Prevention of malaria in pregnancy with intermittent preventive treatment and insecticide treated nets in Mali: a quantitative health systems effectiveness analysis

PLoS One. 2013 Jun 28;8(6):e67520. doi: 10.1371/journal.pone.0067520. Print 2013.


Introduction: The objectives of the study were to evaluate the health system effectiveness of ANC for the delivery of a dose of IPTp and an ITN to women attending ANC during eligible gestation, and to identify the predictors of systems effectiveness.

Methods: A cross sectional study was undertaken in 10 health facilities including structured non-participant observations of the ANC process for 780 pregnant women followed by exit interviews. The proportion of pregnant women receiving a dose of IPTp-SP and an ITN was assessed. Predictors of each ineffective intermediate process were identified using multivariable logistic regression.

Results: Overall, 0% and 24.5% of pregnant women of eligible gestation on the first visit to ANC received a dose of IPTp-SP by DOT at the district and community levels respectively. Ineffective intermediate processes were 'given IPTp-SP at the ANC' 63.9% and 74.0% (95% CI 62.0, 83.3), and 'given IPTp-SP by DOT' 0% and 34.3% (95% CI 10.5, 69.8), at district and community levels, respectively. Delivery of ITNs was effective where they were in stock; however stock-outs were a problem. Predictors of receiving IPTp-SP at the district level were 4 to 6 months gestation, not reporting symptoms of malaria at ANC visit and the amount of money spent during the visit. At the community level, the predictors were 4 to 6 months gestation, maternal education below primary level, routine ANC visit (not for an illness), palpation of the abdomen, and expenditure of money in ANC.

Conclusion: In Segou District, the delivery of IPTp-SP was ineffective; whilst ITN delivery was effective if ITNs were in stock. Predictors of receiving IPTp-SP at the district and community levels included gestational age, the amount of expenditure during the ANC visit and no illness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Delivery of Health Care / methods
  • Female
  • Humans
  • Insecticide-Treated Bednets*
  • Insecticides / administration & dosage*
  • Malaria / prevention & control*
  • Male
  • Mali
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control*
  • Pregnancy Complications, Parasitic / prevention & control*
  • Preventive Medicine / methods
  • Pyrimethamine / administration & dosage
  • Sulfadoxine / administration & dosage
  • Young Adult


  • Insecticides
  • Sulfadoxine
  • Pyrimethamine

Grant support

The study was funded by the Malaria in Pregnancy Consortium which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.