Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries

• Published in: The American journal of tropical medicine and hygiene Vol. 110; no. 3_Suppl; pp. 42 - 49
• Main Authors: Wolf, Katherine, Mostel, Jadmin, Oseni, Lolade, Gomez, Patricia, Kibuka, Tabitha, Emerson, Courtney, Gutman, Julie R, Malpass, Ashley, Youll, Susan, Mukamba, Jean Yves, Tchinda Meli, Eric, Achu, Dorothy, Tjek, Paul, Assa, Jean Louis, Silue, Mamadou, Tanoh, Méa Antoine, Kokrasset-Yah, Colette, Babanawo, Felicia, Asiedu, Amos, Komey, Mildred, Boateng, Paul, Mabiria, Maureen, Ngindu, Augustine, Njiru, Peter, Omar, Ahmeddin Hassan, Sidibe, Fatoumata A, Diallo, Chebou, Kamate, Beh, Kone, Aissata, Elisha, Sanoussi, Maiga, Arouna Djibrilla, Mayaki, Alzouma Ibrahim, Tidjani Issa Gana, Fati, Tetteh, Gladys
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01.03.2024; The American Society of Tropical Medicine and Hygiene
• Subjects: Antimalarials - therapeutic use; Disease prevention; Drug Combinations; Female; Humans; Kenya; Malaria; Malaria - drug therapy; Malaria - prevention & control; Maternal child nursing; Maternal Health Services; Pregnancy; Pregnancy Complications, Parasitic - drug therapy; Pregnancy Complications, Parasitic - prevention & control; Prenatal Care; Pyrimethamine - therapeutic use; Quality of care; Quality of Health Care; Sulfadoxine - therapeutic use; Supervision; Kenya
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.23-0206

Malaria in pregnancy (MiP) intervention coverage, especially intermittent preventive treatment in pregnancy (IPTp), lags behind other global malaria indicators. In 2020, across Africa, only 32% of eligible pregnant women received at least three IPTp doses, despite high antenatal care attendance. We conducted a secondary analysis of data collected during Outreach Training and Supportive Supervision visits from 2019 to 2020 to assess quality of care and explore factors contributing to providers' competence in providing IPTp, insecticide-treated nets, malaria case management, and respectful maternity care. Data were collected during observations of provider-patient interactions in six countries (Cameroon, Cote d'Ivoire, Ghana, Kenya, Mali, and Niger). Competency scores (i.e., composite scores of supervisory checklist observations) were calculated across three domains: MiP prevention, MiP treatment, and respectful maternity care. Scores are used to understand drivers of competency, rather than to assess individual health worker performance. Country-specific multilinear regressions were used to assess how competency score was influenced by commodity availability, training, provider gender and cadre, job aid availability, and facility type. Average competency scores varied across countries: prevention (44-90%), treatment (78-90%), and respectful maternity care (53-93%). The relative association of each factor with competency score varied. Commodity availability, training, and access to job aids correlated positively with competency in multiple countries. To improve MiP service quality, equitable access to training opportunities for different cadres, targeted training, and access to job aids and guidelines should be available for providers. Collection and analysis of routine supervision data can support tailored actions to improve quality MiP services.