Challenges of implementing intermittent preventive treatment in Zambia for malaria prevention in pregnancy

Background: The Zambian Ministry of Health (MOH) began administering intermittent preventive treatment in pregnant women (IPTp) to combat malaria in 2003. Delivered during focused antenatal care (FANC), IPTp is administered three times throughout pregnancy. These women also receive insecticide treated nets and anemia screening and treatment. Method: A rapid assessment was conducted in 69 facilities within 18 districts to identify challenges of IPTp and FANC implementation in Zambia. Quantitative interviews were conducted with 71 providers to assess their knowledge and skills in providing FANC and IPTp. Sixty-nine facility check-lists were completed to determine their availability of equipment and supplies relevant to FANC and IPTp provision. Data was analyzed using SPSS. Results: Averaging one nurse per 3,590 patients, facilities are constrained by a human resource (HR) shortage. All facilities offer IPTp, however 94% provide ANC for less than five days/week due to HR constraints. This limits women accessing IPTp daily and leads to low ANC attendance. Only 41% of providers were trained in FANC and 34% trained in IPTp within the last two years. Only 28% of staff followed MOH guidelines for proper management of malaria in pregnancy. Approximately 65% of the facilities had shortages in FANC and IPTp supplies leading to inconsistent availability for pregnant women requiring the dosage. Conclusion: Shortages in HR and supplies pose major challenges for FANC service delivery, specifically inhibiting IPTp provision. Training of all health workers in IPTp and ensuring that facilities have equipment and supplies is important for effective FANC and IPTp provision.