficiaries of IPTp-SP, adolescents adhered to the required three or more ANC visits significantly less (PG: 46.6%; SG 43.7%) than adults (PG: 61.9%; SG 54.9%) and had lower SP uptake during the malaria transmission season, further showing the difficulty of reaching this age group. Adolescents' structural constraints (such as their social position and household labor requirements) and needs (such as anonymity in the health encounter) leave them highly vulnerable during their pregnancies and, especially, during the high malaria transmission season. CONCLUSION: Our study shows that adolescents need to be targeted specifically, prior to their first pregnancy and with measures adapted to their social context, addressing their structural constraints and needs and going beyond standard health promotion campaigns. Unless such specific measures are taken, adolescents' social vulnerability will present a serious bottleneck for the effectiveness of IPTi-SP
    Original languageEnglish
    JournalPLoS ONE
    Volume5
    Issue number8
    Pages (from-to)e12013
    Number of pages9
    ISSN1932-6203
    DOIs
    Publication statusPublished - 2010

    Keywords

    • B780-tropical-medicine
    • Protozoal diseases
    • Malaria
    • Plasmodium falciparum
    • Vectors
    • Mosquitoes
    • Intermittent preventive treatment
    • Women
    • Pregnancy
    • Effectiveness
    • Coverage
    • Promotion
    • Cultural aspects
    • Vulnerability
    • Adolescents
    • Risk groups
    • Burkina Faso
    • Africa-West

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