Malaria in pregnancy: Improving access and use of quality preventive treatment

Due to its link to various complications during and after pregnancy, the prevention of malaria among pregnant women is an important strategy for reducing mortality and adverse maternal and neonatal health outcomes, such as anemia, low birth weight, and newborn death.
In areas with moderate-to-high malaria transmission rates, the World Health Organization recommends intermittent preventive treatment for pregnant women (IPTp) at each scheduled antenatal care visit (ANC) as a key strategy for prevention. Through IPTp, pregnant women are given a full therapeutic course of antimalarial medicine to reduce malaria episodes and related complications for mothers and newborns. Coverage rates for the recommended doses of IPTp vary widely among African countries, but in all countries they decline after the first dose, and significantly lag behind ANC coverage rates. 
To improve the provision and use of IPTp, USAID and the President’s Malaria Initiative (PMI), through the African Strategies for Health (ASH) project implemented by MSH, conducted a study in Uganda to explore service delivery practices, missed opportunities, and barriers at the facility level that impede IPTp service provision. The formative study contributed to the development of a checklist, a tool designed to improve the provision and use of IPTp at facility level, through a quality improvement approach that complements the supervisory responsibility of Officers in Charge, and enables facility staff to track trends, identify bottlenecks, and revise strategies on an ongoing basis, ultimately contributing toward improved coverage of IPTp. The tool was piloted in health facilities in Uganda, where it was found to successfully focus attention on IPTp-related processes and improve alignment with quality improvement efforts in service delivery.
The checklist should be used to assess progress against standards for quality IPTp service provision and can be restructured to align with the local service delivery context.